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PubMed1992

Riggins v. Nevada.

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Civil Rights↗
PubMed1993

Involuntary medication of patients who are incompetent to stand trial: a descriptive study of the New York experience with judicial review.

The United States Supreme Court, in the recent case of Riggins v. Nevada, extended its examination of the issue of involuntary treatment with antipsychotic medication to the mentally disabled facing criminal trial. A criminal defendant who is "incompetent to stand trial" cannot be subjected to trial. Many such persons are committed to hospitals to be treated and rendered "competent to stand trial," and some of these patients refuse medication. The involuntary administration of antipsychotic medication to such patients raises important and unique medical and moral questions. This highly controversial issue has been understudied. We report here on the first study of persons committed to a state hospital in order to be rendered competent to stand trial who refuse antipsychotic medication and for whom judicial review is requested to allow involuntary treatment, and in which results are given specifically for these subjects. This is a retrospective study to determine the characteristics of such cases and aspects of their outcome in the hospital. We reviewed all cases (N = 68) of application for treatment over objection, filed since the inception in 1986 of the new laws and regulations requiring judicial review through 1990, among patients in the two facilities that receive over 95 percent of all indicted felony offenders in New York State who are incompetent to stand trial. Tentative conclusions are formulated based on the findings that, according to clinical reports, no patient gave only rational reasons for medication refusal, clinicians always indicated the clinical appropriateness of the proposed treatment, judges apparently never found that someone who is "incompetent to stand trial" is "competent" to refuse medication, 93 percent of patients treated involuntarily had a good clinical response, and 87 percent of patients treated involuntarily were restored to "competency to stand trial."

Adult↗
PubMed1995

Involuntary electro-convulsive therapy to restore competency to stand trial: a five year study in New York State.

As a result of the recent United States Supreme Court case of Riggins v. Nevada, lower courts are likely to review if, and under what conditions, pretrial criminal defendants may be treated involuntarily with antipsychotic medication. It may also be time to re-consider the similar use of electro-convulsive therapy (ECT), if indeed it is still being used in this context. This is the first known recent study to determine the frequency of ECT among incompetent defendants. Records from the two forensic psychiatric facilities in New York State that receive over 95% of all indicted felony offenders who are incompetent to stand trial were retrospectively reviewed for a five year study period. All requests to the court for authorization for involuntary treatment with ECT were sought. In the study period, out of approximately 1365 total persons committed, there was one case of a request to the court to administer involuntary ECT to an incompetent defendant. This request was granted after a Rivers hearing. This single case, in which involuntary ECT was not effective, is described. This study serves to demonstrate that involuntary ECT is still requested and administered in New York State to incompetent defendants. In light of the concerns raised in Riggins about involuntary medication, it seems reasonable and necessary to re-consider whether and under what conditions ECT should be involuntarily administered to a pre-trial defendant. Several recommendations are suggested.

Adult↗
PubMed1993

The disposition of criminal charges after involuntary medication to restore competency to stand trial.

The United States Supreme Court, in the recent case of Riggins v. Nevada, extended its examination of the issue of involuntary treatment with anti-psychotic medication to the mentally disabled facing criminal trial. Although this was an extreme case where the defendant faced a possible death sentence, the involuntary administration of anti-psychotic medication to restore 'competency to stand trial' always raises unique medical and moral questions. This highly controversial issue has received little empirical investigation. We report here on the first study to follow-up on the disposition of the criminal charges of persons committed to a hospital for the restoration of 'competency to stand trial' who refused anti-psychotic medication and for whom involuntary treatment was sought. We have previously reported on the characteristics of these cases (N = 68) and aspects of their outcome in the hospital. This cohort of patients represents virtually all indicted felony offenders in New York state who were incompetent to stand trial and for whom involuntary treatment with anti-psychotic medication was requested between 1986 and 1990. The present retrospective report focuses on the disposition of the criminal charges for such cases, in a state that does not have a death penalty. Tentative inferences are considered based on the findings that persons who were involuntarily restored to 'competency to stand trial' had a variety of dispositions of their criminal charges, including plea negotiations that resulted in foreshortened incarceration and several cases of insanity acquittals. Suggestions for further and more conclusive studies are proposed.

Antipsychotic Agents↗
PubMed1999

Informed consent and the refusal of medical treatment in the correctional setting.

Authors note that the legal framework courts use for analyzing patients' decisions to refuse treatment does not accommodate the ethical issues arising when such decisions are made by patients in correctional settings. In lieu of the traditional model, they propose a more cautious approach when inmates refuse life-sustaining medical treatment.

Ethics, Medical↗
PubMed1994

Involuntary community treatment of people who are violent and mentally ill: a legal analysis.

Three major legal mechanisms exist for providing involuntary community treatment to people who are violent and mentally disabled: outpatient commitment, preventive commitment, and conditional release from a hospital. In most states, predicted deterioration is either the explicit or the de facto criterion for involuntary community treatment. However, the constitutionality of this standard has been the subject of considerable debate, centering on whether involuntary treatment in the community requires a showing of imminent dangerousness and an overt act of dangerousness and whether a person who is not dangerous solely because of treatment may be committed. The author suggests that the predicted deterioration standard is constitutional, but only if it is accompanied by limitations on the duration of commitment and proof that involuntary treatment is necessary to prevent danger to self or others. The author also discusses whether a person committed under the predicted deterioration standard has the right to refuse treatment and whether persons hospitalized after being committed to involuntary community treatment should receive a hearing.

Commitment of Persons with Psychiatric Disorders↗