Antipsychotic drugs "alter the chemical balance in a patient's brain and can cause irreversible and fatal side effects." Furthermore, they "act at all levels of the central nervous system as well as on multiple organ systems. [They] can induce catatonic-like states, alter electroencephalographic tracings, and cause swelling of the brain. Adverse reactions include drowsiness, excitement, restlessness, bizarre dreams, hypertension, nausea, vomiting, loss of appetite, salivation, dry mouth, perspiration, headache, constipation, blurred vision, impotency, eczema, jaundice, tremors, and muscle spasms". As well as these symptoms, they can also cause "tardive dyskinsesia, an often irreversible syndrome of uncontrollable movements that can prevent a person from exercising basic functions such as driving an automobile, and neuropleptic malignant syndrome, which is 30% fatal for those who suffer from it. The risk of side effects increases over time". In light of these daunting risks, it is no surprise that the person faced with the risk of forced administration of these drugs stated that he would rather die than take them. The Supreme Court of the United States recently decided whether the state act of forcibly administering these antipsychotic drugs to criminal defendants solely for trial competency purposes is constitutional. The Court previously held that the government could do so under certain circumstances, the most essential of which being that the person in custody pose a danger to himself or others. This present case, however, marked the first time the Court ruled on whether the government could administer the drugs solely to render the defendant competent to stand trial. In the decision, the Court crafted a 4-prong test which the government would have to pass in order to forcibly administer the drugs. However, practically speaking, absent a showing of dangerousness, the delineated test will be difficult, if not impossible, to meet. Unfortunately, since this question of dangerousness is the dispositive issue and the Court has continually failed to outline a clear standard of scrutiny to be applied, the individual's fundamental right to be free from unwanted antipsychotic medication remains in jeopardy, subject to less fundamental and compelling state interests. Part II of this note reviews the substance of the Sell decision, including the test it delineates. It also reviews the paramount cases upon which Sell was decided. Part III focuses on the different standards of scrutiny applied in each of those cases at the Supreme Court level, as well as the lower court's invoked standards of scrutiny. Part IV analyzes where the Court has left this doctrine in light of the Sell decision and why its effectiveness as a safeguard for an individual's significant liberty interest in remaining free from unwanted antipsychotic medication is in serious jeopardy.
Note, United States v. Sell: Involuntary Administration of Antipsychotic Medication - Are You Dangerous or Not, 18 J.L. & Health 297 (2003-2004)