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Forced medication of mentally ill person on death row

The Guardian, October 2003

Convicted murderers with severe mental health problems can be forced to take drugs that would make them clinically sane so that they can be executed, the US supreme court has ruled.

Opponents of the death penalty yesterday described the court's decision to uphold an earlier ruling on the issue - without debating it - as shocking.

The case concerns Charles Singleton who, in 1979, killed a grocery shop worker in Arkansas. He was convicted and sentenced to death later that year.

While awaiting execution, Singleton's mental health deteriorated to such an extent that he believed his victim was still alive, that the authorities had implanted a device in his ear and that his jail cell was under the control of demons.

Because a prisoner has to be technically sane before being executed, the court was asked to decide whether Singleton could be given psychotropic drugs to qualify to be put to death. His lawyers argued that the drugs should not be administered as the only medical purpose of doing so would be to prepare the prisoner for execution.

This year an appeals court in St Louis ruled that it was acceptable to give Singleton the drugs, although the decision was not unanimous. A dissenting judge, Gerald Heaney, said: "I believe that to execute a man who is severely deranged without treatment and arguably incompetent when treated is the pinnacle of ... the barbarity of exacting mindless vengeance." At issue is whether such action amounts to "cruel and unusual punishment" under the American constitution. In 1986 the supreme court ruled that it was cruel and unusual to execute someone if they did not know why they were being executed or even that they were about to be executed.

Another crucial concern is whether a doctor would administer the drug and what the ethical implications would be for the doctor. The ruling could mean that paramedics would have to be specially trained to give the medication.

Richard Dieter, the executive director of the Death Penalty Information Centre in Washington, said yesterday that because the supreme court had upheld the decision without a debate the door was open for a further appeal.

"It is somewhat shocking that someone whose mental condition is so bad that you have to pump them up, so to speak, so that you can put them on the table [is allowed to be executed]," Mr Dieter said. "It seems to be the epitome of cruel punishment and the invasion of the human body.

"I hope at some time there will be a debate [in the supreme court] and I hope that this will get a full hearing."

Mr Dieter said he was aware of only 3 or 4 prisoners who had been spared the death penalty because they were considered mentally incompetent. Many people on death row suffered from mental illness of some sort, ranging from depression and alcoholism to schizophrenia, but this did not often prevent their execution.

"I read a lot of mitigating circumstances and mental illness is often part of the description," Mr Dieter said.

In a separate death penalty dispute, there is growing debate about the lethal injection itself.

Medical experts have argued that while a person being executed may appear serene, it is possible they are in severe pain but unable to cry out because they have been paralysed. A case brought by a prisoner awaiting execution claims that pancuronium bromide, the chemical compound used in some states, leaves the prisoner conscious but unable to communicate.

Lethal injection is now the favoured method of execution in states which permit the punishment. Nebraska, which electrocutes prisoners sentenced to death, is the only one of the 38 states which have the death penalty not to use the method. In some states the prisoner is given a choice, which can include a firing squad (in Utah), a gas chamber or hanging.

Shrinking Prospects on Death Row

It may have slipped by your attention, but a U.S. Court of Appeals ruled 6 to 5 that a murderer on death row who was psychotic had to be forcibly given antipsychotic drugs so he would be sane enough to be executed.

As usual, I did not make this up.

What the judges didn't realize is that without therapy from a doctor, antipsychotic drugs don't make the patient better.
I take you now to death row in an Arkansas maximum-security prison.

Dr. Abramowitz is sitting on a chair in Charles Singleton's cell. Charles is lying on his bunk. The doctor says, "Charles, did you take your drugs today?"

"No, I didn't."

The doctor says, "Why not?"

Charles says, "I may be crazy, but I'm not that crazy. Besides, the pills have side effects. I don't like the dizziness and bladder dysfunction."

"What are you thinking right now?"

"The governor of Arkansas wants to kill me."

"You're making that up. Why would he want to kill you?"

"He says he wants to kill me so justice is served. I read it in the Arkansas Gazette."

"Who else wants to kill you?"

"6 justices on the court of appeals."

The doctor says, "Don't you think you're being paranoid?"

"I hope so. Then they can't execute me."

"Now let's talk about your dreams. What do you dream about?"

"I dream they are dragging me off to the electric chair and I keep screaming, 'Cruel and unusual punishment!'"

"Who else is in your dream?"

"The 9 members of the Supreme Court, who are just sitting there not saying anything."

"That is not unusual. Many people on death row dream of the Supreme Court in hopes of its overturning their convictions."

"I don't want to talk anymore."

"You're going to have to or the antipsychotic pills won't kick in."

"Why do you care?"

"I'm a doctor. I have to heal you, even at the cost of your life."

"Suppose I don't talk to you?"

The doctor said, "It would go on your record that you are being uncooperative and you would lose all your health benefits."

"I wouldn't want that to happen. Tell me, Doc, how much do you charge for these visits?"

"100 dollars an hour, but the state pays for it. Most psychiatrists say the patient has to pay or he won't get anything out of it. In your case, I'm making an exception."

"Am I the first person you've ever treated on death row?"

"You're not the 1st person to flip out, but you're the 1st one who's being force-fed antipsychotic drugs. If you get executed, you'll wind up in the Guinness Book of World Records."

"What do you think, Doc?"

"What do you think, Charles?"

"I asked you first."

"As your doctor, I am not supposed to tell you what to do. Now I'm going to show you some ink blots."

(source: Art Buchwald, Tribune Media Services)

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