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8 Dev. Mental Health L. 1 (1988)

handle is hein.journals/dvmnhlt8 and id is 1 raw text is: A Publication of the Institute of Law, Psychiatry & Public Policy at tie University of Virginia Developments In Mental Health Law Box 100, Blue Ridge Hospital, Charlottesville, VA 2901 (604) 924-5435 Vol. 8, No. 1 January-June 1988 Four comments on United States v. Charters On May 8, 1988, a three-judge panel of the Fourth Circuit Court of Appeals handed down its decision in United States v. Charters (No. 86-5568). The opinion, written by Judge Murnaghan, intensified a long-standing contro- versy over the right of a committed patient to refuse antipsychotic medi- cation. The federal government is cur- rently seeking review en banc of the decision. And the Virginia General Assembly, as this newsletter goes to ress, is considering a broad legisla- tive response to Charters. The case began in 1983 when Michael Charters was charged by fed- eral authorities in Virginia with threat- ening the President of the United States. In February of 1984, and on five subsequent occasions, the District Court for the Eastern District of Vir- ginia found Charters incompetent to stand trial and committed him to Butner Federal Correctional Institu- tion. In 1986 the district court entered an order authorizing the forced medi- cation of Charters. The Fourth Circuit overturned that decision and remanded the case to the district court with instructions to determine first whether Charters should be transferred to a state hospi- tal. If Charters is to remain in federal custody, the district was instructed to determine whether he was medically zompetent. The Fourth Circuit oncluded: if the court determines that Charters is medically competent, he must be permitted to refuse antipsychotic medication. In making the determi- nation of medical competence, the court should evaluate whether Charters has followed a rational pro- cess and can give rational reasons for his choice to refuse antipsy- chotic medication; (3) If the court determines that Charters is not med- ically competent, it should deter- mine whether there is clear and con- vincing evidence of what Charters would do if he were competent; (4) If a substituted judgment cannot be made, the court should order forci- ble medication only upon finding that it is in Charter's best interests. The four comments that follow explore the wide range of issues raised by this opinion: 0 Is the case for recognizing a right to refuse medication stronger after a forensic commitment than after an ordinary civil commitment? While the Fourth Circuit in Charters distin- guished in its footnote 15 an earlier decision of that court essentially per- mitting unrestricted medication of a civilly committed patient, from Larry Fitch's point of view, there are more reasons to force medication in a foren- sic setting. This issue is of immense practical importance since it deter- mines the applicability of the decision to the far more numerous population of civilly committed patients. * Is the decision based on an erroneous understanding of the effect of antipsychotic drugs? Paul Appel- baum and Richard Bonnie take issue with the court's misconceptions about antipsychotic medications. Leo- nard Rubenstein wonders how it is that the court decided that antipsy- chotic medications have a greater impact on patient autonomy than mechanical restraints. If the issue is just one of empirically researched data on side-effects the court may be wrong. If it is only a question of values impinged upon by both the intended and unintended effects of antipsy- chotic medication, then the question is not whether the court is wrong, but whether it is fair. * Is there a middle ground? The parties seem to have presented the court with only two alternatives. The government urged the court to allow forced medication whenever it was the professional judgment of the physi- Continued on next page 1 Also in this issue: The Practice of Psychiatry and Suicide Litigation .... 4 Forensic Evaluation Research Report ................. 6 In the United States Supreme Court ................... 8 Eleventh Annual Mental Health Law Symposium ..... 9 Social Security Notes .................................. 15

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