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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
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

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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