San Diego Law Review


Dora W. Klein

Library of Congress Authority File


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Part I of this Article discusses the legal protections against involuntary medical treatment. In the typical right to refuse treatment case, a patient’s interests are divided—the patient’s interest in autonomous decisionmaking about his health requires that he be allowed to refuse medical treatment but the patient’s interest in preserving his health, and perhaps even his life, requires that he be administered involuntary treatment. Generally, when a patient chooses to refuse treatment at the expense of his own life or health, courts have ruled that the government’s interest in preserving the patient’s life or health is insufficient to justify involuntary treatment. In a small subset of right to refuse treatment cases, however, the government seeks to administer involuntary treatment for some purpose other than preserving the patient’s life or health. Part II examines such cases, including several Supreme Court cases decided under the Due Process Clause and several decided under the Fourth Amendment. As Part III explains, in following the Supreme Court’s decisions in the Due Process Clause cases, trial courts have permitted the government to administer involuntary antipsychotic medications that risk causing, and in some cases have caused, harms that are at least as severe as harms that in the Fourth Amendment cases prompted the Supreme Court to rule that involuntary medical treatment was not justified. Part IV analyzes the government’s interest in rendering criminal defendants competent to stand trial, proposing that a Fourth Amendment-like balancing test—instead of the current due process medical appropriateness test—would better ensure that courts decide to allow involuntary antipsychotic medications only when the government’s interest in rendering a criminal defendant competent to stand trial is important enough to justify the harms. The Article concludes that under the current due process test, incompetent criminal defendants are being subjected to harms that might not be justified by the government’s interest in bringing them to trial.

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