OCTOBER TERM, 1991
Syllabus
RIGGINS
v. NEVADA
CERTIORARI TO THE SUPREME COURT OF NEVADA No. 90-8466. Argued
January 15, 1992-Decided May 18, 1992
When petitioner Riggins, while awaiting a Nevada trial on murder
and robbery charges, complained of hearing voices and having sleep
problems, a psychiatrist prescribed the antipsychotic drug
Mellaril. After he was found competent to stand trial, Riggins made
a motion to suspend the Mellaril's administration until after his
trial, arguing that its use infringed upon his freedom, that its
effect on his demeanor and mental state during trial would deny him
due process, and that he had the right to show jurors his true
mental state when he offered an insanity defense. After hearing the
testimony of doctors who had examined Riggins, the trial court
denied the motion with a one-page order giving no indication of its
rationale. At Riggins' trial, he presented his insanity defense and
testified, was convicted, and was sentenced to death. In affirming,
the State Supreme Court held,
inter alia, that expert
testimony presented at trial was sufficient to inform the jury of
the Mellaril's effect on Riggins' demeanor and testimony.
Held: The forced administration of antipsychotic
medication during Riggins' trial violated rights guaranteed by the
Sixth and Fourteenth Amendments. Pp. 133-138.
(a) The record narrowly defines the issues in this case.
Administration of Mellaril was involuntary once Riggins' motion to
terminate its use was denied, but its administration was medically
appropriate. In addition, Riggins' Eighth Amendment argument that
the drug's administration denied him the opportunity to show jurors
his true mental condition at the sentencing hearing was not raised
below or in the petition for certiorari and, thus, will not be
considered by this Court. P.133.
(b) A pretrial detainee has an interest in avoiding involuntary
administration of antipsychotic drugs that is protected under the
Due Process Clause. Cf.
Washington v.
Harper,
494 U. S. 210;
Bell v.
Wolfish, 441 U. S. 520, 545. Once Riggins
moved to terminate his treatment, the State became obligated to
establish both the need for Mellaril and its medical
appropriateness. Cf.
Harper, supra, at 227. Due process
certainly would have been satisfied had the State shown that the
treatment was medically appropriate and, considering less intrusive
alternatives, essential for Riggins' own safety or the safety of
others. The State also might have been able to justify the
treatment, if medically appro-
128
Syllabus
priate, by showing that an adjudication of guilt or innocence
could not be obtained by using less intrusive means. However, the
trial court allowed the drug's administration to continue without
making
any determination of the need for this course or
any findings about reasonable alternatives, and it failed to
acknowledge Riggins' liberty interest in freedom from antipsychotic
drugs. Pp. 133-137.
(c) There is a strong possibility that the trial court's error
impaired Riggins' constitutionally protected trial rights. Efforts
to prove or disprove actual prejudice from the record before this
Court would be futile, and guesses as to the trial's outcome had
Riggins' motion been granted would be speculative. While the
precise consequences of forcing Mellaril upon him cannot be shown
from a trial transcript, the testimony of doctors who examined
Riggins establishes the strong possibility that his defense was
impaired. Mellaril's side effects may have impacted not only his
outward appearance, but also his testimony's content, his ability
to follow the proceedings, or the substance of his communication
with counsel. Thus, even if the expert testimony presented at trial
allowed jurors to assess Riggins' demeanor fairly, an unacceptable
risk remained that forced medication compromised his trial rights.
Pp. 137-138.
(d) While trial prejudice can sometimes be justified by an
essential state interest, the record here contains no finding to
support a conclusion that administration of antipsychotic
medication was necessary to accomplish an essential state policy.
P. 138.
107 Nev. 178,808 P. 2d 535, reversed and remanded.
O'CONNOR, J., delivered the opinion of the Court, in which
REHNQUIST, C. J., and WHITE, BLACKMUN, STEVENS, and SOUTER, JJ.,
joined. KENNEDY, J., filed an opinion concurring in the judgment,
post, p. 138. THOMAS, J., filed a dissenting opinion, in
which SCALIA, J., joined except as to Part II-A,
post, p.
146.
Mace J. Yampolsky argued the cause for
petitioner. With him on the briefs were
Jay Topkis, Neal H.
Klausner, and
Steven C.
Herzog.
James Tufteland argued the cause for respondent. With him
on the brief was
Rex Bell. *
*Briefs of
amici curiae urging reversal were filed for
the Coalition for Fundamental Rights of Equality of Ex-patients by
Peter Margulies, Herbert Semmel, and
Patrick Reilly;
for the National Association of Criminal
129
JUSTICE O'CONNOR delivered the opinion of the Court. Petitioner
David Riggins challenges his murder and robbery convictions on the
ground that the State of Nevada unconstitutionally forced an
antipsychotic drug upon him during trial. Because the Nevada courts
failed to make findings sufficient to support forced administration
of the drug, we reverse.
I
During the early hours of November 20, 1987, Paul Wade was found
dead in his Las Vegas apartment. An autopsy revealed that Wade died
from multiple stab wounds, including wounds to the head, chest, and
back. David Riggins was arrested for the killing 45 hours
later.
A few days after being taken into custody, Riggins told Dr. R.
Edward Quass, a private psychiatrist who treated patients at the
Clark County Jail, about hearing voices in his head and having
trouble sleeping. Riggins informed Dr. Quass that he had been
successfully treated with Mellaril in the past. Mellaril is the
trade name for thioridazine, an antipsychotic drug. After this
consultation, Dr. Quass prescribed Mellaril at a level of 100
milligrams per day. Because Riggins continued to complain of voices
and sleep problems in the following months, Dr. Quass gradually
increased the Mellaril prescription to 800 milligrams per day.
Riggins also received a prescription for Dilantin, an antiepileptic
drug.
In January 1988, Riggins successfully moved for a determination
of his competence to stand trial. App. 6. Three
Defense Lawyers by
David M. Eldridge; and for Nevada
Attorneys for Criminal Justice by
Kevin M. Kelly.
Briefs of
amici curiae were filed for the State of
Louisiana et al. by
William J. Guste, Jr.,
Attorney General of Louisiana, and
M. Patricia Jones and
Kathleen E. Petersen, Assistant Attorneys General, and by
the Attorneys General for their respective States as follows:
Charles M. Oberly III of Delaware and
Michael E.
Carpenter of Maine; and for the American Psychiatric
Association by
Richard G.
Taranto and
Joel I.
Klein.
130
court-appointed psychiatrists performed examinations during
February and March, while Riggins was taking 450 milligrams of
Mellaril daily. Dr. William O'Gorman, a psychiatrist who had
treated Riggins for anxiety in 1982, and Dr. Franklin Master
concluded that Riggins was competent to stand trial. The third
psychiatrist, Dr. Jack Jurasky, found that Riggins was incompetent.
The Clark County District Court determined that Riggins was legally
sane and competent to stand trial,
id., at 13, so
preparations for trial went forward.
In early June, the defense moved the District Court for an order
suspending administration of Mellaril and Dilantin until the end of
Riggins' trial.
Id., at 20. Relying on both the Fourteenth
Amendment and the Nevada Constitution, Riggins argued that
continued administration of these drugs infringed upon his freedom
and that the drugs' effect on his demeanor and mental state during
trial would deny him due process. Riggins also asserted that,
because he would offer an insanity defense at trial, he had a right
to show jurors his "true mental state."
Id., at 22. In
response, the State noted that Nevada law prohibits the trial of
incompetent persons, see Nev. Rev. Stat. § 178.400 (1989), and
argued that the court therefore had authority to compel Riggins to
take medication necessary to ensure his competence. App. 31-32.
On July 14, 1988, the District Court held an evidentiary hearing
on Riggins' motion. At the hearing, Dr. Master "guess[ed]" that
taking Riggins off medication would not noticeably alter his
behavior or render him incompetent to stand trial. Record 412. Dr.
Quass testified that, in his opinion, Riggins would be competent to
stand trial even without the administration of Mellaril, but that
the effects of Mellaril would not be noticeable to jurors if
medication continued.
Id., at 443-445. Finally, Dr. O'Gorman
told the court that Mellaril made the defendant calmer and more
re-
131
laxed but that an excessive dose would cause drowsiness.
Id., at 464-466. Dr. O'Gorman was unable to predict how
Riggins might behave if taken off antipsychotic medication, yet he
questioned the need to give Riggins the high dose he was receiving.
Id., at 474-476. The court also had before it a written
report in which Dr. Jurasky held to his earlier view that Riggins
was incompetent to stand trial and predicted that if taken off
Mellaril the defendant "would most likely regress to a manifest
psychosis and become extremely difficult to manage." App. 19.
The District Court denied Riggins' motion to terminate
medication with a one-page order that gave no indication of the
court's rationale.
Id., at 49. Riggins continued to receive
800 milligrams of Mellaril each day through the completion of his
trial the following November.
At trial, Riggins presented an insanity defense and testified on
his own behalf. He indicated that on the night of Wade's death he
used cocaine before going to Wade's apartment. Riggins admitted
fighting with Wade, but claimed that Wade was trying to kill him
and that voices in his head said that killing Wade would be
justifiable homicide. A jury found Riggins guilty of murder with
use of a deadly weapon and robbery with use of a deadly weapon.
After a penalty hearing, the same jury set the murder sentence at
death.
Riggins presented several claims to the Nevada Supreme Court,
among them that forced administration of Mellaril denied him the
ability to assist in his own defense and prejudicially affected his
attitude, appearance, and demeanor at trial. This prejudice was not
justified, Riggins said in his opening brief, because the State
neither demonstrated a need to administer Mellaril nor explored
alternatives to giving him 800 milligrams of the drug each day.
Record 1020. Riggins amplified this claim in his reply brief,
objecting that the State intruded upon his constitutionally
protected lib-
132
erty interest in freedom from antipsychotic drugs without
considering less intrusive options. Riggins argued:
"In United States v. Bryant, 670 F. Supp. 840, 843 (Minn.
1987)[,] the court, in reference to medicating prisoners against
their will, stated that 'courts have recognized a protectable
liberty interest ... in the freedom to avoid unwanted
medication with such drugs.' The court in so stating cited Bee
v. Greaves, 744 F.2d
1387 (10th Cir. 1984)[,] which addressed the issue of
medicating pre-trial detainees and stated that 'less restrictive
alternatives, such as segregation or the use of less controversial
drugs like tranquilizers or sedatives, should be ruled out before
resorting to antipsychotic drugs.' In the case at bar, no less
restrictive alternatives were utilized, considered or even
proposed." Record 10701071 (emphasis in original).
The Nevada Supreme Court affirmed Riggins' convictions and death
sentence. 107 Nev. 178, 808 P. 2d 535 (1991). With respect to
administration of Mellaril, the court held that expert testimony
presented at trial "was sufficient to inform the jury of the effect
of the Mellaril on Riggins' demeanor and testimony."
Id., at
181, 808 P. 2d, at 538. Thus, although Riggins' demeanor was
relevant to his insanity defense, the court held that denial of the
defense's motion to terminate medication was neither an abuse of
discretion nor a violation of Riggins' trial rights. In a
concurring opinion, Justice Rose suggested that the District Court
should have determined whether administration of Mellaril during
trial was "absolutely necessary" by ordering a pretrial suspension
of medication.
Id., at 185, 808 P. 2d, at 540 (concurring
opinion). Justice Springer dissented, arguing that antipsychotic
drugs may never be forced on a criminal defendant solely to allow
prosecution.
Id., at 186, 808 P. 2d, at 541.
We granted certiorari, 502 U. S. 807 (1991), to decide whether
forced administration of antipsychotic medication
133
during trial violated rights guaranteed by the Sixth and
Fourteenth Amendments.
II
The record in this case narrowly defines the issues before us.
The parties have indicated that once the District Court denied
Riggins' motion to terminate use of Mellaril, subsequent
administration of the drug was involuntary. See,
e.
g., Brief for Petitioner 6 (medication was "forced"); Brief
for Respondent 14, 22, 28 (describing medication as "unwanted,"
"over objection," and "compelled"). This understanding accords with
the determination of the Nevada Supreme Court. See 107 Nev., at
181; 808 P. 2d, at 537 (describing medication as "involuntary" and
"forced"). Given the parties' positions on this point and the
absence of any record evidence to the contrary, we adhere to the
understanding of the State Supreme Court.
We also presume that administration of Mellaril was medically
appropriate. Although defense counsel stressed that Riggins
received a very high dose of the drug, at no point did he suggest
to the Nevada courts that administration of Mellaril was medically
improper treatment for his client.
Finally, the record is dispositive with respect to Riggins'
Eighth Amendment claim that administration of Mellaril denied him
an opportunity to show jurors his true mental condition at the
sentencing hearing. Because this argument was presented neither to
the Nevada Supreme Court nor in Riggins' petition for certiorari,
we do not address it here.
With these considerations in mind, we turn to Riggins' core
contention that involuntary administration of Mellaril denied him
"a full and fair trial." Pet. for Cert. i. Our discussion in
Washington v.
Harper, 494 U. S. 210 (1990),
provides useful background for evaluating this claim. In
Harper, a prison inmate alleged that the State of Washington
and various individuals violated his right to due process by giving
him Mellaril and other antipsychotic drugs against his will.
Although the inmate did not prevail, we agreed that
134
his interest in avoiding involuntary administration of
antipsychotic drugs was protected under the Fourteenth Amendment's
Due Process Clause. "The forcible injection of medication into a
nonconsenting person's body," we said, "represents a substantial
interference with that person's liberty."
Id., at 229. In
the case of antipsychotic drugs like Mellaril, that interference is
particularly severe:
"The purpose of the drugs is to alter the chemical balance in a
patient's brain, leading to changes, intended to be beneficial, in
his or her cognitive processes. While the therapeutic benefits of
antipsychotic drugs are well documented, it is also true that the
drugs can have serious, even fatal, side effects. One such side
effect identified by the trial court is acute dystonia, a severe
involuntary spasm of the upper body, tongue, throat, or eyes. The
trial court found that it may be treated and reversed within a few
minutes through use of the medication Cogentin. Other side effects
include akathesia (motor restlessness, often characterized by an
inability to sit still); neuroleptic malignant syndrome (a
relatively rare condition which can lead to death from cardiac
dysfunction); and tardive dyskinesia, perhaps the most discussed
side effect of antipsychotic drugs. Tardive dyskinesia is a
neurological disorder, irreversible in some cases, that is
characterized by involuntary, uncontrollable movements of various
muscles, especially around the face .... [T]he proportion of
patients treated with antipsychotic drugs who exhibit the symptoms
of tardive dyskinesia ranges from 10% to 25%. According to the
American Psychiatric Association, studies of the condition indicate
that 60% of tardive dyskinesia is mild or minimal in effect, and
about 10% may be characterized as severe." Id., at 229-230
(citations omitted).
Taking account of the unique circumstances of penal confinement,
however, we determined that due process allows a
135
mentally ill inmate to be treated involuntarily with
antipsychotic drugs where there is a determination that "the inmate
is dangerous to himself or others and the treatment is in the
inmate's medical interest."
Id., at 227.
Under
Harper, forcing antipsychotic drugs on a convicted
prisoner is impermissible absent a finding of overriding
justification and a determination of medical appropriateness. The
Fourteenth Amendment affords at least as much protection to persons
the State detains for trial. See
Bell v.
Wolfish,
441 U. S. 520,
545 (1979) ("[P]retrial detainees, who have not been convicted of
any crimes, retain at least those constitutional rights that we
have held are enjoyed by convicted prisoners");
O'Lone v.
Estate of Shabazz, 482 U. S. 342, 349 (1987)
("[P]rison regulations ... are judged under a 'reasonableness' test
less restrictive than that ordinarily applied to alleged
infringements of fundamental constitutional rights"). Thus, once
Riggins moved to terminate administration of antipsychotic
medication, the State became obligated to establish the need for
Mellaril and the medical appropriateness of the drug.
Although we have not had occasion to develop substantive
standards for judging forced administration of such drugs in the
trial or pretrial settings, Nevada certainly would have satisfied
due process if the prosecution had demonstrated, and the District
Court had found, that treatment with antipsychotic medication was
medically appropriate and, considering less intrusive alternatives,
essential for the sake of Riggins' own safety or the safety of
others. See
Harper, supra, at 225-226; cf.
Addington
v.
Texas, 441
U. S. 418 (1979) (Due Process Clause allows civil commitment of
individuals shown by clear and convincing evidence to be mentally
ill and dangerous). Similarly, the State might have been able to
justify medically appropriate, involuntary treatment with the drug
by establishing that it could not obtain an adjudication of
Riggins' guilt or innocence by using less intrusive means. See
Illinois v.
Allen, 397 U. S. 337, 347
136
(1970) (Brennan, J., concurring) ("Constitutional power to bring
an accused to trial is fundamental to a scheme of 'ordered liberty'
and prerequisite to social justice and peace"). We note that during
the July 14 hearing Riggins did not contend that he had the right
to be tried without Mellaril if its discontinuation rendered him
incompetent. See Record 424-425, 496, 500. The question whether a
competent criminal defendant may refuse antipsychotic medication if
cessation of medication would render him incompetent at trial is
not before us.
Contrary to the dissent's understanding, we do not "adopt a
standard of strict scrutiny."
Post, at 156. We have no
occasion to finally prescribe such substantive standards as
mentioned above, since the District Court allowed administration of
Mellaril to continue without making
any determination of the
need for this course or
any findings about reasonable
alternatives. The court's laconic order denying Riggins' motion did
not adopt the State's view, which was that continued administration
of Mellaril was required to ensure that the defendant could be
tried; in fact, the hearing testimony casts considerable doubt on
that argument. See
supra, at 130-131. Nor did the order
indicate a finding that safety considerations or other compelling
concerns outweighed Riggins' interest in freedom from unwanted
antipsychotic drugs.
Were we to divine the District Court's logic from the hearing
transcript, we would have to conclude that the court simply weighed
the risk that the defense would be prejudiced by changes in
Riggins' outward appearance against the chance that Riggins would
become incompetent if taken off Mellaril, and struck the balance in
favor of involuntary medication. See Record 502 ("[T]hat he was
nervous and so forth ... can all be brought out [through expert
testimony]. And when you start weighing the consequences of taking
him off his medication and possibly have him revert into an
incompetent situation, I don't think that that is a good exper-
137
iment"). The court did not acknowledge the defendant's liberty
interest in freedom from unwanted antipsychotic drugs.
This error may well have impaired the constitutionally protected
trial rights Riggins invokes. At the hearing to consider
terminating medication, Dr. O'Gorman suggested that the dosage
administered to Riggins was within the toxic range,
id., at
483, and could make him "uptight,"
id., at 484. Dr. Master
testified that a patient taking 800 milligrams of Mellaril each day
might suffer from drowsiness or confusion.
Id., at 416. Cf.
Brief for American Psychiatric Association as
Amicus Curiae
10-11 ("[I]n extreme cases, the sedationlike effect [of
antipsychotic medication] may be severe enough (akinesia) to affect
thought processes"). It is clearly possible that such side effects
had an impact upon not just Riggins' outward appearance, but also
the content of his testimony on direct or cross examination, his
ability to follow the proceedings, or the substance of his
communication with counsel.
Efforts to prove or disprove actual prejudice from the record
before us would be futile, and guesses whether the outcome of the
trial might have been different if Riggins' motion had been granted
would be purely speculative. We accordingly reject the dissent's
suggestion that Riggins should be required to demonstrate how the
trial would have proceeded differently if he had not been given
Mellaril. See
post, at 149-150. Like the consequences of
compelling a defendant to wear prison clothing, see
Estelle
v.
Williams, 425 U. S. 501, 504-505
(1976), or of binding and gagging an accused during trial, see
Allen, supra, at 344, the precise consequences of forcing
antipsychotic medication upon Riggins cannot be shown from a trial
transcript. What the testimony of doctors who examined Riggins
establishes, and what we will not ignore, is a strong possibility
that Riggins' defense was impaired due to the administration of
Mellaril.
We also are persuaded that allowing Riggins to present expert
testimony about the effect of Mellaril on his de-
138
KENNEDY, J., concurring in judgment
meanor did nothing to cure the possibility that the substance of
his own testimony, his interaction with counsel, or his
comprehension at trial were compromised by forced administration of
Mellaril. Even if (as the dissent argues,
post, at 147-149)
the Nevada Supreme Court was right that expert testimony allowed
jurors to assess Riggins' demeanor fairly, an unacceptable risk of
prejudice remained. See 107 Nev., at 181, 808 P. 2d, at
537-538.
To be sure, trial prejudice can sometimes be justified by an
essential state interest. See
Holbrook v.
Flynn,
475 U. S. 560,
568-569 (1986);
Allen, supra, at 344 (binding and gagging
the accused permissible only in extreme situations where it is the
"fairest and most reasonable way" to control a disruptive
defendant); see also
Williams, supra, at 505 (compelling
defendants to wear prison clothing at trial furthers no essential
state policy). Because the record contains no finding that might
support a conclusion that administration of antipsychotic
medication was necessary to accomplish an essential state policy,
however, we have no basis for saying that the substantial
probability of trial prejudice in this case was justified.
The judgment of the Nevada Supreme Court is reversed, and the
case is remanded for further proceedings not inconsistent with this
opinion.
It is so ordered.
JUSTICE KENNEDY, concurring in the judgment.
The medical and pharmacological data in the
amicus briefs
and other sources indicate that involuntary medication with
antipsychotic drugs poses a serious threat to a defendant's right
to a fair trial. In the case before us, there was no hearing or
well-developed record on the point, and the whole subject of
treating incompetence to stand trial by drug medication is somewhat
new to the law, if not to medicine. On the sparse record before us,
we cannot give full consideration to the issue. I file this
separate opinion, however, to express
139
my view that absent an extraordinary showing by the State, the
Due Process Clause prohibits prosecuting officials from
administering involuntary doses of antipsychotic medicines for
purposes of rendering the accused competent for trial, and to
express doubt that the showing can be made in most cases, given our
present understanding of the properties of these drugs.
At the outset, I express full agreement with the Court's
conclusion that one who was medicated against his will in order to
stand trial may challenge his conviction. When the State commands
medication during the pretrial and trial phases of the case for the
avowed purpose of changing the defendant's behavior, the concerns
are much the same as if it were alleged that the prosecution had
manipulated material evidence. See
Brady v.
Maryland,
373 U. S. 83, 87
(1963) (suppression by the prosecution of material evidence
favorable to the accused violates due process);
Arizona v.
Youngblood, 488
U. S. 51, 58 (1988) (bad-faith failure to preserve potentially
useful evidence constitutes a due process violation). I cannot
accept the premise of JUSTICE THOMAS' dissent that the involuntary
medication order comprises some separate procedure, unrelated to
the trial and foreclosed from inquiry or review in the criminal
proceeding itself. To the contrary, the allegations pertain to the
State's interference with the trial. Thus, review in the criminal
proceeding is appropriate.
I also agree with the majority that the State has a legitimate
interest in attempting to restore the competence of otherwise
incompetent defendants. Its interest derives from the State's right
to bring an accused to trial and from our holding in
Pate v.
Robinson, 383
U. S. 375, 378 (1966), that conviction of an incompetent
defendant violates due process. Unless a defendant is competent,
the State cannot put him on trial. Competence to stand trial is
rudimentary, for upon it depends the main part of those rights
deemed essential to a fair trial, including the right to effective
assistance of coun-
140
KENNEDY, J., concurring in judgment
sel, the rights to summon, to confront, and to cross-examine
witnesses, and the right to testify on one's own behalf or to
remain silent without penalty for doing so.
Drope v.
Missouri, 420
U. S. 162, 171-172 (1975). Although the majority is correct
that this case does not require us to address the question whether
a defendant may waive his right to be tried while competent, in my
view a general rule permitting waiver would not withstand scrutiny
under the Due Process Clause, given our holdings in
Pate and
Drope. A defendant's waiver of the right to be tried while
competent would cast doubt on his exercise or waiver of all
subsequent rights and privileges through the whole course of the
trial.
The question is whether the State's interest in conducting the
trial allows it to ensure the defendant's competence by involuntary
medication, assuming of course there is a sound medical basis for
the treatment. The Court's opinion will require further proceedings
on remand, but there seems to be little discussion about what is to
be considered. The Court's failure to address these issues is
understandable in some respects, for it was not the subject of
briefing or argument; but to underscore my reservations about the
propriety of involuntary medication for the purpose of rendering
the defendant competent, and to explain what I think ought to be
express qualifications of the Court's opinion, some discussion of
the point is required.
This is not a case like
Washington v.
Harper,
494 U. S. 210
(1990), in which the purpose of the involuntary medication was to
ensure that the incarcerated person ceased to be a physical danger
to himself or others. The inquiry in that context is both objective
and manageable. Here the purpose of the medication is not merely to
treat a person with grave psychiatric disorders and enable that
person to function and behave in a way not dangerous to himself or
others, but rather to render the person competent to stand trial.
It is the last part of the State's objective, medicating the person
for the purpose of bringing him to trial, that causes most
141
serious concern. If the only question were whether some bare
level of functional competence can be induced, that would be a
grave matter in itself, but here there are even more far reaching
concerns. The avowed purpose of the medication is not functional
competence, but competence to stand trial. In my view elementary
protections against state intrusion require the State in every case
to make a showing that there is no significant risk that the
medication will impair or alter in any material way the defendant's
capacity or willingness to react to the testimony at trial or to
assist his counsel. Based on my understanding of the
medicalliterature, I have substantial reservations that the State
can make that showing. Indeed, the inquiry itself is elusive, for
it assumes some baseline of normality that experts may have some
difficulty in establishing for a particular defendant, if they can
establish it at all. These uncertainties serve to underscore the
difficult terrain the State must traverse when it enters this
domain.
To make these concerns concrete, the effects of antipsychotic
drugs must be addressed. First introduced in the 1950's,
antipsychotic drugs such as Mellaril have wide acceptance in the
psychiatric community as an effective treatment for psychotic
thought disorders. See American Psychiatric Press Textbook of
Psychiatry 770-774 (J. Talbott, R. Hales, & S. Yodofsky eds.
1988) (Textbook of Psychiatry); Brief for American Psychiatric
Association as
Amicus Curiae 6-7. The medications restore
normal thought processes by clearing hallucinations and delusions.
Textbook of Psychiatry 774. See also Brief for American Psychiatric
Association as
Amicus Curiae 9 ("The mental health produced
by antipsychotic medication is no different from, no more
inauthentic or alien to the patient than, the physical health
produced by other medications, such as penicillin for pneumonia").
For many patients, no effective alternative exists for treatment of
their illnesses.
Id., at 7, and n. 3.
142
KENNEDY, J., concurring in judgment
Although these drugs have changed the lives of psychiatric
patients, they can have unwanted side effects. We documented some
of the more serious side effects in
Washington v.
Harper,
supra, at 229-230, and they are mentioned again in the majority
opinion. More relevant to this case are side effects that, it
appears, can compromise the right of a medicated criminal defendant
to receive a fair trial. The drugs can prejudice the accused in two
principal ways: (1) by altering his demeanor in a manner that will
prejudice his reactions and presentation in the courtroom, and (2)
by rendering him unable or unwilling to assist counsel.
It is a fundamental assumption of the adversary system that the
trier of fact observes the accused throughout the trial, while the
accused is either on the stand or sitting at the defense table.
This assumption derives from the right to be present at trial,
which in turn derives from the right to testify and rights under
the Confrontation Clause.
Taylor v.
United States,
414 U. S. 17, 19
(1973)
(per curiam). At all stages of the proceedings, the
defendant's behavior, manner, facial expressions, and emotional
responses, or their absence, combine to make an overall impression
on the trier of fact, an impression that can have a powerful
influence on the outcome of the trial. If the defendant takes the
stand, as Riggins did, his demeanor can have a great bearing on his
credibility and persuasiveness, and on the degree to which he
evokes sympathy. The defendant's demeanor may also be relevant to
his confrontation rights. See
Coy v.
Iowa, 487 U. S. 1012,
1016-1020 (1988) (emphasizing the importance of the face-to-face
encounter between the accused and the accuser).
The side effects of antipsychotic drugs may alter demeanor in a
way that will prejudice all facets of the defense. Serious due
process concerns are implicated when the State manipulates the
evidence in this way. The defendant may be restless and unable to
sit still. Brief for American Psychiatric Association as
Amicus
Curiae 10. The drugs can induce
143
a condition called parkinsonism, which, like Parkinson's
disease, is characterized by tremor of the limbs, diminished range
of facial expression, or slowed functions, such as speech.
Ibid. Some of the side effects are more subtle.
Antipsychotic drugs such as Mellaril can have a "sedationlike
effect" that in severe cases may affect thought processes.
Ibid. At trial, Dr. Jurasky testified that Mellaril has "a
tranquilizer effect." Record 752. See also
ibid. ("If you
are dealing with someone very sick then you may prescribe up to 800
milligrams which is the dose he had been taking which is very, very
high. I mean you can tranquilize an elephant with 800 milligrams").
Dr. Jurasky listed the following side effects of large doses of
Mellaril: "Drowsiness, constipation, perhaps lack of alertness,
changes in blood pressure .... Depression of the psychomotor
functions. If you take a lot of it you become stoned for all
practical purposes and can barely function."
Id., at
753.
These potential side effects would be disturbing for any
patient; but when the patient is a criminal defendant who is going
to stand trial, the documented probability of side effects seems to
me to render involuntary administration of the drugs by prosecuting
officials unacceptable absent a showing by the State that the side
effects will not alter the defendant's reactions or diminish his
capacity to assist counsel. As the American Psychiatric Association
points out:
"By administering medication, the State may be creating a
prejudicial negative demeanor in the defendantmaking him look
nervous and restless, for example, or so calm or sedated as to
appear bored, cold, unfeeling, and unresponsive .... That such
effects may be subtle does not make them any less real or
potentially influentiaL" Brief for American Psychiatric Association
as Amicus Curiae 13.
As any trial attorney will attest, serious prejudice could
result if medication inhibits the defendant's capacity to react
144
KENNEDY, J., concurring in judgment
and respond to the proceedings and to demonstrate remorse or
compassion. The prejudice can be acute during the sentencing phase
of the proceedings, when the sentencer must attempt to know the
heart and mind of the offender and judge his character, his
contrition or its absence, and his future dangerousness. In a
capital sentencing proceeding, assessments of character and remorse
may carry great weight and, perhaps, be determinative of whether
the offender lives or dies. See Geimer & Amsterdam, Why Jurors
Vote Life or Death: Operative Factors in Ten Florida Death Penalty
Cases, 15 Am. J. Crim. L. 1,51-53 (1987-1988).
Concerns about medication extend also to the issue of
cooperation with counsel. We have held that a defendant's right to
the effective assistance of counsel is impaired when he cannot
cooperate in an active manner with his lawyer.
Massiah v.
United States, 377 U. S. 201 (1964);
Geders v.
United States, 425 U. S. 80 (1976) (trial
court order directing defendant not to consult with his lawyer
during an overnight recess held to deprive him of the effective
assistance of counsel). The defendant must be able to provide
needed information to his lawyer and to participate in the making
of decisions on his own behalf. The side effects of antipsychotic
drugs can hamper the attorney-client relation, preventing effective
communication and rendering the defendant less able or willing to
take part in his defense. The State interferes with this relation
when it administers a drug to dull cognition. See Brief for
National Association of Criminal Defense Lawyers as
Amicus
Curiae 42 ("[T]he chemical flattening of a person's will can
also lead to the defendant's loss of self-determination undermining
the desire for selfpreservation which is necessary to engage the
defendant in his own defense in preparation for his trial").
It is well established that the defendant has the right to
testify on his own behalf, a right we have found essential to our
adversary system.
In re Oliver, 333 U. S. 257, 273
(1948). We have found the right implicit as well in the Com-
145
pulsory Process Clause of the Sixth Amendment.
Rock v.
Arkansas, 483
U. S. 44 (1987). In
Rock, we held that a state rule
excluding all testimony aided or refreshed by hypnosis violated the
defendant's constitutional right to take the stand in her own
defense. We observed that barring the testimony would contradict
not only the right of the accused to conduct her own defense, but
also her right to make this defense in person: "'It is the accused,
not counsel, who must be "informed of the nature and cause of the
accusation," who must be "confronted with the witnesses against
him," and who must be accorded "compulsory process for obtaining
witnesses in his favor."'"
Id., at 52, quoting
Faretta v.
California, 422 U. S. 806, 819
(1975). We gave further recognition to the right of the accused to
testify in his or her own words, and noted that this in turn was
related to the Fifth Amendment choice to speak "in the unfettered
exercise of his own will."
Rock, supra, at 53. In my view
medication of the type here prescribed may be for the very purpose
of imposing constraints on the defendant's own will, and for that
reason its legitimacy is put in grave doubt.
If the State cannot render the defendant competent without
involuntary medication, then it must resort to civil commitment, if
appropriate, unless the defendant becomes competent through other
means. If the defendant cannot be tried without his behavior and
demeanor being affected in this substantial way by involuntary
treatment, in my view the Constitution requires that society bear
this cost in order to preserve the integrity of the trial process.
The state of our knowledge of antipsychotic drugs and their side
effects is evolving and may one day produce effective drugs that
have only minimal side effects. Until that day comes, we can permit
their use only when the State can show that involuntary treatment
does not cause alterations raising the concerns enumerated in this
separate opinion.
With these observations, I concur in the judgment reversing the
conviction.
146
JUSTICE THOMAS, with whom JUSTICE SCALIA joins except as to Part
II-A, dissenting.
Petitioner David Edward Riggins killed Paul William Wade by
stabbing him 32 times with a knife. He then took cash, drugs, and
other items from Wade's home. A Nevada jury convicted Riggins of
first-degree murder and robbery with a deadly weapon and sentenced
him to death. The Nevada Supreme Court affirmed. 107 Nev. 178, 808
P. 2d 535 (1991). This Court reverses the conviction, holding that
Nevada unconstitutionally deprived Riggins of his liberty interest
in avoiding unwanted medication by compelling him to take an
antipsychotic drug. I respectfully dissent.
The Court's opinion, in my view, confiates two distinct
questions: whether Riggins had a full and fair criminal trial and
whether Nevada improperly forced Riggins to take medication. In
this criminal case, Riggins is asking, and may ask, only for the
reversal of his conviction and sentence. He is not seeking, and may
not seek, an injunction to terminate his medical treatment or
damages for an infringement of his personal rights. I agree with
the positions of the majority and concurring opinions in the Nevada
Supreme Court: Even if the State truly forced Riggins to take
medication, and even if this medication deprived Riggins of a
protected liberty interest in a manner actionable in a different
legal proceeding, Riggins nonetheless had the fundamentally fair
criminal trial required by the Constitution. I therefore would
affirm his conviction.
I
Riggins contended in the Nevada Supreme Court that he did not
have a " 'full and fair' trial" for two reasons, the first relating
to exclusion of evidence of his mental condition and the second
concerning his ability to assist in his defense. Record 1018. To
the extent that Riggins' arguments below involved federal
constitutional issues, I believe that the Nevada Supreme Court
correctly rejected them.
147
A
Riggins first argued that the trial court improperly prevented
him from presenting relevant evidence of his demeanor. As the Court
notes, Riggins suffers from a mental illness and raised insanity as
a defense at trial. When Riggins killed Wade, he was not using any
antipsychotic medication. During his trial, however, Riggins was
taking large doses of the antipsychotic drug Mellaril. Riggins
believed that this drug would make his appearance at trial
different from his appearance when he attacked Wade and that this
difference might cause the jury to misjudge his sanity. To show his
mental condition as it existed at the time of the crime, Riggins
requested permission to appear before the jury in an unmedicated
state. App. 20-24, 42-47. The trial court denied the request, and
the Nevada Supreme Court affirmed.
This Court has no power to decide questions concerning the
admissibility of evidence under Nevada law.
Estelle v.
McGuire, 502 U.
S. 62, 67-68 (1991). We therefore may conduct only a limited
review of a Nevada court's decision to exclude a particular form of
demeanor evidence. Except in cases involving a violation of a
specific constitutional provision such as the Confrontation Clause,
see,
e. g., Ohio v.
Roberts, 448 U. S. 56 (1980), this
Court may not reverse a state "trial judge's action in the
admission of evidence" unless the evidentiary ruling "so infuse[s]
the trial with unfairness as to deny due process of law."
Lisenba v.
California, 314 U. S. 219, 228 (1941). See
also
Marshall v.
Lonberger, 459 U. S. 422, 438, n. 6
(1983);
Burgett v.
Texas, 389 U. S. 109, 113-114
(1967). In this case, I see no basis for concluding that Riggins
had less than a full and fair trial.
The Court declines to decide whether Mellaril actually affected
Riggins' appearance. On the basis of some pretrial psychiatric
testimony it speculates only that Riggins might have looked less
uptight, drowsy, or confused if he had not taken the drug.
Ante, at 137. Other evidence casts doubt
148
on this possibility. At least one psychiatrist believed that a
jury would not "be able to notice whether or not [Riggins] was on
Mellaril as compared to the period of the time when he was not
medicated by that drug." Record 445. Yet, even if Mellaril
noticeably affected Riggins' demeanor, the Court fails to explain
why the medication's effects rendered Riggins' trial fundamentally
unfair.
The trial court offered Riggins the opportunity to prove his
mental condition as it existed at the time of the crime through
testimony instead of his appearance in court in an unmedicated
condition. Riggins took advantage of this offer by explaining to
the jury the history of his mental health, his usage of Mellaril,
and the possible effects of Mellaril on his demeanor.
Id.,
at 739-740. Riggins also called Dr. Jack A. Jurasky, a
psychiatrist, who testified about Riggins' condition after his
arrest and his likely mental state at the time of the crime.
Id., at 747-748. Dr. Jurasky also explained Riggins' use of
Mellaril and how it might be affecting him.
Id., at 752-753,
760-761.
The Nevada Supreme Court concluded that this "testimony was
sufficient to inform the jury of the effect of the Mellaril on
Riggins' demeanor and testimony." 107 Nev., at 181, 808 P. 2d, at
538. Its analysis comports with that of other state courts that
also have held that expert testimony may suffice to clarify the
effects of an antipsychotic drug on a defendant's apparent
demeanor. See
State v.
Law, 270 S. C. 664, 673, 244
S. E. 2d 302, 306 (1978);
State v.
Jojola, 89 N. M.
489, 493, 553 P. 2d 1296, 1300 (1976). Cf.
In re Pray, 133
Vt. 253, 257-258, 336 A. 2d 174, 177 (1975) (reversing a conviction
because no expert testimony explained how antipsychotic medicine
affected the defendant's appearance). Having reviewed the record as
a whole, I see no reason to disturb the conclusion of the Nevada
Supreme Court. On the facts of this case, Riggins' inability to
introduce evidence of his mental condition as he desired did not
render his trial fundamentally unfair. See
Rock v.
Arkansas, 483
149
u. S. 44, 55, n. 11 (1987);
id., at 64-65 (REHNQUIST, C.
J., dissenting).
B
Riggins also argued in the Nevada Supreme Court, although not in
his briefs to this Court, that he did not have a "'full and fair'
trial" because Mellaril had side effects that interfered with his
ability to participate in his defense. Record 1018. He alleged, in
particular, that the drug tended to limit his powers of perception.
The Court accepts this contention, stating: "It is clearly
possible that such side effects had an impact upon ... the
content of his testimony on direct or cross examination, his
ability to follow the proceedings, or the substance of his
communication with counsel."
Ante, at 137 (emphasis added).
I disagree. We cannot conclude that Riggins had less than a full
and fair trial merely because of the possibility that Mellaril had
side effects.
All criminal defendants have a right to a full and fair trial,
and a violation of this right may occur if a State tries a
defendant who lacks a certain ability to comprehend or participate
in the proceedings. We have said that "the Due Process Clause
guarantees the fundamental elements of fairness in a criminal
trial,"
Spencer v.
Texas, 385 U. S. 554, 563-564
(1967), and have made clear that "conviction of an accused person
while he is legally incompetent violates due process,"
Pate
v.
Robinson, 383 U. S. 375, 378
(1966).
Riggins has no claim of legal incompetence in this case.
The trial court specifically found him competent while he was
taking Mellaril under a statute requiring him to have "sufficient
mentality to be able to understand the nature of the criminal
charges against him, and ... to aid and assist his counsel in the
defense interposed upon the trial." Nev. Rev. Stat. § 178.400(2)
(1989). Riggins does not assert that due process imposes a higher
standard.
The record does not reveal any other form of unfairness relating
to the purported side effects of Mellaril. Riggins has failed to
allege specific facts to support his claim that he
150
could not participate effectively in his defense. He has not
stated how he would have directed his counsel to examine or
cross-examine witnesses differently. He has not identified any
testimony or instructions that he did not understand. The record,
moreover, does not even support his assertion that Mellaril made
him worse off. As Justice Rose noted in his concurring opinion
below: "Two psychiatrists who had prescribed Mellaril for Riggins,
Dr. Quass and Dr. O'Gorman, testified that they believed it was
helpful to him. Additional psychiatric testimony established that
Mellaril may have increased Riggins' cognitive ability .... " 107
Nev., at 185, 808 P. 2d, at 540. See also
State v.
Hayes, 118 N. H. 458, 461, 389 A. 2d 1379, 1381 (1978)
(holding a defendant's perception adequate because "[a]ll the
expert evidence support[ed] the conclusion that the medication
ha[d] a beneficial effect on the defendant's ability to
function").l Riggins' competence, moreover, tends to confirm that
he had a fair trial. See
State v.
Jojola, supra, at
492, 553 P. 2d, at 1299 (presuming, absent other evidence, that the
side effects of an antipsychotic drug did not render a competent
defendant unable to participate fully in his trial). I thus see no
basis for reversing the Nevada Supreme Court.
II
Riggins also argues for reversal on the basis of our holding in
Washington v.
Harper, 494 U. S. 210, 221
(1990), that the Due Process Clause protects a substantive "liberty
interest" in avoiding unwanted medication. Riggins asserts that
Nevada unconstitutionally deprived him of this liberty interest by
forcing him to take Mellaril. The Court agrees, ruling
1 We previously have noted that "'[p]sychotropic medication is
widely accepted within the psychiatric community as an
extraordinarily effective treatment for both acute and chronic
psychoses, particularly schizophrenia.'''
Washington v.
Harper, 494 U.
S. 210,226, n. 9 (1990) (quoting Brief for American Psychiatric
Association et al. as
Amici Curiae, O. T. 1989, No. 88-599,
pp. 10-11).
151
that "the Nevada courts failed to make findings sufficient to
support forced administration of the drug" in this case.
Ante, at 129. I consider reversal on this basis
improper.
A
Riggins may not complain about a deprivation of the liberty
interest that we recognized in
Harper because the record
does not support his version of the facts. Shortly after his
arrest, as the Court notes, Riggins told a psychiatrist at his jail
that he was hearing voices and could not sleep. The psychiatrist
prescribed Mellaril. When the prescription did not eliminate the
problem, Riggins sought further treatment and the psychiatrist
increased the dosage. Riggins thus began taking the drug
voluntarily.
Ante, at 129.
The Court concludes that the medication became involuntary when
the trial court denied Riggins' motion for permission not to take
the drug during the trial.
Ante, at 133. I disagree.
Although the court denied Riggins' motion, it did not order him to
take any medication.2 Moreover, even though Riggins
alleges
that the
state physicians forced him to take the medication
after the court's order, the record contains no finding of fact
with respect to this allegation. The Court admits that it merely
assumes that the physicians drugged him, and attempts to justify
its assumption by observing that the Nevada Supreme Court also
assumed that involuntary medication occurred.
Ibid. The
Nevada Supreme Court, however, may have made its assumption for the
purpose of argument; the assumption, in its view, did
2 Riggins' counsel confirmed this interpretation of the order at
oral argument:
"QUESTION: ... [D]id the court ever go further than saying I
will not order the State to stop administering the medication? ...
It simply said ... I won't intervene and enjoin the administration
of this medication[.] "MR. YAMPOLSKY: yes ....
"QUESTION: SO if [Riggins] had then said, well, I'm not going to
take it, he wouldn't be in violation of the court order? ...
"Mr. YAMPOLSKY: Apparently not." Tr. of Oral Arg. 10.
152
not change the result of the case. The Court cannot make the
same assumption if it requires reversal of Riggins' conviction.
Riggins also cannot complain about a violation of
Harper
because he did not argue below for reversal of his conviction on
the ground that Nevada had deprived him of a liberty interest.
Riggins consistently maintained in the Nevada courts that he did
not have a "full and fair trial" because the medication deprived
him of the opportunity to present his demeanor to the jury and to
participate in his defense. App. 20-24 (trial court motion);
id., at 42-47 (trial court reply); Record 1018-1021
(appellate brief);
id., at 1068-1071 (appellate reply
brief). As counsel for Nevada put it at oral argument: "The way
this issue was initially presented to the trial court was really a
question of trial strategy. There was never an indication in this
case that Mr. Riggins was a Harper-type defendant who did not want
to be medicated." Tr. of Oral Arg. 23.3
Because the claims that Riggins raised below have no merit,
Riggins has altered his theory of the case. The Court, therefore,
should not condemn the Nevada courts because they "did not
acknowledge the defendant's liberty interest in freedom from
unwanted antipsychotic drugs."
Ante, at 137. The Nevada
courts had no reason to consider an argument that Riggins did not
make. We have said quite recently that "[i]n reviewing the
judgments of state courts under the jurisdictional grant of 28 U.
s. C. § 1257, the Court has, with very rare exceptions, refused to
consider petition-
3 Riggins noted in his reply brief before the Nevada Supreme
Court that the courts in
United States v.
Bryant, 670
F. Supp. 840, 843 (Minn. 1987), and
Bee v.
Greaves,
744 F.2d
1387 (CA1O 1984), had recognized a personal liberty interest in
avoiding unwanted medication. Record 1070-1071. Yet, Riggins never
asked for reversal because of a deprivation of this interest. He
argued for reversal in that brief only on grounds that the
medication "violated [his] right to a 'full and fair' trial because
it denied him the ability to assist in his defense, and prejudiced
his demeanor, attitude, and appearance to the jury."
Id., at
1068.
153
ers' claims that were not raised or addressed below."
Yee
v.
Escondido, 503 U. S. 519, 533
(1992). Although "we have expressed inconsistent views as to
whether this rule is jurisdictional or prudential in cases arising
from state courts,"
ibid., the Court does not attempt to
justify its departure here.
Finally, we did not grant certiorari to determine whether the
Nevada courts had made the findings required by
Harper to
support forced administration of a drug. We took this case to
decide "[w]hether forced medication during trial violates a
defendant's constitutional right to a full and fair trial." Pet.
for Cert. The Court declines to answer this question one way or the
other, stating only that a violation of
Harper "may well
have impaired the constitutionally protected trial rights Riggins
invokes."
Ante, at 137. As we have stated, "we ordinarily do
not consider questions outside those presented in the petition for
certiorari."
Yee v.
Escondido, supra, at 535. I
believe that we should refuse to consider Riggins'
Harper
argument.
B
The
Harper issue, in any event, does not warrant reversal
of Riggins' conviction. The Court correctly states that Riggins, as
a detainee awaiting trial, had at least the same liberty interest
in avoiding unwanted medication that the inmate had in
Harper. This case, however, differs from
Harper in a
very significant respect. When the inmate in
Harper
complained that physicians were drugging him against his will, he
sought damages and an injunction against future medication in a
civil action under 42 U. S. C. § 1983. See 494 U. S., at 217.
Although Riggins also complains of forced medication, he is seeking
a reversal of his criminal conviction. I would not expand
Harper to include this remedy.
We have held that plaintiffs may receive civil remedies for all
manner of constitutional violations under § 1983. See
154
Dennis v.
Higgins, 498 U. S. 439, 443-451
(1991). This Court, however, has reversed criminal convictions only
on the basis of two kinds of constitutional deprivations: those
"which occu[r] during the presentation of the case" to the trier of
fact, and those which cause a "structural defect affecting the
framework" of the trial.
Arizona v.
Fulminante,
499 U. S. 279,
307, 310 (1991). The Court does not reveal why it considers a
deprivation of a liberty interest in avoiding unwanted medication
to fall into either category of reversible error. Even if Nevada
failed to make the findings necessary to support forced
administration of Mellaril, this failure, without more, would not
constitute a trial error or a flaw in the trial mechanism. See 107
Nev., at 185,808 P. 2d, at 540 (Rose, J., concurring). Although
Riggins might be entitled to other remedies, he has no right to
have his conviction reversed.4
4 A State, however, might violate a defendant's due process
right to a fundamentally fair trial if its administration of
medication were to
diminish substantially the defendant's
mental faculties during the trial, even if he were not thereby
rendered incompetent. See 3 E. Coke, Institutes *34 (1797) ("If
felons come in judgement to answer, ... they shall be out of irons,
and all manner of bonds, so that their pain shall not take away any
manner of reason, nor them constrain to answer, but at their free
will"); Resolutions of the Judges upon the Case of the Regicides,
Kelyng's Report of Divers Cases in Pleas of the Crown 10 (1708)
(Old Bailey 1660) ("It was resolved that when Prisoners come to the
Bar to be tryed, their Irons ought to be taken off, so that they be
not in any Torture while they make their defense, be their Crime
never so great"), reprinted in 5 How. St. Tr. 971, 979-980 (1816);
Trial of Christopher Layer, 16 How. St. Tr. 94, 100 (1812)
[K. B. 1722] ("[T]he authority is that [the defendant] is not to be
'in vinculis' during his trial, but should be so far free, that he
should have the use of his reason, and all advantages to clear his
innocence"); see also
State v.
Williams, 18 Wash. 47,
49-51, 50 P. 580, 581 (1897) ("'[T]he condition of the prisoner in
shackles may, to some extent, deprive him of the free and calm use
of all his faculties''') (quoting
State v.
Kring, 64
Mo. 591 (1877)). Riggins has not made (much less proved) any such
allegation in this Court; indeed, the record indicates that
Riggins' mental capacity was
enhanced by his administration
of Mellaril.
155
We applied a similar analysis in
Estelle v.
Williams, 425
U. S. 501 (1976). In that case, a prisoner challenged his
conviction on grounds that the State had required him to wear
prison garb before the jury. In reviewing the challenge, we did not
ask whether the State had violated some personal right of the
defendant to select his attire. Instead, we considered only whether
the prison clothing had denied him a "fair trial" by making his
appearance less favorable to the jury.
Id., at 503. Although
we ultimately declined to reach the merits because the prisoner had
waived the issue at trial,
id., at 512, we observed that
lower courts had held that "a showing of actual prejudice must be
made by a defendant seeking to have his conviction overturned on
this ground,"
id., at 504, n. 1. In my view, just as the
validity of the conviction in
Estelle v.
Williams
would depend on whether the prisoner had a fair trial, so does the
validity of Riggins' conviction.
The need for requiring actual unfairness in this case (either in
the form of a structural defect or an error in the presentation of
evidence) becomes apparent when one considers how the Court might
apply its decision to other cases. A State could violate
Harper by forcibly administering
any kind of
medication to a criminal defendant. Yet, the Court surely would not
reverse a criminal conviction for a
Harper violation
involving medications such as penicillin or aspirin. Perhaps
Mellaril, in general, has a greater likelihood of affecting a
person's appearance and powers of perceptions than these
substances. As noted above, however, we have no indication in this
case, considering the record as a whole, that Mellaril unfairly
prejudiced Riggins.
I do not mean in any way to undervalue the importance of a
person's liberty interest in avoiding forced medication or to
suggest that States may drug detainees at their whim. Under
Harper, detainees have an interest in avoiding unwanted
medication that the States must respect. In appropriate instances,
detainees may seek damages or injunctions
156
against further medication in civil actions either under § 1983,
as in
Harper, or under state law. Yet, when this Court
reviews a state-court criminal conviction of a defendant who has
taken medication, it cannot undo any violation that already has
occurred or punish those responsible. It may determine only whether
the defendant received a proper trial, free of the kinds of
reversible errors that we have recognized. Because Riggins had a
full and fair trial in this case, I would affirm the Nevada Supreme
Court.
C
For the foregoing reasons, I find it unnecessary to address the
precise standards governing the forced administration of drugs to
persons such as Riggins. Whether or not Nevada violated these
standards, I would affirm Riggins' conviction. I note, however,
that the Court's discussion of these standards poses troubling
questions. Although the Court purports to rely on
Washington
v.
Harper, the standards that it applies in this case differ
in several respects.
The Court today, for instance, appears to adopt a standard of
strict scrutiny. It specifically faults the trial court for failing
to find either that the "continued administration of Mellaril was
required to ensure that the defendant could be tried,"
ante, at 136 (emphasis added), or that "other
compelling concerns outweighed Riggins' interest in freedom
from unwanted antipsychotic drugs,"
ibid. (emphasis added).
We specifically rejected this high standard of review in
Harper. In that case, the Washington Supreme Court had held
that state physicians could not administer medication to a prisoner
without showing that it "was both necessary and effective for
furthering a compelling state interest." 494 U. S., at 218. We
reversed, holding that the state court "erred in refusing to apply
the standard of reasonableness."
Id., at 223.
The Court today also departs from
Harper when it says
that the Nevada Supreme Court erred by not "considering
157
less intrusive alternatives."
Ante, at 135. The Court
presumably believes that Nevada could have treated Riggins with
smaller doses of Mellaril or with other kinds of therapies. In
Harper, however, we imposed no such requirement. In fact, we
specifically ruled that "[t]he alternative means proffered by [the
prisoner] for accommodating his interest in rejecting the forced
administration of antipsychotic drugs do not demonstrate the
invalidity of the State's policy." 494 U. S., at 226.
This case differs from
Harper because it involves a
pretrial detainee and not a convicted prisoner. The standards for
forcibly medicating inmates well may differ from those for persons
awaiting trial. The Court, however, does not rely on this
distinction in departing from
Harper; instead, it purports
to be applying
Harper to detainees.
Ante, at 135.
Either the Court is seeking to change the
Harper standards
or it is adopting different standards for detainees without stating
its reasons. I cannot accept either interpretation of the Court's
opinion. For all of these reasons, I respectfully dissent.
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