Jared Lee Loughner, the Tuscon shooting suspect, can refuse anti-psychotic medication that prison officials had forced him to take, a federal appeals court ruled.
The ruling Tuesday by the 9th Circuit Court of Appeals keeps in place a July 1 order that stopped officials at a federal prison in Springfield, Mo. from forcing Loughner to take the drugs.
The Loughner case has reignited a legal debate over when prisoners with mental illness can be forcibly medicated with anti-psychotic drugs.
In May a district court concluded that Loughner was mentally incompetent to stand trial for the shootings in Arizona that killed six people including federal Judge John Roll and wounded Congresswoman Gabrielle Giffords and others. If at a later date he is deemed competent for trial, the case against him will proceed in federal court.
The three-judge panel of the 9th Circuit noted the government had an interest in Loughner, 22, being healthy enough to be determined to be competent to stand trial but that Loughner's right to be free of unwanted drugs overrode those considerations.
"Because Loughner has not been convicted of a crime, he is presumptively innocent and is therefore entitled to greater constitutional rights than a convicted inmate," said the appeals panel headed by Chief Judge Alex Kozinski.
The ruling against involuntary treatment will remain in place until Loughner's appeal of the prison medical team's treatment is decided. The next hearing is Aug. 29 in San Francisco.
Prison officials say they administered the drugs because he was "dangerous to himself" and others. In court papers they write that Loughner twice threw a plastic chair at one of his doctors and that he spat and lunged at his attorney in April.
But lawyers for Loughner fought back saying that the federal prison officials were forcibly medicating their client in part not to reduce his alleged dangerousness but instead to restore his competency to stand trial for the shooting rampage in Arizona.
In court papers they write: "A very serious question is posed in this case as to when a criminal defendant may be forcibly medicated pretrial with powerful, mind-altering psychotropic drugs." They argued their client should have been given milder drugs that would have mitigated danger concerns but not treated his underlying mental illness against his will.
The legal debate boils down to the justification for the medication. In broad terms the Supreme Court has ruled that prisoners can be forcibly medicated if they are dangerous to themselves or others. However for the purposes of rendering a prisoner competent to stand trial, the government can only forcibly medicate a non-dangerous defendant under limited circumstances.
The requirement includes a formal court hearing to discuss whether the treatment is medically appropriate and if it is necessary to further an important government interest.
Loughner's lawyers believe that the prison officials are trying to avoid such a hearing by claiming Loughner is exhibiting dangerous behavior in custody.
"State and federal courts have faced these questions in a line of precedent setting cases, including a line of cases from the U.S. Supreme Court that seek to balance the constitutional rights of persons to refuse forced psychotropic medication as against the right of the state to control dangerous behaviors." says Dr. Mel Guyer, professor of psychology at the University of Michigan Health System's Department of Psychiatry.
"Generally, the courts have given deference to a prisoner's, patient's 'dangerousness' as a rationale for forced medication," Guyer says.
Those opposed to the drugs point out that the patient often suffers severe side effects and the drugs are not guaranteed to alter the behavior.
But Dr. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, believes that even though such medication could eventually make Loughner mentally fit to face a potential trial and death penalty sentence, he should be medicated.
"At the end of the day what has to drive decision making regarding Jared Loughner is not his trial or what he has alleged to have done, it's right now if he is a threat to himself and others in the eyes of his doctors. Then he deserves the ability to try the medication."
Guyer agrees that in Loughner's case the threshold question will be whether Loughner is currently considered dangerous.
"If the defendant is found dangerous, the government can avoid" a formal hearing, he says. "The initial forced medication jousting will turn on whether the defendant is presently dangerous. Mental health experts are notoriously unreliable in predicting dangerousness and so courts may require clear evidence of present dangerousness."