Competency to Stand Trial

Psychotropic medication is the principal treatment technique used in the restoration to trial competence. Although some courts and hospitals had once followed an approach that precluded a defendant from being considered competent when competency was maintained by ongoing medication, this practice has now been rejected.

The reverse problem is raised when a defendant seeks to refuse psychotropic medication. This occurred in Riggins v. Nevada (504 U.S. 127 (1992)), in which the defendant had been receiving antipsychotic medication in the jail, but sought to refuse the continuation of such medication during his trial. The trial judge refused, and he was convicted. The Supreme Court reversed, finding that the defendant's trial while on a heavy dose of unwanted antipsychotic medication violated due process because the trial court had failed to make findings sufficient to justify such forced medication. The Court's holding was a narrow one, but in important dicta it suggested the kinds of findings that would have justified involuntary medication during trial. Such medication would have been justified if the trial court had found it to be a medically appropriate and least intrusive alternative method of protecting the defendant's own safety or the safety of others in the jail. In addition, the Court noted that the state might have been able to justify such medication if medically appropriate and the least intrusive means of restoring him to competence and maintaining his competency.

Although Riggins does not resolve the question of whether the state's interest in competency restoration would outweigh a defendant's assertion of a right to refuse psychotropic medication, this dicta suggests that the Court would find such a state interest sufficient, and most lower courts have so held. Riggins leaves open many issues concerning when psychotropic medication can be authorized in the criminal trial process and the disposition of those for whom it may not that the lower courts must face. Riggins also alerts the courts to the need to insure that the side effects of psychotropic medication do not impair the defendant's demeanor and trial performance in ways that would be prejudicial, and should lead to increased judicial attention to drug administration practices in the competency to stand trial process.