Case Title: Winnebago County v. C.S.

Citation: 

Docket Number: 2016AP001982

State: wisconsin

Court: Wisconsin Supreme Court

Date: 2020-04-10T00:00:00Z

Document:
2020 WI 33 
 
SUPREME COURT OF WISCONSIN 
 
 
 
 
 
CASE NO.: 
2016AP1982 
 
 
 
COMPLETE TITLE: 
In the matter of the mental commitment of C.S.: 
 
Winnebago County, 
          Petitioner-Respondent, 
     v. 
C. S., 
          Respondent-Appellant-Petitioner. 
 
 
 
 
 
REVIEW OF DECISION OF THE COURT OF APPEALS 
Reported at 386 Wis. 2d 612,927 N.W.2d 576 
PDC No:2019 WI App 16 - Published 
 
 
OPINION FILED: 
April 10, 2020   
SUBMITTED ON BRIEFS: 
        
ORAL ARGUMENT: 
January 15, 2020   
 
 
SOURCE OF APPEAL: 
 
 
COURT: 
Circuit   
 
COUNTY: 
Winnebago   
 
JUDGE: 
Karen L. Seifert & Barbara H. Key   
 
 
 
JUSTICES: 
 
ZIEGLER, J., delivered the majority opinion of the Court, in 
which ANN WALSH BRADLEY, KELLY, and DALLET, JJ., joined.  
REBECCA GRASSL BRADLEY, J., filed a dissenting opinion.  
HAGEDORN, J., filed a dissenting opinion, in which ROGGENSACK, 
C.J., joined. 
NOT PARTICIPATING: 
        
 
 
 
ATTORNEYS: 
 
For the respondent-appellant-petitioner, there were briefs 
filed by Kaitlin A. Lamb, assistant state public defender. There 
was an oral argument by Kaitlin A. Lamb.  
 
For the petitioner-respondent, there was a brief filed by 
Mary A. Mueller, Catherine B. Scherer, and Winnebago County office 
of Corporation Counsel, Oshkosh. There was an oral argument by 
Mary A. Mueller. 
 
 
2 
 
An amicus curiae brief was filed on behalf of the Attorney 
General by Maura FJ Whenal, assistant attorney general; with whom 
on the brief is Joshua L. Kaul, attorney general.  
 
An Amicus curiae brief was filed on behalf of Disability 
Rights Wisconsin by Todd G. Smith, Deborah Machalow, and Godfrey 
& Kahn, Madison.  
 
 
 
 
2020 WI 33
NOTICE 
This opinion is subject to further 
editing and modification.  The final 
version will appear in the bound 
volume of the official reports.   
No.   2016AP1982 
(L.C. No. 
2015ME267) 
STATE OF WISCONSIN  
 
 
   : 
IN SUPREME COURT 
 
 
In the matter of the mental commitment of C.S.: 
 
Winnebago County, 
 
          Petitioner-Respondent, 
 
     v. 
 
C.S., 
 
          Respondent-Appellant-Petitioner. 
 
FILED 
 
APR 10, 2020 
 
Sheila T. Reiff 
Clerk of Supreme Court 
 
 
 
 
ZIEGLER, J., delivered the majority opinion of the Court, in which 
ANN WALSH BRADLEY, KELLY, and DALLET, JJ., joined.  REBECCA GRASSL 
BRADLEY, J., filed a dissenting opinion.  HAGEDORN, J., filed a 
dissenting opinion, in which ROGGENSACK, C.J., joined. 
 
 
REVIEW of a decision of the Court of Appeals.  Reversed and 
cause remanded.   
 
¶1 
ANNETTE KINGSLAND ZIEGLER, J.   This is a review of a 
published decision of the court of appeals, Winnebago County v. 
C.S., 2019 WI App 16, 386 Wis. 2d 612, 927 N.W.2d 576 ("C.S. III"), 
affirming the Winnebago County circuit court's order of extension 
of commitment, order for involuntary medication and treatment, and 
No. 
2016AP1982   
 
2 
 
order denying C.S.'s postcommitment motion.1  C.S. suffers from 
schizophrenia and was an inmate in the Wisconsin prison system.  
While he was incarcerated, C.S. was committed and determined 
incompetent 
to 
refuse 
medication 
pursuant 
to 
Wis. 
Stat. 
§ 51.61(1)(g) (2015-16)2 and, therefore, was the subject of 
multiple involuntary medication court orders. 
¶2 
C.S.'s commitment and involuntary medication orders were 
not based upon a determination of dangerousness because neither 
Wis. Stat. § 51.20(1)(ar) nor Wis. Stat. § 51.61(1)(g)3. require 
a determination of dangerousness.  Rather, under § 51.20(1)(ar), 
C.S. was committed based on determinations that he was mentally 
ill, a proper subject for treatment, and in need of treatment.  
Then, under § 51.61(1)(g)3., C.S. was involuntarily medicated 
because he was determined incompetent to refuse medication.  
Accordingly, the crux of the issue in this case is whether 
§ 51.61(1)(g)3. is facially unconstitutional when an inmate 
committed under § 51.20(1)(ar) is involuntarily medicated based on 
a determination of incompetence to refuse medication only——without 
any determination of dangerousness at any stage.   
¶3 
C.S. 
argues 
that 
Wis. 
Stat. 
§ 51.61(1)(g)3. 
is 
unconstitutional when it permits the involuntary medication of any 
inmate who was committed under Wis. Stat. § 51.20(1)(ar) without 
                                                 
1 The Honorable Karen L. Seifert entered the order extending 
C.S.'s commitment and the order for involuntary medication and 
treatment.  The Honorable Barbara H. Key entered the order denying 
C.S.'s postcommitment motion. 
2 All subsequent references to the Wisconsin Statutes are to 
the 2015-16 version unless otherwise indicated. 
No. 
2016AP1982   
 
3 
 
a determination that the inmate is "dangerous" at any stage in the 
proceedings.  Winnebago County argues the statute is facially 
constitutional and invokes the County's parens patriae power.  The 
County posits that it has a legitimate interest in the care and 
assistance of a mentally ill and incompetent inmate, thus 
eliminating any need for a determination of dangerousness with 
respect to an involuntary medication order of an inmate.  
¶4 
The court of appeals concluded that "the involuntary 
medication and treatment of a prisoner is facially constitutional 
as there is a legitimate reason for the [S]tate to medicate/treat 
even when there is no finding of dangerousness——the general welfare 
of the prisoner."  C.S. III, 386 Wis. 2d 612, ¶8.  We reverse. 
¶5 
We conclude that Wis. Stat. § 51.61(1)(g)3. is facially 
unconstitutional for any inmate who is involuntarily committed 
under Wis. Stat. § 51.20(1)(ar), which does not require a 
determination of dangerousness, when the inmate is involuntarily 
medicated based merely on a determination that the inmate is 
incompetent to refuse medication.  Incompetence to refuse 
medication alone is not an essential or overriding State interest 
and cannot justify involuntary medication.  Accordingly, we 
reverse the court of appeals and remand to the circuit court with 
an order to vacate C.S.'s June 2015 order for involuntary 
medication and treatment. 
 
No. 
2016AP1982   
 
4 
 
I.  FACTUAL BACKGROUND AND PROCEDURAL POSTURE3 
¶6 
Because this is a facial challenge, the relevant facts 
are few.  C.S. suffers from schizophrenia.  In 2005 C.S. was 
convicted of mayhem as a repeat offender and sentenced to ten years 
of initial confinement and ten years of extended supervision.  In 
2012 Winnebago County petitioned to involuntarily commit and 
medicate C.S.  C.S. has since been subject to multiple involuntary 
commitment orders, involuntary medication orders, and extensions 
thereof. 
¶7 
C.S. previously challenged his involuntary commitment 
before this court.  He argued that an involuntary commitment 
statute, Wis. Stat. § 51.20(1)(ar) (2013-14), was facially 
unconstitutional because it allows the involuntary commitment of 
an inmate without a conclusion of dangerousness.  We rejected that 
argument and concluded that § 51.20(1)(ar) is "reasonably related 
to the State's legitimate interest in providing care and assistance 
to inmates suffering from mental illness."  Winnebago County v. 
Christopher S., 2016 WI 1, ¶24, 366 Wis. 2d 1, 878 N.W.2d 109 
("C.S. I").  C.S. did not challenge the constitutionality of Wis. 
Stat. § 51.61(1)(g)3. at that time.  But he does now. 
¶8 
Relevant to C.S.'s current challenge to his involuntary 
medication, Winnebago County petitioned for an extension of C.S.'s 
                                                 
3 C.S. is currently challenging his involuntary medication 
order.  C.S. also previously challenged his involuntary commitment 
before this court.  For a more detailed discussion of the factual 
and procedural history of this case, we refer the reader to our 
prior opinion, Winnebago County v. Christopher S., 2016 WI 1, 366 
Wis. 2d 1, 878 N.W.2d 109 ("C.S. I"). 
No. 
2016AP1982   
 
5 
 
commitment in May 2015.4  The petition asserted that it was the 
"opinion and recommendation of the Department of Human Services" 
that C.S. was mentally ill, a proper subject for treatment, and 
that there was a substantial likelihood that C.S. would be a proper 
subject for commitment if treatment were withdrawn.  Winnebago 
County attached to the petition a letter from Dr. Kate Keshena.  
Dr. Keshena stated her opinion to a reasonable degree of medical 
certainty that C.S. "continue[d] to have substantial disorders of 
thought, mood and perception" and was "incapable of expressing an 
understanding of the advantages" of his psychotropic medication 
"or appreciating how he benefits from them."  Essentially, 
Dr. Keshena concluded that C.S. was mentally ill and incompetent 
to refuse medication. 
¶9 
C.S. objected to the extension and the circuit court 
held a jury trial in June, 2015.  The jury found that the elements 
of Wis. Stat. § 51.20(1)(ar) were met.  Specifically, the jury 
found that: (1) C.S. was mentally ill; (2) C.S. was a proper 
subject for treatment and in need of treatment; (3) C.S. was an 
inmate in a Wisconsin state prison; (4) less restrictive forms of 
appropriate treatment had been attempted unsuccessfully; and (5) 
C.S. had been fully informed of his treatment needs, the mental 
health services available to him, and his rights, and he had an 
opportunity to discuss those matters with a licensed physician or 
                                                 
4 C.S. also challenged his June 2014 orders of extension, but 
the court of appeals dismissed that challenge as moot.  Winnebago 
County v. C.S., No. 2016AP1955, unpublished slip op. (Wis. Ct. 
App. Aug. 16, 2017) ("C.S. II").  We do not review that decision. 
No. 
2016AP1982   
 
6 
 
psychologist.  See § 51.20(1)(ar).  On June 30, 2015, the circuit 
court entered an order of extension of commitment and an order for 
involuntary medication and treatment.  Pursuant to Wis. Stat. 
§ 51.61(1)(g), the order for involuntary medication stated that 
the order was "due to" "mental illness" and that C.S. was "not 
competent to refuse psychotropic medication or treatment because" 
he was "substantially incapable of applying an understanding of 
the advantages, disadvantages and alternatives to his condition in 
order to make an informed choice as to whether to accept or refuse 
psychotropic medications." Importantly, at no point in these 
proceedings did Winnebago County allege, the jury find, or the 
circuit court conclude that C.S. was dangerous.  Thus, the circuit 
court order permitted Winnebago County to involuntarily medicate 
C.S. merely because he was mentally ill and incompetent to refuse 
medication——without 
any 
finding 
or 
conclusions 
regarding 
dangerousness. 
¶10 In July, 2015 C.S. was released from prison and began 
extended supervision.  After his release, C.S. was no longer 
subject to the involuntary commitment or involuntary medication 
orders.  C.S. then filed a notice of intent to pursue 
postcommitment relief and a motion for postcommitment relief.  He 
argued that Wis. Stat. § 51.61(1)(g) is facially unconstitutional 
for 
any 
inmate 
involuntarily 
committed 
under 
Wis. 
Stat. 
§ 51.20(1)(ar) without a conclusion of dangerousness.  On 
September 15, 2016, the circuit court held a hearing and issued an 
order denying C.S.'s postcommitment motion.  The circuit court 
concluded that Winnebago County could involuntarily medicate C.S. 
No. 
2016AP1982   
 
7 
 
pursuant to § 51.61(1)(g) because it was in the legitimate 
interests of both the County and C.S.   
¶11 On October 6, 2016, C.S. filed a notice of appeal and 
the court of appeals stayed the appeal pending its decision in 
Winnebago County v. C.S., No. 2016AP1955, unpublished slip op. 
(Wis. Ct. App. Aug. 16, 2017) ("C.S. II") (concluding that C.S.'s 
challenge to his June 2014 orders of extension was moot).  Then, 
on March 27, 2019, the court of appeals affirmed in C.S. III.  The 
court of appeals acknowledged that C.S. was no longer subject to 
the June 2015 involuntary commitment and involuntary medication 
orders.  It stated, "Although this case is moot, for the reasons 
stated in C.S. I, 366 Wis. 2d 1, ¶¶30-32, we will reach the merits 
of this appeal."5  C.S. III, 386 Wis. 2d 612, ¶2 n.4.  It then 
concluded that "the involuntary medication and treatment of a 
prisoner [pursuant to Wis. Stat. § 51.61(1)(g)] is facially 
constitutional as there is a legitimate reason for the State to 
medicate/treat even when there is no finding of dangerousness——
the general welfare of the prisoner."  Id., ¶8. 
                                                 
5 In C.S. I we concluded that although C.S.'s original 
commitment order was expired, we would nonetheless review it under 
an exception to the mootness doctrine because "the issues presented 
[were] of great public importance as they would affect a large 
number of persons in the Wisconsin State prison system."  C.S. I, 
366 Wis. 2d 1, ¶32.  The court of appeals applied this same logic 
to C.S.'s current challenge to his involuntary medication order.  
Now we do as well.  Even if moot, C.S.'s facial challenge to Wis. 
Stat. § 51.61(1)(g) is "of great public importance" and "would 
affect a large number of persons in the Wisconsin State prison 
system."  Id.  Accordingly, this court will also reach the merits 
of C.S.'s challenge. 
No. 
2016AP1982   
 
8 
 
¶12 On April 26, 2019, C.S. petitioned this court for review.  
We granted the petition. 
 
II.  STANDARD OF REVIEW 
¶13 This 
case 
requires 
the 
court 
to 
review 
the 
constitutionality of portions of Wis. Stat. § 51.61(1)(g)3.  The 
constitutionality of a statute is a question of law we review de 
novo.  State v. Wood, 2010 WI 17, ¶15, 323 Wis. 2d 321, 780 
N.W.2d 63. 
¶14 C.S. 
brings 
a 
facial 
challenge 
to 
Wis. 
Stat. 
§ 51.61(1)(g)3. to the extent that it permits the involuntary 
medication of an inmate involuntarily committed under Wis. Stat. 
§ 51.20(1)(ar) without a determination of dangerousness.  "Under 
a facial challenge, 'the challenger must show that the law cannot 
No. 
2016AP1982   
 
9 
 
be enforced under any circumstances.'"6  C.S. I, 366 Wis. 2d 1, 
¶34 (quoting Wood, 323 Wis. 2d 321, ¶13).  We presume that the 
statute under review is constitutional and the burden is on the 
party challenging the statute to prove that it is unconstitutional 
beyond a reasonable doubt.  Id.; State v. Fitzgerald, 2019 WI 69, 
¶12, 387 Wis. 2d 384, 929 N.W.2d 165.  "'[B]eyond a reasonable 
doubt' expresses the force or conviction with which a court must 
conclude, as a matter of law, that a statute is unconstitutional 
before the statute . . . can be set aside."  Mayo v. Wisconsin 
Injured Patients & Families Comp. Fund, 2018 WI 78, ¶27, 383 
Wis. 2d 1, 914 N.W.2d 678.  Thus, C.S. must prove beyond a 
                                                 
6 A typical facial challenge comes to this court in this form: 
a party asks us to conclude that a law is always unconstitutional 
in every possible application to every possible person.  C.S.'s 
challenge is a facial one that presents itself differently.  He 
does not challenge the entirety of Wis. Stat. § 51.61(1)(g).  Nor 
does he challenge every possible application of it to both inmates 
and non-inmates.  Rather, C.S. brings a categorical facial 
challenge.  Specifically, he presents a categorical facial 
challenge to a portion of § 51.61(1)(g)3. when its language permits 
the involuntary medication of any inmate who is committed under 
Wis. Stat. § 51.20(1)(ar) based merely on a determination that the 
inmate is incompetent to refuse medication.  We have previously 
made clear that this categorical approach to a facial challenge is 
still a facial challenge and is subject to the same facial 
challenge standard.  See Gabler v. Crime Victims Rights Bd., 2017 
WI 67, ¶29, 376 Wis. 2d 147, 897 N.W.2d 384 ("Judge Gabler by no 
means seeks to invalidate the entirety of Chapter 950 as contrary 
to the Wisconsin Constitution.  But he does contend that the Board 
can never constitutionally take action against a judge under Wis. 
Stat. § 950.09(2)(a), (2)(c)-(d), or (3).  To prevail, Judge Gabler 
therefore must meet the standard for a facial challenge and 
demonstrate that the disputed portions of Wis. Stat. § 950.09 
'cannot be constitutionally enforced' by the Board against judges 
'under any circumstances.' Tammy W-G. v. Jacob T., 2011 WI 30, 
¶46, 333 Wis. 2d 273, 797 N.W.2d 854 (quoting Soc'y Ins. v. LIRC, 
2010 WI 68, ¶26, 326 Wis. 2d 444, 786 N.W.2d 385)."). 
No. 
2016AP1982   
 
10 
 
reasonable doubt that § 51.61(1)(g)3. is facially unconstitutional 
"under all circumstances" involving the involuntary medication of 
any inmate, who was involuntarily committed under § 51.20(1)(ar), 
based merely on a determination of incompetence to refuse 
medication.7  C.S. I, 366 Wis. 2d 1, ¶34. 
 
                                                 
7 C.S. argues that the "beyond a reasonable doubt" standard 
results in excessive deference to the legislature, to the detriment 
of the constitutional balance of authority between the judicial 
and legislative branches.  C.S. invites this court to correct the 
alleged imbalance, adopt the United States Supreme Court's 
standard, and require a "plain showing" or "clear demonstration" 
of unconstitutionality instead, citing Mayo v. Wisconsin Injured 
Patients & Families Comp. Fund, 2018 WI 78, ¶¶79, 90, 383 
Wis. 2d 1, 
914 
N.W.2d 678 
(Rebecca 
Grassl 
Bradley, 
J., 
concurring).  We heard a similar argument last term in State v. 
Fitzgerald, 2019 WI 69, 387 Wis. 2d 384, 929 N.W.2d 165.  However, 
just as in Fitzgerald, "[w]e need not resolve" C.S.'s challenge to 
our standard because Wis. Stat. § 51.61(1)(g)3. is "undoubtedly 
unconstitutional" when it permits the involuntary medication of an 
inmate involuntarily committed under Wis. Stat. § 51.20(1)(ar), 
which does not require a determination of dangerousness, based 
merely on a determination that the inmate is incompetent to refuse.  
Id., ¶12.  We decline to adopt a different standard today. 
No. 
2016AP1982   
 
11 
 
III.  ANALYSIS 
A.  Involuntary Commitment And Involuntary Medication Statutes 
¶15 C.S. argues that it is unconstitutional to involuntarily 
medicate an inmate without a conclusion of "dangerousness."8  This 
argument is rooted in a comparison with people who are not inmates.  
As we explain below, in order to involuntarily medicate a person 
who is not in prison, the petitioner (here, Winnebago County) must 
prove that the subject is dangerous, as that term is statutorily 
defined.  Yet, under Wis. Stat. § 51.61(1)(g)3., C.S. and other 
inmates, unlike others committed, can be involuntarily medicated 
without a determination of dangerousness.  This distinction 
between inmates and non-inmates is embedded in the Wisconsin 
Statutes.  Thus, before delving into our analysis in this case, we 
will summarize the involuntary commitment and involuntary 
medication statutory schemes in Wisconsin.  We begin with non-
inmates. 
¶16 To involuntarily commit a non-inmate, the petitioner 
must prove that the non-inmate is mentally ill, a proper subject 
for treatment, and dangerous.  See Wis. Stat. § 51.20(a)(1)-(2).  
                                                 
8 At argument, counsel for C.S. clarified that, for purposes 
of his argument, C.S. uses "dangerousness" broadly to refer to an 
individualized showing that medication is necessary to prevent 
serious physical harm to the inmate or others.  Accordingly, C.S. 
argues 
that 
Wis. 
Stat. 
§ 51.61(1)(g)3. 
is 
facially 
unconstitutional to the extent that it permits the involuntary 
medication of any inmate who was involuntarily committed under 
Wis. Stat. § 51.20(1)(ar), without an individualized showing that 
medication is necessary to prevent serious physical harm to the 
inmate or others.  Like C.S., we will use "dangerousness" as a 
shorthand for this individualized showing. 
No. 
2016AP1982   
 
12 
 
There are five different definitions of dangerousness under 
§ 51.20(a)(2), but all require a "substantial probability" of harm 
to that person or another.  See § 51.20(a)2.a.-e.9 
                                                 
9 Under Wis. Stat. § 51.20(1)(a)2.a.-e.: 
The individual is dangerous because he or she does any 
of the following: 
a.  Evidences a substantial probability of physical 
harm to himself or herself as manifested by evidence of 
recent threats of or attempts at suicide or serious 
bodily harm. 
b.  Evidences a substantial probability of physical 
harm to other individuals as manifested by evidence of 
recent homicidal or other violent behavior, or by 
evidence that others are placed in reasonable fear of 
violent behavior and serious physical harm to them, as 
evidenced by a recent overt act, attempt or threat to do 
serious physical harm. . . .   
c.  Evidences such impaired judgment, manifested by 
evidence of a pattern of recent acts or omissions, that 
there 
is 
a 
substantial 
probability 
of 
physical 
impairment or injury to himself or herself or other 
individuals. . . .  
d.  Evidences behavior manifested by recent acts or 
omissions that, due to mental illness, he or she is 
unable to satisfy basic needs for nourishment, medical 
care, shelter or safety without prompt and adequate 
treatment so that a substantial probability exists that 
death, 
serious 
physical 
injury, 
serious 
physical 
debilitation, 
or 
serious 
physical 
disease 
will 
imminently ensue unless the individual receives prompt 
and adequate treatment for this mental illness. . . .  
e.  For an individual, other than an individual who 
is alleged to be drug dependent or developmentally 
disabled, after the advantages and disadvantages of and 
alternatives to accepting a particular medication or 
treatment have been explained to him or her and because 
of mental illness, evidences either incapability of 
expressing an understanding of the advantages and 
disadvantages of accepting medication or treatment and 
No. 
2016AP1982   
 
13 
 
¶17 In contrast, to involuntarily commit an inmate, the 
petitioner need not prove dangerousness.  Pursuant to Wis. Stat. 
§ 51.20(1)(ar):  
If the individual is an inmate of a state prison, the 
petition may allege that the inmate is mentally ill, is 
a proper subject for treatment and is in need of 
treatment.  The petition shall allege that appropriate 
less restrictive forms of treatment have been attempted 
with the individual and have been unsuccessful and it 
shall include a description of the less restrictive 
forms of treatment that were attempted.  The petition 
shall also allege that the individual has been fully 
informed about his or her treatment needs, the mental 
health services available to him or her and his or her 
rights under this chapter and that the individual has 
had an opportunity to discuss his or her needs, the 
services available to him or her and his or her rights 
with a licensed physician or a licensed psychologist.  
The petition shall include the inmate's sentence and his 
or her expected date of release as determined under s. 
302.11 or 302.113, whichever is applicable.  The 
petition shall have attached to it a signed statement by 
a licensed physician or a licensed psychologist of a 
state prison and a signed statement by a licensed 
physician or a licensed psychologist of a state 
treatment facility attesting either of the following: 
                                                 
the 
alternatives, 
or 
substantial 
incapability 
of 
applying 
an 
understanding 
of 
the 
advantages, 
disadvantages, and alternatives to his or her mental 
illness in order to make an informed choice as to whether 
to accept or refuse medication or treatment; and 
evidences a substantial probability, as demonstrated by 
both the individual's treatment history and his or her 
recent acts or omissions, that the individual needs care 
or 
treatment 
to 
prevent 
further 
disability 
or 
deterioration and a substantial probability that he or 
she will, if left untreated, lack services necessary for 
his or her health or safety and suffer severe mental, 
emotional, or physical harm that will result in the loss 
of the individual's ability to function independently in 
the community or the loss of cognitive or volitional 
control over his or her thoughts or actions. . . .  
No. 
2016AP1982   
 
14 
 
1.  That the inmate needs inpatient treatment at a 
state treatment facility because appropriate treatment 
is not available in the prison. 
2.  That the inmate's treatment needs can be met on 
an outpatient basis in the prison. 
§ 51.20(1)(ar) (emphases added).  Thus, to involuntarily commit an 
inmate, the petitioner must prove that the inmate is mentally ill, 
a proper subject for treatment, and in need of treatment, but the 
petitioner need not prove dangerousness. 
¶18 Once involuntarily committed, both inmates and non-
inmates have a general right to refuse unwanted medication and 
treatment.  Wisconsin Stat. § 51.61 details the rights of patients, 
including "any individual who is receiving services for mental 
illness[.]"  § 51.61(1).  Among those rights is the right to refuse 
medication and treatment.  § 51.61(1)(g).  But the statute also 
places some limits on a patient's right to refuse medication if 
certain requirements are met.  Patients "have the right to refuse 
all medication and treatment except as ordered by the court under 
[§ 51.61(1)(g)2.], or in a situation in which the medication or 
treatment is necessary to prevent serious physical harm to the 
patient or to others."  § 51.61(1)(g)1.  Under § 51.61(1)(g)2.: 
At or after the hearing to determine probable cause for 
commitment but prior to the final commitment order, 
. . . the court shall, upon the motion of any interested 
person, and may, upon its own motion, hold a hearing to 
determine whether there is probable cause to believe 
that the individual is not competent to refuse 
medication or treatment and whether the medication or 
treatment will have therapeutic value and will not 
unreasonably impair the ability of the individual to 
prepare 
for 
or 
participate 
in 
subsequent 
legal 
proceedings.  If the court determines that there is 
probable cause to believe the allegations under this 
No. 
2016AP1982   
 
15 
 
subdivision, the court shall issue an order permitting 
medication or treatment to be administered to the 
individual regardless of his or her consent. 
§ 51.61(1)(g)2. (emphases added).  And § 51.61(1)(g)3., the 
subdivision we review in this case, states that following a final 
commitment order, patients: 
have the right to exercise informed consent with regard 
to all medication and treatment unless the committing 
court or the court in the county in which the individual 
is located, within 10 days after the filing of the motion 
of any interested person and with notice of the motion 
to the individual's counsel, if any, the individual and 
the applicable counsel under s. 51.20(4), makes a 
determination, following a hearing, that the individual 
is not competent to refuse medication or treatment or 
unless a situation exists in which the medication or 
treatment is necessary to prevent serious physical harm 
to the individual or others.  A report, if any, on which 
the motion is based shall accompany the motion and notice 
of motion and shall include a statement signed by a 
licensed physician that asserts that the subject 
individual needs medication or treatment and that the 
individual is not competent to refuse medication or 
treatment, based on an examination of the individual by 
a licensed physician. 
§ 51.61(1)(g)3. (emphases added).  Thus, under § 51.61(1)(g)3., a 
patient may be involuntarily medicated if: (1) "the individual is 
not 
competent 
to 
refuse 
medication" 
or; 
(2) 
"the 
medication . . . is necessary to prevent serious physical harm to 
the individual or others."  § 51.61(1)(g)3.  In this case, we 
review involuntary medication based on the former——incompetence to 
refuse medication.  We pause a moment to note what the portion of 
Wis. Stat. § 51.61(1)(g)3. which we review does not require.  It 
does not require a determination that the inmate is dangerous.  
Nor does it require a determination that the medication is 
medically appropriate or in the inmate's medical interest.  Nor 
No. 
2016AP1982   
 
16 
 
does it require a determination that the inmate needs medication.  
Nor does it require an expert report of any kind.  See 
§ 51.61(1)(g)3. ("A report, if any, on which the motion is based 
shall accompany the motion and notice of motion . . . " (emphasis 
added).)   
¶19 Wisconsin Stat. § 51.61(1)(g)4. defines incompetence in 
the context of involuntary medication. 
For purposes of a determination under subd. 2. or 3., an 
individual is not competent to refuse medication or 
treatment if, because of mental illness, developmental 
disability, alcoholism or drug dependence, and after the 
advantages and disadvantages of and alternatives to 
accepting the particular medication or treatment have 
been explained to the individual, one of the following 
is true: 
a.  The individual is incapable of expressing an 
understanding of the advantages and disadvantages of 
accepting medication or treatment and the alternatives. 
b.  The individual is substantially incapable of 
applying 
an 
understanding 
of 
the 
advantages, 
disadvantages and alternatives to his or her mental 
illness, developmental disability, alcoholism or drug 
dependence in order to make an informed choice as to 
whether to accept or refuse medication or treatment. 
§ 51.61(1)(g)4. (emphases added). 
¶20 Thus, both inmates and non-inmates, once lawfully 
committed, may be involuntarily medicated based on a conclusion 
that either: (1) medication is "necessary to prevent serious 
physical harm"; or (2) they are "not competent to refuse 
medication."  See Wis. Stat. § 51.61(1)(g)3.  The relevant 
distinction is that the lawfully committed non-inmate has already 
been determined by a court to be dangerous, see Wis. Stat. 
No. 
2016AP1982   
 
17 
 
§ 51.20(1)(a)1.-2.a.-e., and the inmate need not be, see 
§ 51.20(1)(ar).  C.S.'s challenge is grounded in this statutory 
disparity.  C.S. was not involuntarily medicated due to an 
independent conclusion of dangerousness.  Nor was he involuntarily 
medicated because a court concluded that involuntary medication 
was "necessary to prevent serious physical harm."  Rather, the 
circuit court's § 51.61(1)(g) involuntary medication order was 
based merely on a determination that C.S. was incompetent to refuse 
medication.10  See § 51.61(1)(g)3.  Thus, C.S. argues that 
§ 51.61(1)(g)3. is facially unconstitutional to the extent that it 
permits the involuntary medication of any inmate, who is 
involuntarily 
committed 
under 
§ 51.20(1)(ar), 
without 
a 
determination 
of 
dangerousness 
(or, 
based 
merely 
on 
a 
determination of incompetence to refuse medication).  We agree. 
 
B.  Wisconsin Stat. § 51.61(1)(g)3. Is Facially  
Unconstitutional For Any Inmate Involuntarily Committed  
Under Wis. Stat. § 51.20(1)(ar) When The Inmate  
Is Involuntarily Medicated Based Merely On A Determination  
That The Inmate Is Incompetent To Refuse Medication. 
¶21 Under the United States Constitution, no State shall 
"deprive any person of life, liberty, or property, without due 
process of law . . . ."  U.S. Const. Amend XIV.  All people have 
                                                 
10 Accordingly, we do not review the involuntary medication 
of an inmate under Wis. Stat. § 51.61(1)(g)3. pursuant to a 
determination that the medication is "necessary to prevent serious 
physical harm."  Nor do we review the involuntary medication of an 
inmate under § 51.61(1)(g)3m. pursuant to a determination that the 
inmate is dangerous under Wis. Stat. § 51.20(1)(a)2.e.  We review 
only the involuntary medication of an inmate, who is committed 
under § 51.20(1)(ar), based merely on a determination of 
incompetence to refuse medication pursuant to § 51.61(1)(g)3. 
No. 
2016AP1982   
 
18 
 
a "'significant liberty interest'" in refusing involuntary 
medication.  Fitzgerald, 387 Wis. 2d 384, ¶13 (quoting Washington 
v. Harper, 494 U.S. 210, 221 (1990)).  We conclude that Wis. Stat. 
§ 51.61(1)(g)3. is facially unconstitutional for any inmate who is 
involuntarily committed under Wis. Stat. § 51.20(1)(ar), which 
does not require a determination of dangerousness, when the inmate 
is involuntarily medicated based merely on a determination of 
incompetence to refuse medication.  Our conclusion is rooted in a 
trilogy of United States Supreme Court involuntary medication 
cases, and our decisions in Fitzgerald, 387 Wis. 2d 384, and Lenz 
v. L.E. Phillips Career Development Center, 167 Wis. 2d 53, 482 
N.W.2d 60 (1992)——all of which inform the content of an 
individual's "significant liberty interest" in refusing medication 
and the government's ability to infringe upon it. 
¶22 To begin, in Washington v. Harper, the Supreme Court 
reviewed a prison policy which permitted the involuntary 
medication of an inmate if the inmate suffered from a "mental 
disorder" and was either "gravely disabled" or posed a "likelihood 
of serious harm" to self, another, or property.  494 U.S. at 215.  
Harper was an inmate and was involuntarily medicated on the basis 
of a mental disorder and a "likelihood of serious harm."  See id. 
at 217. The Court stated that Harper "possesse[d] a significant 
liberty interest in avoiding the unwanted administration of 
antipsychotic drugs under the Due Process Clause of the Fourteenth 
Amendment."  Id. at 221-22.  Indeed, involuntary medication is a 
significant intrusion of a person's body. 
No. 
2016AP1982   
 
19 
 
The 
forcible 
injection 
of 
medication 
into 
a 
nonconsenting person's body represents a substantial 
interference with that person's liberty.  The purpose of 
[antipsychotic 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. 
Id. at 229 (citations omitted).  
¶23 While an inmate's liberty interest is significant, 
"[t]he extent of a prisoner's rights under the [Due Process] Clause 
to avoid the unwanted [medication] must be defined in the context 
of the inmate's confinement."  Id. at 222.  "The legitimacy, and 
the necessity, of considering the State's interests in prison 
safety and security are well established[.]" Id. at 223.  
Furthermore, "[w]here an inmate's mental disability is the root 
cause of the threat he poses to the inmate population, the State's 
interest 
in 
decreasing 
the 
danger 
to 
others 
necessarily 
encompasses an interest in providing him with medical treatment 
for his illness."  Id. at 225-26.  In light of the inmates' and 
the State's competing interests, the Court upheld Harper's 
involuntary medication and concluded that, "given the requirements 
of the prison environment, the Due Process Clause permits the State 
to treat a prison inmate who has a serious mental illness with 
antipsychotic drugs against his will, if the inmate is dangerous 
to himself or others and the treatment is in the inmate's medical 
interest."  Id. at 227.  Thus, the Harper Court held that a state 
may, if medication is in the inmate's medical interest, 
involuntarily medicate an inmate who is proven dangerous.  To be 
No. 
2016AP1982   
 
20 
 
clear, the Court's rational basis analysis did not conclude that 
a state has a legitimate interest in involuntarily medicating an 
inmate absent a determination of dangerousness.  Rather, it 
expressly linked the State's authority to involuntarily medicate 
to (1) dangerousness and (2) the inmate's medical interest.  Id. 
at 227 (emphasis added) ("We hold that, given the requirements of 
the prison environment, the Due Process Clause permits the State 
to treat a prison inmate who has a serious mental illness with 
antipsychotic drugs against his will, if the inmate is dangerous 
to himself or others and the treatment is in the inmate's medical 
interest.")  The portion of Wis. Stat. § 51.61(1)(g)3. which we 
review is not linked to either.11  As a result, Harper does not 
answer the question we address here.  
¶24 Next, in Riggins v. Nevada, the Supreme Court reviewed 
the involuntary medication of a criminal defendant during trial.  
504 U.S. 127, 129 (1992).  In doing so, it shed additional light 
on the Harper standard.  The Court stated, "Under Harper, forcing 
antipsychotic drugs on a convicted prisoner is impermissible 
absent a finding of [(1)] overriding justification and [(2)] a 
determination of medical appropriateness.  The Fourteenth 
Amendment affords at least as much protection to persons the State 
detains for trial."  Id. at 135.  "Thus, once Riggins moved to 
terminate administration of antipsychotic medication [rendering 
                                                 
11 Furthermore, the Harper Court (Washington v. Harper, 494 
U.S. 210 (1990)) did not conclude that a mentally ill inmate's 
incompetence to refuse medication alone would survive rational 
basis review.  Nor would it.  A mentally ill inmate's incompetence 
to refuse medication alone is not reasonably related to a 
penological interest. 
No. 
2016AP1982   
 
21 
 
his medication involuntary], the State became obligated to 
establish the need for . . . and the medical appropriateness of 
the drug."  Id.  The Court held that Riggins' forced medication 
violated due process "[b]ecause the record contains no finding 
that 
might 
support 
a 
conclusion 
that 
administration 
of 
antipsychotic medication was necessary to accomplish an essential 
state policy[.]"  Id. at 138. 
¶25 The Riggins Court made clear that Nevada ran afoul of 
the Due Process Clause because the record regarding why Riggins 
needed medication was lacking.  "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."  Id. at 135 (citing Harper, 494 
U.S. at 225-26).  "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."  Id. 
at 135 (citing Illinois v. Allen, 397 U.S. 337, 347 (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.")).  But the Court 
did not explicitly adopt a precise standard for forced medication 
during trial because it was sufficient to say that the district 
court did not make "any determination of the need for this course 
or any findings about reasonable alternatives."  Id. at 136. 
No. 
2016AP1982   
 
22 
 
¶26 Third, in Sell v. United States, the Supreme Court 
reviewed the involuntary medication of a mentally ill defendant to 
render him competent to stand trial.  539 U.S. 166, 169 (2003).  
The Court summarized the crux of Harper and Riggins.  Id. at 178-
79.  "In Riggins, the Court repeated that [under Harper] an 
individual has a constitutionally protected liberty 'interest in 
avoiding involuntary administration of antipsychotic drugs'——an 
interest that only an 'essential' or 'overriding' state interest 
might overcome."  Id. (quoting Riggins, 504 U.S. at 134, 135).  
The Court then concluded: 
These two cases, Harper and Riggins, indicate that 
the Constitution permits the Government involuntarily to 
administer antipsychotic drugs to a mentally ill 
defendant facing serious criminal charges in order to 
render that defendant competent to stand trial, but only 
if 
the 
treatment 
is 
medically 
appropriate, 
is 
substantially unlikely to have side effects that may 
undermine the fairness of the trial, and, taking account 
of 
less 
intrusive 
alternatives, 
is 
necessary 
significantly to further important governmental trial-
related interests. 
Id. at 179. 
¶27 The Court made clear that the standard it set forth was 
a heavy burden for a State to justify involuntary medication.  
"This standard will permit involuntary administration of drugs 
solely for trial competence purposes in certain instances.  But 
those instances may be rare."  Id. at 180.  "That is because the 
standard says or fairly implies the following:  First, a court 
must find that important governmental interests are at stake."  
Id. (additional emphasis added).  "Second, the court must conclude 
that involuntary medication will significantly further those 
No. 
2016AP1982   
 
23 
 
concomitant state interests."  Id. at 181.  "Third, the court must 
conclude that involuntary medication is necessary to further those 
interests."  Id. (additional emphasis added).  "Fourth, . . . the 
court must conclude that administration of the drugs is medically 
appropriate, i.e., in the patient's best medical interest in light 
of his medical condition."  Id.  
¶28 The Court then contrasted the standards set forth in 
Sell and Harper.  Sell's standard was for the involuntary 
medication of a criminal defendant incompetent to stand trial.  
Sell, 539 U.S. at 181.  But the standard in Harper addressed 
involuntary medication for a "different purpose, such as the 
purposes 
set 
out 
in 
Harper 
related 
to 
the 
individual's 
dangerousness, or purposes related to the individual's own 
interests where refusal to take drugs puts his health gravely at 
risk."  Id. at 182.12  We note again that the portion of Wis. Stat. 
§ 51.61(1)(g)3. which we review is not linked to dangerousness, 
the inmate’s medical interest, or grave health risks. 
¶29 Turning to this court and Wisconsin law, just last term 
we recognized that the Sell factors must be satisfied before a 
                                                 
12 To the extent that Sell can be read as permitting 
involuntary medication under a lower standard than Harper-type 
dangerousness, 
we 
note 
that 
Sell 
sets 
the 
standard 
for 
involuntarily medicating a criminal defendant to render the 
defendant competent to stand trial only.  Thus, the involuntary 
medication, 
though 
intruding 
on 
one 
of 
the 
defendant's 
constitutional rights, is aimed at protecting another——a fair 
trial.  Indeed, the Sell Court framed the government interest at 
stake as "a concomitant, constitutionally essential interest in 
assuring that the defendant's trial is a fair one."  Sell v. United 
States, 539 U.S. 166, 180 (2003).    
No. 
2016AP1982   
 
24 
 
circuit court may order involuntary medication of a criminal 
defendant to render the defendant competent to stand trial.  
Fitzgerald, 387 Wis. 2d 384, ¶¶2, 35.  We held that an involuntary 
medication statute, Wis. Stat. § 971.14(3)(dm) and (4)(b) (2017-
18), was unconstitutional to the extent that it "require[d] circuit 
courts to order involuntary medication when the Sell factors have 
not been met, [because] the statute unconstitutionally infringe[d] 
the individual liberty interest in avoiding the unwanted 
administration of anti-psychotropic drugs."  Id., ¶32.   
¶30 This case is not controlled by the Sell and Fitzgerald 
factors.  Rather, this case, like Harper, involves involuntary 
medication of an inmate for a "different purpose" than competence 
to stand trial.13  Sell, 539 U.S. at 182.  But our discussion in 
Fitzgerald of a person's significant liberty interest in avoiding 
involuntary medication is relevant to our analysis in this case.  
We said: 
Under the Due Process Clause, individuals have a 
"significant liberty interest in avoiding the unwanted 
administration of antipsychotic drugs."  [Harper, 494 
U.S. at 221].  "[O]nly an 'essential' or 'overriding' 
state interest" can overcome this constitutionally-
                                                 
13 Accordingly, our opinion in this case does not limit the 
constitutionality of involuntary medication of a defendant, absent 
a determination of dangerousness, for the purpose of rendering the 
defendant competent to stand trial under Sell, 539 U.S. 166, or 
Fitzgerald, 387 Wis. 2d 384. 
No. 
2016AP1982   
 
25 
 
protected liberty interest.  [Sell, 539 U.S. at 179 
(quoting Riggins, 504 U.S. at 134)].[14] 
Fitzgerald, 387 Wis. 2d 384, ¶13.  Furthermore, we said, "[t]he 
mere inability of a defendant to express an understanding of 
medication or make an informed choice about it is constitutionally 
insufficient to override a defendant's 'significant liberty 
interest[.]'"  Id., ¶25 (quoting Harper, 494 U.S. at 221) (emphasis 
added).  Thus, we have already concluded that a mentally ill 
inmate’s incompetence to refuse alone is not an essential or 
overriding interest justifying involuntary medication.  Fitzgerald 
was not the first time that we stated that incompetence to refuse 
alone does not justify intrusions into a person's body.   
                                                 
14 Some might argue that the language in Harper, 494 U.S. 210, 
establishes that the test for involuntary medication of an inmate 
is whether the regulation is reasonably related to a legitimate 
penological interest.  But this conclusion fails to appreciate 
that Harper was not the Court's last word on the issue.  It fails 
to appreciate the United States Supreme Court's subsequent 
statements in Riggins v. Nevada, 504 U.S. 127 (1992), and Sell, 
539 U.S. 166; statements which this court already recognized in 
Fitzgerald, 
387 
Wis. 2d 384, 
¶13. 
 
Together, 
the 
Harper/Riggins/Sell trilogy of cases sets forth a clear standard 
in involuntary medication cases like this: "Under the Due Process 
Clause, individuals have a 'significant liberty interest in 
avoiding the unwanted administration of antipsychotic drugs.'  
[Harper, 494 U.S. at 221].  'O]nly an "essential" or "overriding" 
state interest' can overcome this constitutionally-protected 
liberty interest.  [Sell, 539 U.S. at 179 (quoting Riggins, 504 
U.S. at 134, 135)]."  Fitzgerald, 387 Wis. 2d 384, ¶13.   
Furthermore, even under a rational basis review, a mentally 
ill inmate's incompetence to refuse medication alone would still 
be constitutionally insufficient.  Without more, mental illness 
and incompetence to refuse medication alone are not reasonably 
related to a legitimate penological interest.  The State may not 
force a particular medication on a mentally ill inmate merely 
because the inmate is incompetent to refuse it. 
No. 
2016AP1982   
 
26 
 
¶31 In Lenz we made clear that incompetence does not diminish 
a person's right to refuse.  167 Wis. 2d at 74.  In that case, we 
reviewed "whether an incompetent individual in a persistent 
vegetative state has a right to refuse life-sustaining medical 
treatment, including artificial nutrition and hydration[.]"  Id. 
at 63.  We concluded "that an individual's right to refuse unwanted 
life-sustaining medical treatment extends to artificial nutrition 
and hydration."  Id. at 73.  We also concluded "that the right to 
refuse all unwanted life-sustaining medical treatment extends to 
incompetent as well as competent individuals."  Id. 
An incompetent individual does not relinquish the right 
to refuse unwanted treatment by virtue of incompetency.  
[In re Guardianship of Grant, 747 P.2d 445, 449 (Wash. 
1987); Rasmussen by Mitchell v. Fleming, 741 P.2d 674, 
686 (Ariz. 1987)] ("Other jurisdictions have unanimously 
concluded that the right to refuse medical treatment is 
not lost merely because the individual has become 
incompetent and has failed to preserve that right.")  
The existence and viability of a long established 
personal right does not hinge upon its prescient 
exercise, nor is it extinguished when one is adjudged 
incompetent. 
Id. at 74. 
¶32 Of course, C.S. was not in a persistent vegetative state 
and refusing life-sustaining treatment.  He was a mentally ill 
inmate refusing involuntary medication.  But the same logic 
applies.  "[T]he right to refuse [involuntary medication] extends 
to incompetent as well as competent [inmates]."  Lenz, 167 Wis. 2d 
at 73.  "We find no reason to differentiate between the rights of 
the competent and incompetent.  To the extent that it is possible, 
No. 
2016AP1982   
 
27 
 
both must be assured the benefit of the exercise of the same 
constitutional right of choice."  Id. at 77. 
¶33 Under Harper, Riggins, Sell, Fitzgerald, and Lenz, Wis. 
Stat. § 51.61(1)(g)3. is facially unconstitutional for any inmate 
who is involuntarily committed under Wis. Stat. § 51.20(1)(ar), 
which does not require a determination of dangerousness, when the 
inmate is involuntarily medicated based merely on a determination 
that the inmate is incompetent to refuse medication.  All people 
have a "significant liberty interest in avoiding" involuntary 
medication.  Harper, 494 U.S. at 221; Fitzgerald, 387 Wis. 2d 384, 
¶13.  An inmate's liberty interest "must be defined in the context 
of the inmate's confinement."  Harper, 494 U.S. at 222.  But only 
an "essential" or "overriding" State interest can overcome an 
inmate's significant liberty interest in avoiding involuntary 
medication.  Fitzgerald, 387 Wis. 2d 384, ¶13; Sell, 539 U.S. at 
178-79; Riggins, 504 U.S. at 134, 135.  For example, if medication 
is in an inmate's "medical interest," a conclusion of dangerousness 
gives rise to an "essential" or "overriding" state interest that 
may constitutionally justify involuntary medication.  Harper, 494 
U.S. at 227; Riggins, 504 U.S. at 134, 135.  But "[t]he mere 
inability" of an inmate "to express an understanding of medication 
or make an informed choice" is "constitutionally insufficient" to 
override an inmate's "'significant liberty interest'" in avoiding 
involuntary medication.  Fitzgerald, 387 Wis. 2d 384, ¶25 (quoting 
Harper, 494 U.S. at 221).  That is because an inmate has the same 
right to refuse medication whether the inmate is competent or 
incompetent.  Lenz, 167 Wis. 2d at 73.  Incompetence to refuse 
No. 
2016AP1982   
 
28 
 
medication alone is not an "essential" or "overriding" State 
interest and does not permit the State to involuntarily medicate 
a mentally ill inmate.   
¶34 Thus, we conclude that Wis. Stat. § 51.61(1)(g)3. is 
facially unconstitutional for any inmate who is involuntarily 
committed under Wis. Stat. § 51.20(1)(ar), which does not require 
a determination of dangerousness, when the inmate is involuntarily 
medicated based merely on a determination that the inmate is 
incompetent to refuse medication.15  Incompetence to refuse, alone, 
without any determination of dangerousness at any stage in the 
proceedings, 
is 
insufficient 
grounds 
for 
the 
involuntary 
medication of an inmate. 
 
C.  All Arguments To The Contrary Are Unavailing. 
¶35 The court of appeals relied on C.S. I and Wood to 
conclude 
that 
Wis. 
Stat. 
§ 51.61(1)(g) 
was 
facially 
constitutional.  See C.S. III, 386 Wis. 2d 612, ¶¶13-20.  That 
reliance was misplaced.  Both cases are factually and legally 
distinguishable. 
¶36 In C.S. I, we reviewed an involuntary commitment 
statute, Wis. Stat. § 51.20(1)(ar) (2013-14).  C.S. I, 366 
Wis. 2d 1, ¶3.  C.S. argued that § 51.20(1)(ar) was facially 
                                                 
15 Our conclusion is a narrow one.  We form no conclusion as 
to the involuntary medication of an inmate under Wis. Stat. 
§ 51.61(1)(g)3. pursuant to a determination that the medication is 
"necessary to prevent serious physical harm."  Nor do we form a 
conclusion as to the involuntary medication of an inmate under 
Wis. Stat. § 51.61(1)(g)3m. pursuant to a determination that the 
inmate is dangerous under Wis. Stat. § 51.20(1)(a)2.e. 
No. 
2016AP1982   
 
29 
 
unconstitutional because it authorizes the involuntary commitment 
of an inmate without a conclusion of dangerousness.  Id.  We held 
that the statute is "facially constitutional because it is 
reasonably related to the State's legitimate interest in providing 
care and assistance to inmates suffering from mental illness."  
Id., ¶57.  We said, "The State has more than a well-established 
and legitimate interest; it has a compelling interest in providing 
care and assistance to those who suffer from a mental disorder."  
Id., ¶44 (internal quotations omitted).  That remains true.  But 
involuntary commitment is not involuntary medication.  Nor is care 
and assistance necessarily involuntary medication.  And what 
justifies one does not automatically justify the other.  Indeed, 
in C.S. I, we twice expressly limited our decision to involuntary 
commitment.  See C.S. I, 366 Wis. 2d 1, ¶6 ("[C.S.] does not in 
any way challenge the constitutionality of the involuntary 
medication or treatment statute, Wis. Stat. § 51.61(1)(g)."); see 
also 
id., 
¶42 
n.24. 
("[C.S.] 
is 
not 
challenging 
the 
constitutionality of the involuntary medication or treatment 
statute under Wis. Stat. § 51.61(1)(g).  As such, this case does 
not provide an occasion for us to apply any level of scrutiny to 
the involuntary medication or treatment statute."). 
¶37 We note that, for an inmate to be involuntarily committed 
under Wis. Stat. § 51.20(1)(ar), the circuit court must conclude 
that the inmate "is a proper subject for treatment and is in need 
of 
treatment." 
 
§ 51.20(1)(ar). 
 
Accordingly, 
an 
inmate 
involuntarily committed under § 51.20(1)(ar) can and often does 
receive treatment (assuming the inmate does not refuse treatment, 
No. 
2016AP1982   
 
30 
 
which the inmate, of course, may refuse).  But treatment is not 
necessarily involuntary medication.   
¶38 Indeed, as corporation counsel for Winnebago County made 
clear at oral argument, treatment involves many things, not just 
involuntary 
medication. 
 
Wisconsin 
psychiatric 
treatment 
facilities for inmates who are confined to the Department of 
Corrections 
take 
a 
"wholistic 
approach." 
 
"There 
are 
psychiatrists, there are psychologists, there are social workers, 
there are nurses."  "[T]here are recreational programs, there is 
spiritual counseling, there is exercise, there is therapy.  So 
it's not just 'let's give someone a shot.'"  Thus, C.S. I does not 
support a conclusion that the State's "legitimate interest in 
providing care and assistance to inmates suffering from mental 
illness" permits the State to involuntarily medicate an inmate 
merely because the inmate is incompetent. 
¶39 The court of appeals also relied on our decision in Wood, 
323 Wis. 2d 321.  In that case, we reviewed and upheld the 
involuntary medication of committed persons who are found not 
guilty of a crime by reason of mental disease or defect ("NGI") 
and incompetent to refuse medication——without a conclusion of 
dangerousness——under Wis. Stat. § 971.17(3)(c) (2005-06).  Id., 
¶4.  Wood is also readily distinguishable from this case.  During 
a delusional episode, Wood "beat his stepfather to death with a 
brick."  Id., ¶5.  He was charged with second-degree homicide, 
found NGI, and committed to institutional care at Mendota Mental 
Health Institute.  Id.  When a defendant pleads NGI, the "plea 
admits that but for lack of mental capacity the defendant committed 
No. 
2016AP1982   
 
31 
 
all the essential elements of the offense charged[.]"  Wis. Stat. 
§ 971.06(1)(d) (emphasis added).  Thus, when Wood was found NGI, 
that meant that his mental illness caused his violent criminal 
conduct.   
¶40 Our conclusion in Wood relied heavily on the nature of 
NGI adjudications, not commitment and involuntary medication 
proceedings.  "[I]nstitutions holding individuals adjudged NGI 
have a somewhat different interest than a prison would."  Wood, 
323 Wis. 2d 321, ¶32.  "In light of that overriding interest and 
the nature of original proceedings in which defendant is adjudged 
NGI, we [did] not believe that a finding of present dangerousness 
is required when considering whether to issue an order to forcibly 
medicate such an individual."  Id., ¶33 (citing Sell, 539 U.S. at 
181-82) (emphasis added).  We also noted that "Wis. Stat. 
§ 971.17(3), at a minimum, implicitly provides for [a conclusion 
of dangerousness]."  Id., ¶34.  We reasoned that § 971.17(3)(a) 
"includes requirements for a determination of dangerousness at the 
time 
of 
commitment" 
and 
§ 971.17(4)(d), 
"setting 
forth 
requirements for periodic reviews," "include[s] a dangerousness 
determination."  Id. 
¶41 Thus, Wood does not support a conclusion that Wis. Stat. 
§ 51.61(1)(g)3. is facially constitutional when it permits the 
involuntary medication of an inmate based merely on the inmate's 
incompetence to refuse.  The statute in this case does not require 
a conclusion that the inmate's mental illness caused the inmate to 
commit a crime.  Nor does it require a conclusion of dangerousness 
at any time.  The relevant statutes in Wood required both. 
No. 
2016AP1982   
 
32 
 
¶42 Essentially, the court of appeals relied on two 
factually and legally distinguishable cases to conclude that Wis. 
Stat. § 51.61(1)(g) was facially constitutional.  It failed to 
recognize important differences among C.S. I, Wood, and this case.  
Involuntary commitment is not involuntary medication.  Involuntary 
medication is much more invasive and must be justified by an 
overriding or essential interest.  Fitzgerald, 387 Wis. 2d 384, 
¶13; Sell, 539 U.S. at 178-79; Riggins, 504 U.S. at 134, 135.  And 
the involuntary medication of a defendant adjudicated NGI is 
supported by a unique State interest in medicating a defendant 
whose mental illness caused violent criminal conduct, which is not 
present in this case. 
¶43 Finally, the court of appeals concluded that "the 
involuntary medication and treatment of a prisoner is facially 
constitutional as there is a legitimate reason for the [S]tate to 
medicate/treat even when there is no finding of dangerousness——
the general welfare of the prisoner."  C.S. III, 386 Wis. 2d 612, 
¶8 (emphasis added).  Similarly, Winnebago County invokes its 
parens patriae power to argue that it may involuntarily medicate 
a mentally ill and incompetent inmate because it has an interest 
in the inmate's care and assistance.  We reject such limitless 
assertions of the State's power to involuntarily medicate 
committed inmates.  
¶44 The State's parens patriae power is not limitless.  As 
we have previously said: 
The [S]tate has a legitimate interest under its 
parens patriae powers in providing care to its citizens 
No. 
2016AP1982   
 
33 
 
who are unable to care for themselves.  The [S]tate also 
has authority under its police power to protect the 
community from any dangerous mentally ill persons.  The 
[S]tate's legitimate interest ceases to exist, however, 
if those sought to be confined are not mentally ill or 
if they do not pose some danger to themselves or others. 
State v. Dennis H., 2002 WI 104, ¶36, 255 Wis. 2d 359, 647 
N.W.2d 851 (emphases added) (internal quotations and citations 
omitted).  Thus, the State's parens patriae power is related to 
dangerousness.  The portion of Wis. Stat. § 51.61(1)(g)3. we review 
is not.  Once again, § 51.61(1)(g)3. permits the involuntary 
medication of an inmate committed under Wis. Stat. § 51.20(1)(ar) 
based on a determination of incompetence to refuse only.16  Such a 
determination does not even approach dangerousness. 
¶45 Accordingly, the State interests asserted in this case 
are insufficient to save the facial unconstitutionality of Wis. 
Stat. § 51.61(1)(g)3.17 
                                                 
16 The County asserts that under its parens patriae power it 
has an interest in providing "care and assistance to non-dangerous 
inmates who are mentally ill and in need of treatment in the form 
of medication, but are not competent to refuse such treatment."  
The United States Supreme Court has recognized that "[a]n inmate 
must rely on prison authorities to treat his medical needs; if the 
authorities fail to do so, those needs will not be met."  Estelle 
v. Gamble, 429 U.S. 97, 103 (1976) (emphases added).  And we have 
said: "Under the theory of parens patriae it is the right and duty 
of the state to step in and act in what appears to be the best 
interests of the ward."  Lenz v. L.E. Phillips Career Dev. Ctr., 
167 Wis. 2d 53, 76 n.9, 482 N.W.2d 60 (1992) (emphasis added).  
But Wis. Stat. § 51.61(1)(g)3. does not require a determination 
that the inmate needs medication or that the medication is in the 
inmate's best interests.  It requires a determination of 
incompetence to refuse medication only.  § 51.61(1)(g)3. 
17 Our decision today does not place us in conflict with other 
jurisdictions.  There is no conflict because other cases from 
Alaska, Ohio, and New York require more than incompetence to refuse 
medication in order to justify involuntary medication.  See Myers 
No. 
2016AP1982   
 
34 
 
 
IV.  CONCLUSION 
¶46 We conclude that Wis. Stat. § 51.61(1)(g)3. is facially 
unconstitutional for any inmate who is involuntarily committed 
under Wis. Stat. § 51.20(1)(ar), which does not require a 
determination of dangerousness, when the inmate is involuntarily 
medicated based merely on a determination that the inmate is 
incompetent to refuse medication.  Incompetence to refuse 
medication alone is not an essential or overriding state interest 
and cannot justify involuntary medication.  Accordingly, we 
reverse the court of appeals and remand to the circuit court with 
an order to vacate C.S.'s June 2015 order for involuntary 
medication and treatment. 
 
                                                 
v. Alaska Psychiatric Inst., 138 P.3d 238, 254 (Alaska 2006) 
(emphasis added) (holding that the Alaska Constitution "require[s] 
an independent judicial determination of an incompetent mental 
patient's best interests" before a court may authorize involuntary 
medication); Steele v. Hamilton Cty. Cmty. Mental Health Bd., 736 
N.E.2d 10, 15 (Ohio 2000) (emphases added) (footnote omitted) 
(holding "that a court may issue an order permitting the 
administration of antipsychotic medication against a patient's 
wishes without a finding that the patient is dangerous when the 
court finds by clear and convincing evidence that the patient lacks 
the capacity to give or withhold informed consent regarding 
treatment, the medication is in the patient's best interest, and 
no less intrusive treatment will be as effective in treating the 
mental illness"); Rivers v. Katz, 495 N.E.2d 337, 345 (N.Y. 1986) 
(emphasis added) (predating Harper, and concluding that "[w]hen 
the medication is determined to be necessary in order to care for 
a patient who is unable to care for himself because of mental 
illness, the State's parens patriae power would be implicated").  
None of these other jurisdictions have invoked parens patriae power 
to justify the involuntary medication of an inmate based on 
incompetence to refuse medication only. 
No. 
2016AP1982   
 
35 
 
By the Court.—The decision of the court of appeals is 
reversed, and the cause is remanded to the circuit court for 
further proceedings consistent with this opinion. 
 
No. 
2016AP1982   
 
36 
 
No.  2016AP1982.rgb 
 
1 
 
¶47 REBECCA GRASSL BRADLEY, J.   (dissenting).  C.S. argues 
Wis. Stat. § 51.61(1)(g) violates his "substantive" due process 
rights under the Fourteenth Amendment to the United States 
Constitution because that statute permits the involuntary 
medication of an incompetent but non-dangerous inmate.  The 
majority agrees with C.S.  I do not.  The text of the Fourteenth 
Amendment's Due Process Clause does not protect any substantive 
rights.  Although both the Privileges or Immunities Clause of the 
Fourteenth Amendment and Article I, Section 1 of the Wisconsin 
Constitution affirmatively guarantee certain individual rights, 
C.S. does not invoke either constitutional provision.  The 
"substantive" due process argument C.S. does make is insupportable 
under the original meaning of the Fourteenth Amendment.1  Nor has 
the United States Supreme Court ever recognized an inmate's 
"substantive" due process right to avoid the involuntary 
administration of medication absent a finding of dangerousness. 
¶48 I also write to again encourage this court to discard 
the evidentiary burden of proof it applies in constitutional 
challenges to Wisconsin statutes.  This court should instead adopt 
the standard employed by the United States Supreme Court, which 
has abandoned the requirement that parties prove statutes 
unconstitutional "beyond a reasonable doubt," in favor of a "plain 
                                                 
1 See also Michels v. Lyons, 2019 WI 57, ¶60, 387 Wis. 2d 1, 
927 N.W.2d 486 (Rebecca Grassl Bradley, J., concurring). 
No.  2016AP1982.rgb 
 
2 
 
showing" or a "clear[] demonstrat[ion]" that a statute is 
unconstitutional.2  I respectfully dissent. 
I 
¶49 The 
Fourteenth 
Amendment 
to 
the 
United 
States 
Constitution, in relevant part, provides: 
All persons born or naturalized in the United States and 
subject to the jurisdiction thereof, are citizens of the 
United States and of the State wherein they reside.  No 
State shall make or enforce any law which shall abridge 
the privileges or immunities of citizens of the United 
States; nor shall any State deprive any person of life, 
liberty, or property, without due process of law; nor 
deny to any person within its jurisdiction the equal 
protection of the laws. 
U.S. Const. amend XIV, § 1 (emphasis added).  I acknowledge that 
the United States Supreme Court has interpreted the emphasized 
text to confer "substantive" due process rights.  See, e.g., 
Washington v. Glucksberg, 521 U.S. 702, 720-21 (1997); Washington 
v. Harper, 494 U.S. 210, 221-22 (1990); Near v. Minnesota ex rel. 
Olson, 283 U.S. 697, 707 (1931) (right to free speech); Gitlow v. 
New York, 268 U.S. 652, 666 (1925) (same).  However, as several 
justices and legal scholars have explained, the Due Process Clause 
says nothing about substantive rights, which are expressly 
protected by other provisions of the Constitution.  Rather, the 
Due Process Clause speaks solely in terms of "process of law"——
words that mean procedurally fair treatment in the justice system.  
"Whereas the Privileges or Immunities Clause protects a broad set 
of rights——including life, liberty, and property——of all citizens 
from improper laws, the Due Process Clause protects the life, 
                                                 
2 See National Fed'n of Indep. Bus. v. Sebelius, 567 U.S. 519, 
538 (2012); United States v. Morrison, 529 U.S. 598, 607 (2000). 
No.  2016AP1982.rgb 
 
3 
 
liberty, or property of all persons from an improper application 
of an otherwise proper law."  Randy E. Barnett, Restoring the Lost 
Constitution:  The Presumption of Liberty 203 (2003) (emphasis in 
original).  For this reason, Justice Antonin Scalia rightly 
referred to "substantive due process" as an "oxymoron"3 an 
"atrocity" and "judicial usurpation."4  Legal scholars have 
powerfully criticized the doctrine as a "made up atextual 
invention," characterizing it as the "most anti-constitutional 
branch of constitutional law."  See Michael Stokes Paulsen, Does 
the Constitution Prescribe Rules for Its Own Interpretation, 103 
Nw. U. L. Rev. 857, 897 (2009); Nelson Lund & John O. McGinnis, 
Lawrence v. Texas and Judicial Hubris, 102 Mich. L. Rev. 1555, 
1557 (2004).  "It is clear that the text of the due process clause 
simply will not support judicial efforts to pour substantive rather 
than procedural meaning into it."  Robert H. Bork, The Tempting of 
America, 32 (1990). 
¶50 Although the Supreme Court has read substantive rights 
into the Due Process Clause, Justice Clarence Thomas has 
emphatically rejected this interpretation: 
All of this is a legal fiction.  The notion that a 
constitutional provision that guarantees only "process" 
before a person is deprived of life, liberty, or property 
could define the substance of those rights strains 
credulity for even the most casual user of words. 
                                                 
3 United States v. Carlton, 512 U.S. 26, 39 (1994) (Scalia, 
J., concurring in judgment) ("If I thought that 'substantive due 
process' were a constitutional right rather than an oxymoron, I 
would think it violated by bait-and-switch taxation."). 
4 City of Chicago v. Morales, 527 U.S. 41, 85 (1999) (Scalia, 
J., dissenting). 
No.  2016AP1982.rgb 
 
4 
 
McDonald v. City of Chicago, 561 U.S. 742, 811 (2010) (Thomas, J., 
concurring in part and in judgment).  Identifying the proper 
foundation for constitutional protections is much more than a 
formalistic concern.  Once judges endeavor to read something into 
the Constitution that cannot be found in its text, the law bends 
to the will of the judge rather than the people. 
[T]his fiction is a particularly dangerous one.  The one 
theme that links the Court's substantive due process 
precedents together is their lack of a guiding principle 
to 
distinguish 
"fundamental" 
rights 
that 
warrant 
protection from nonfundamental rights that do not.  
Today's decision illustrates the point.  Replaying a 
debate that has endured from the inception of the Court's 
substantive due process jurisprudence, the dissents laud 
the "flexibility" in this Court's substantive due 
process doctrine . . . while the plurality makes yet 
another effort to impose principled restraints on its 
exercise, [citing Justice Alito's opinion at 3044 – 
3048].  But neither side argues that the meaning they 
attribute to the Due Process Clause was consistent with 
public understanding at the time of its ratification. 
. . . . 
[A]ny serious argument over the scope of the Due Process 
Clause must acknowledge that neither its text nor its 
history suggests that it protects the many substantive 
rights this Court's cases now claim it does. 
Id. at 811-12 (Thomas, J. concurring in part and in judgment); see 
also Bork, The Tempting of America, supra ¶49, at 31 (describing 
the invention of substantive due process as an "obvious sham"). 
¶51 Returning to an interpretation of the Fourteenth 
Amendment that revives the original meaning of the Due Process 
Clause would not necessarily eliminate those fundamental rights 
previously recognized under that provision; rather, the source of 
constitutionally-protected rights would simply shift to the 
No.  2016AP1982.rgb 
 
5 
 
Privileges or Immunities Clause.  "When the Fourteenth Amendment 
was ratified, the terms privileges and immunities had an 
established meaning as synonyms for rights."  Timbs v. Indiana, 
586 U.S. ____, 139 S. Ct. 682, 692 (2019) (Thomas, J., concurring 
in judgment) (citation omitted; internal quotation marks omitted).  
Historically, people "understood the Privileges or Immunities 
Clause to guarantee those 'fundamental principles' 'fixed' by the 
Constitution[.]"  Id. at 698. 
¶52 Tethering the recognition of constitutional rights to 
the original meaning of the Constitution has the advantage of 
grounding rights in the text of the document rather than individual 
judges' inherently subjective perceptions of which rights should 
be accorded preferred status over others, as the amorphous 
substantive due process framework invites: 
I believe the original meaning of the Fourteenth 
Amendment offers a superior alternative, and that a 
return to that meaning would allow this Court to enforce 
the rights the Fourteenth Amendment is designed to 
protect with greater clarity and predictability than the 
substantive due process framework has so far managed. 
McDonald, 561 U.S. at 812 (Thomas, J., concurring in part and in 
judgment).  Undertaking an analysis of rights under the Privileges 
or Immunities Clause rather than the Due Process Clause would not 
unravel every precedent employing a "substantive" due process 
framework: 
[A]s judges, we interpret the Constitution one case or 
controversy at a time.  The question presented in this 
case is not whether our entire Fourteenth Amendment 
jurisprudence must be preserved or revised, but only 
whether, and to what extent, a particular Clause in the 
Constitution protects the particular right at issue 
here.  With the inquiry appropriately narrowed, I 
No.  2016AP1982.rgb 
 
6 
 
believe this case presents an opportunity to reexamine, 
and begin the process of restoring, the meaning of the 
Fourteenth Amendment agreed upon by those who ratified 
it. 
Id. at 812-13. 
¶53 Although 
some 
justices 
appreciate 
the 
defective 
foundation for the "substantive" due process doctrine, they 
nevertheless uphold it, capitulating to its jurisprudential 
longevity.  While the doctrine of stare decisis lends stability to 
the law, it should not deter the court from fulfilling its duty to 
say what the law is.  After all, "the purpose of stare decisis 'is 
to make us say that what is false under proper analysis must 
nonetheless be held to be true, all in the interest of stability.'"  
State v. Grandberry, 2018 WI 29, ¶86, 380 Wis. 2d 541, 910 
N.W.2d 214 (Rebecca Grassl Bradley, J., dissenting) (quoting 
Antonin Scalia, A Matter of Interpretation:  Federal Courts and 
the Law 138-40 (1997)).  As a primary judicial function, faithfully 
declaring the meaning of the Constitution overrides application of 
a tool that merely guides our work: 
I acknowledge the volume of precedents that have been 
built upon the substantive due process framework, and I 
further acknowledge the importance of stare decisis to 
the stability of our Nation's legal system.  But stare 
decisis is only an "adjunct" of our duty as judges to 
decide by our best lights what the Constitution means. 
Planned Parenthood of Southeastern Pa. v. Casey, 505 
U.S. 833, 963 (1992) (Rehnquist, C. J., concurring in 
judgment in part and dissenting in part).  It is not "an 
inexorable command." Lawrence [v. Texas, 539 U.S. 558, 
577 (2003)]. 
McDonald, 561 U.S. at 812 (Thomas, J., concurring in part and in 
judgment). 
No.  2016AP1982.rgb 
 
7 
 
¶54 I agree with Justice Thomas that the text of the Due 
Process Clause does not protect any substantive rights and applying 
an originalist interpretation of the Fourteenth Amendment 
pinpoints the Privileges or Immunities Clause, rather than the Due 
Process Clause, as the proper source for safeguarding fundamental 
constitutional 
rights. 
 
The 
United 
States 
Supreme 
Court 
"'marginaliz[ed]' the Privileges or Immunities Clause in the late 
19th century by defining the collection of rights covered by the 
Clause 'quite narrowly.'"  Timbs, 586 U.S. at ____, 139 S. Ct. at 
691 (Thomas, J., concurring in judgment) (quoting McDonald, 561 
U.S. at 808-09 (Thomas, J., concurring in part and in judgment)).  
Over time, the Privileges or Immunities Clause ceased to be applied 
as a protection of the people's rights, leaving the clause dormant.  
Implanting substantive rights into purely procedural protections 
while ignoring their actual textual source "relegat[es] a 'clause 
in the constitution' 'to be without effect.'"  Gamble v. United 
States, 587 U.S. ___, 139 S. Ct. 1960, 1989 (2019) (Thomas, J., 
concurring) (citing McDonald, 561 U.S. at 813, and Timbs, 586 U.S. 
at ___, 139 S. Ct. at 691-98).  A doctrine that eviscerates an 
entire clause of the Constitution, effectuating substantial 
violence against the supreme law of the land, should be discarded.   
¶55 Such a constrictive interpretation of the Privileges or 
Immunities Clause is incompatible with its historical meaning and 
such an expansive construction of the Due Process Clause is 
irreconcilable with its text: 
Unfortunately, the Court has doggedly adhered to these 
erroneous substantive-due-process precedents again and 
again, often to disastrous ends. See, e.g., Stenberg v. 
Carhart, 530 U.S. 914, 982 (2000) (Thomas, J., 
No.  2016AP1982.rgb 
 
8 
 
dissenting) ("The standard set forth in the Casey 
plurality has no historical or doctrinal pedigree" and 
"is the product of its authors' own philosophical views 
about abortion" with "no origins in or relationship to 
the Constitution").  
Gamble, 587 U.S. ___, 139 S. Ct. at 1989 (Thomas, J., concurring).  
Disastrous ends indeed.  "Substantive" due process was invented in 
1856 by Chief Justice Roger Taney in order to recognize a 
constitutional right to slave ownership, a "right . . . nowhere to 
be found in the Constitution" and "that concept has been used 
countless times since by judges who want to write their personal 
beliefs into a document that, most inconveniently, does not contain 
those beliefs."  Bork, The Tempting of America, supra ¶49, at 31.  
The odious origins of "substantive" due process alone should have 
persuaded jurists to recoil from it long ago.  However, "the 
Supreme 
Court 
will 
not 
abandon 
[the 
doctrine], 
despite 
demonstrations of its utter illegitimacy, precisely because it is 
an ever flowing fount of judicial power."  Id. at 32. 
¶56 Justice Neil Gorsuch has signaled skepticism of the 
"substantive" due process doctrine as well as receptiveness toward 
application of an originalist view of the Privileges or Immunities 
Clause.  See Gundy v. United States, 588 U.S. ___, 139 S. Ct. 2116, 
2141 (2019) (Gorsuch, J., dissenting) ("When one legal doctrine 
becomes unavailable to do its intended work, the hydraulic 
pressures of our constitutional system sometimes shift the 
responsibility to different doctrines."  (citing McDonald's 
reliance on the Due Process Clause instead of the Privileges or 
Immunities Clause)); see also Timbs, 586 U.S. at ___, 139 S. Ct. 
at 691 (Gorsuch, J., concurring) ("As an original matter, I 
No.  2016AP1982.rgb 
 
9 
 
acknowledge, the appropriate vehicle for incorporation may well be 
the Fourteenth Amendment's Privileges or Immunities Clause, rather 
than, as this Court has long assumed, the Due Process Clause."  
(citations omitted)). 
¶57 Neither the "text nor [the] history" of the Due Process 
Clause "suggests that it protects the many substantive rights" 
that the Supreme Court or this court claim it does.  See McDonald, 
561 U.S. at 812 (Thomas, J., concurring in part and in judgment).  
In this case, not a single United States Supreme Court precedent 
recognizes the right the majority pronounces.  Therefore, I cannot 
agree with the majority's conclusion that Wis. Stat. § 51.61(1)(g) 
is unconstitutional under a "substantive" due process analysis, 
C.S.'s sole basis for challenging the medication order.  C.S. does 
not invoke the Fourteenth Amendment's Privilege or Immunities 
Clause nor the Life, Liberty, and Pursuit of Happiness Clause of 
Article I, Section 1 of the Wisconsin Constitution.  Unlike the 
Due Process Clause, each of these constitutional provisions 
protect substantive rights and could serve as a source of 
constitutional protection against the forced administration of 
involuntary medication absent a finding of dangerousness. 
¶58 The Privileges or Immunities Clause provides:  "No State 
shall make or enforce any law which shall abridge the privileges 
or immunities of citizens of the United States."  U.S. Const. amend 
XIV, § 1.  "[T]he Privileges or Immunities Clause has long been 
understood to operate as the principal substantive limitation on 
a state's lawmaking powers."  Ilya Shapiro and Josh Blackman, The 
Once and Future Privileges or Immunities Clause, 26 Geo. Mason L. 
No.  2016AP1982.rgb 
 
10 
 
Rev. 1023, 1213 (2019).  Because C.S. does not present "a challenge 
based upon the Privileges [or] Immunities Clause" this case "does 
not present an opportunity to reevaluate the meaning of that 
Clause[]" or apply it to C.S.'s asserted right to avoid the 
involuntary administration of medication.  See Troxel v. 
Granville, 530 U.S. 57, 80 & n.* (Thomas, J., concurring in 
judgment) (citing Saenz v. Roe, 526 U.S. 489, 527–28 (1999) 
(Thomas, J., dissenting) (discussing the original meaning of 
privileges or immunities and the Court's treatment of the Clause). 
¶59 The Life, Liberty, and Pursuit of Happiness Clause in 
Art. I, Sect 1 of the Wisconsin Constitution provides:  "All people 
are born equally free and independent, and have certain inherent 
rights; among these are life, liberty and the pursuit of happiness; 
to secure these rights, governments are instituted, deriving their 
just powers from the consent of the governed."  Wis. Const. art. 
I, § 1.  "[E]choing language from our nation's Declaration of 
Independence," this provision "recogniz[es] that the proper role 
of government——the very reason governments are instituted——is to 
secure our inherent rights, including liberty[.]"  Porter v. State, 
2018 WI 79, ¶52, 382 Wis. 2d 697, 913 N.W.2d 842 (Rebecca Grassl 
Bradley and Kelly, JJ., dissenting). 
While the people empower the legislature to enact laws 
and make policy, the constitution compels the judiciary 
to protect the liberty of the individual from intrusion 
by the majority.  "[C]ourts of justice are to be 
considered as bulwarks of a limited Constitution against 
legislative encroachments . . . ."  The Federalist No. 
78, at 469 (Alexander Hamilton) (Clinton Rossiter ed., 
1961).  Consistent with that duty, courts must earnestly 
scrutinize laws that are challenged for infringing 
constitutional rights. 
No.  2016AP1982.rgb 
 
11 
 
Id., ¶53. 
¶60 In C.S.'s prior case, we explained that "a valid criminal 
conviction and a prison sentence extinguish a defendant's right to 
freedom from confinement."  Winnebago Cty. v. C.S., 2016 WI 1, 
¶39, 366 Wis. 2d 1, 878 N.W.2d 109 (quoting Vitek v. Jones, 445 
U.S. 480, 493 (1980) (citing Greenholtz v. Nebraska Penal Inmates, 
442 U.S. 1, 7 (1979) ("But the conviction, with all its procedural 
safeguards, has extinguished that liberty right:  '[G]iven a valid 
conviction, the criminal defendant has been constitutionally 
deprived of his liberty.'"  (quoting Meachum v. Fano, 427 U.S. 
215, 224 (1976) ("But given a valid conviction, the criminal 
defendant has been constitutionally deprived of his liberty to the 
extent that the State may confine him and subject him to the rules 
of its prison system . . . .")))).  In doing so, however, we 
expressly disclaimed any "suggesti[on] that an inmate loses all, 
or even most, of his or her constitutional rights while he or she 
is serving his or her sentence.  Rather, a prison inmate 'retains 
those [constitutional] rights that are not inconsistent with his 
status as a prisoner or with the legitimate penological objectives 
of the corrections system.'  Turner v. Safley, 482 U.S. 78, 95 
(1987) (alteration in original) (internal quotation marks omitted) 
(quoting Pell v. Procunier, 417 U.S. 817, 822 (1974))."  Winnebago 
Cty., 366 Wis. 2d 1, ¶39 (footnote and some internal citations 
omitted).  In particular, we did not decide whether the same 
"legitimate 
penological" 
interest 
renders 
the 
involuntary 
medication of inmates constitutional, because C.S. did not make a 
No.  2016AP1982.rgb 
 
12 
 
constitutional challenge to Wis. Stat. § 51.61(1)(g) in his prior 
case before this court.  Winnebago Cty., 366 Wis. 2d 1, ¶48. 
¶61 Because C.S. did not argue that the involuntary 
administration of medication violates his rights under the Life, 
Liberty, and Pursuit of Happiness Clause in Art. I, Sec. 1 of the 
Wisconsin Constitution, absent a finding of dangerousness, this 
case does not present an opportunity to undertake an analysis of 
how an inmate's curtailed liberty interest may impact the 
constitutionality of Wis. Stat. § 51.61(1)(g) under the Wisconsin 
Constitution.5 
¶62 Rather than applying the fiction of "substantive" due 
process to C.S.'s claims, "I would follow the text of the 
Constitution, which sets forth certain substantive rights that 
cannot be taken away, and adds, beyond that, a right to due process 
when life, liberty, or property is to be taken away."  United 
States v. Carlton, 512 U.S. 26, 42 (1994) (Scalia, J., concurring 
in judgment).  C.S. grounds his claim solely in "substantive" due 
process and does not advance any argument that he was deprived of 
due process of law.  No United States Supreme Court case recognizes 
an inmate's "substantive" due process right to avoid the 
involuntary administration of medication absent a finding of 
dangerousness. 
 
Accordingly, 
C.S.'s 
challenge 
to 
the 
                                                 
5 C.S. references Article I, Section 1 of the Wisconsin 
Constitution only once, tying it to substantive due process:  "An 
individual's substantive due process rights are rooted in the 
Fourteenth Amendment to the United States Constitution, and 
Article I, § 1 of the Wisconsin Constitution." 
No.  2016AP1982.rgb 
 
13 
 
constitutionality of Wis. Stat. § 51.61(1)(g) on this basis should 
fail.  
II 
¶63 C.S. urges the court to abandon the standard of review 
applicable to his claim and instead align our law with the United 
States Supreme Court's adopted standard.  For many years, this 
court has imposed a "heavy" burden on any party challenging the 
constitutionality 
of 
a 
statute; 
"the 
court 
presumes 
the 
legislation is constitutional, engages in every attempt to uphold 
it, and in a facial challenge, requires a party challenging a law 
to prove it 'is unconstitutional beyond a reasonable doubt.'"  Mayo 
v. Wisconsin Injured Patients and Families Comp. Fund., 2018 WI 
78, ¶68, 383 Wis. 2d 1, 914 N.W.2d 678 (Rebecca Grassl Bradley, 
J., concurring) (citing State v. Smith, 2010 WI 16, ¶8, 323 
Wis. 2d 377, 780 N.W.2d 90).  "To succeed in a facial challenge, 
a party must also show the law cannot be enforced under any 
circumstances."  Id. (citing State v. Wood, 2010 WI 17, ¶13, 323 
Wis. 2d 321, 780 N.W.2d 63).  In Mayo, I "question[ed] the court's 
continued adherence to an evidentiary burden of proof when deciding 
a statute's constitutionality[,]" identifying several flaws 
intrinsic to the standard while tracing its origins and outlining 
its evolution in Wisconsin cases.  See Mayo, 383 Wis. 2d 1, ¶¶68-
97 (Rebecca Grassl Bradley, J., concurring).  I will not repeat 
that exhaustive treatment here but will re-emphasize some 
pertinent points.   
¶64 As a preliminary matter, "a statute either comports with 
the constitution or it does not."  Id. at ¶69.  "[I]mposing a 
No.  2016AP1982.rgb 
 
14 
 
burden of proof heavily weighted in favor of the legislature on 
matters of constitutional interpretation" risks "abdication of our 
core judicial powers to exercise impartial judgment" by according 
"almost unfettered deference to the legislature."  Id. (citing 
Gabler v. Crime Victims Rights Board, 2017 WI 67, ¶37, 376 
Wis. 2d 147, 897 N.W.2d 384).  More than a century ago, Daniel 
Webster suggested the legislature may pass a law of questionable 
constitutionality, confident the judiciary will provide a check on 
the actions of a co-equal branch of government; however, if "its 
unconstitutionality is doubtful," the court will uphold the law, 
at the expense of the people governed by it.  James B. Thayer, The 
Origin and Scope of the American Doctrine of Constitutional Law, 
7 Harv. L. Rev. 129, 146 (1893).  "While the courts are deferring 
to the legislature, the legislature in turn is deferring to the 
courts.  By this ruse, any scrutiny of legislation to ensure it is 
within the just powers of a legislature is avoided."  Randy E. 
Barnett, Our Republican Constitution:  Securing the Liberty and 
Sovereignty of We the People 128 (2016).  Under this paradigm, no 
one assumes responsibility for verifying the constitutionality of 
a law, but the people are nonetheless bound by it. 
¶65 The United States Supreme Court has abandoned the 
beyond-a-reasonable-doubt 
standard 
for 
assessing 
the 
constitutionality of statutory law.  Edward C. Dawson, Adjusting 
the Presumption of Constitutionality Based on Margin of Statutory 
Passage, 16 U. Pa. J. Const. L. 97, 109 (2013) ("[T]he 'beyond a 
[reasonable or] rational doubt' formulation has disappeared.").  
Instead, the Court will strike down a statute upon a "plain 
No.  2016AP1982.rgb 
 
15 
 
showing" of its unconstitutionality, United States v. Morrison, 
529 U.S. 598, 607 (2000), or if its unconstitutionality is "clearly 
demonstrated.'"  National Fed'n of Indep. Bus. v. Sebelius, 567 
U.S. 519, 538 (2012) (quoting United States v. Harris, 106 U.S. 
629, 635 (1883)).  Previously, this court has not acknowledged the 
United States Supreme Court's reformulation of the standard to be 
applied in challenges to the constitutionality of a statute, but 
in this case, the majority expressly "decline[s] to adopt a 
different standard." Majority op., ¶14 n.7. 
¶66 Although the majority in this case recites the 
presumption of constitutionality for Wis. Stat. § 51.61(1)(g) as 
well as the burden 
on C.S. to establish the statute's 
unconstitutionality beyond a reasonable doubt, the majority 
appears to apply a different standard.  Specifically, the majority 
seems to employ a weaker presumption while flipping the burden 
onto the government to justify its encroachment on an inmate's 
liberty.  The majority declares "[a]ll people have a 'significant 
liberty interest in avoiding' involuntary medication[]" and "only 
an 'essential' or 'overriding' state interest can overcome an 
inmate's significant liberty interest in avoiding involuntary 
medication."  Majority op., ¶33.  The majority's expression of the 
law it applies in this case certainly sounds like a presumption of 
liberty afforded the challenger, with the burden to overcome it 
falling on the government.  See Randy E. Barnett, Restoring the 
Lost Constitution:  The Presumption of Liberty 275 (2003) (arguing 
that courts should change the standard from a "presumption of 
constitutionality" to a "presumption of liberty" wherein the 
No.  2016AP1982.rgb 
 
16 
 
government, not the challenger, must prove the "necessity and 
propriety of its restrictions on liberty"). 
¶67 Applying a non-evidentiary standard would relieve courts 
from the "absurd position" in which the beyond a reasonable doubt 
standard places them:  "We could determine a law is more likely 
than not unconstitutional, and we would still uphold it.  We could 
even conclude a party has shown clearly and convincingly that a 
law is unconstitutional, and still we would sustain it."  Mayo, 
383 Wis. 2d 1, ¶84 (Rebecca Grassl Bradley, J., concurring) 
(footnotes omitted).  Requiring instead a "plain showing" or 
"clear[] demonstrat[ion]" of unconstitutionality would restore 
"the constitutional roles of the judiciary and the legislature" as 
well as "the hierarchy of laws" under which the Constitution reigns 
supreme over statutory law.  Id. 
The Constitution is either a superior, paramount law, 
unchangeable by ordinary means, or it is on a level with 
ordinary legislative acts, and, like other acts, is 
alterable when the legislature shall please to alter it.  
If the former part of the alternative be true, then a 
legislative act contrary to the Constitution is not law:  
if the latter part be true, then written Constitutions 
are absurd attempts on the part of the people, to limit 
a power, in its own nature illimitable.   
Marbury v. Madison, 5 U.S. (1 Cranch) 137, 177 (1803).  "Judicial 
respect for its co-equal branch, the legislature, cannot amount to 
surrender of judicial power or abdication of judicial duty."  Mayo, 
383 Wis. 2d 1, ¶84 (Rebecca Grassl Bradley, J., concurring). 
¶68 Among "the Framers' chief concerns" was preventing the 
legislature from being "the 'constitutional judges of their own 
powers.'"  Id., ¶86 (citing David M. Burke, The Presumption of 
Constitutionality Doctrine and the Rehnquist Court: A Lethal 
No.  2016AP1982.rgb 
 
17 
 
Combination for Individual Liberty, 18 Harv. J. L. & Pub. Pol'y 
73, 90 (1994) (citing The Federalist No. 78, supra ¶59, at 467 
(Alexander 
Hamilton)). 
 
Requiring 
those 
challenging 
the 
constitutionality of a legislative enactment to convince a court 
beyond a reasonable doubt accords such deference to legislators as 
to hand them "both the pen and the gavel over their own laws" 
thereby risking "the constitutional overreach of legislative 
power."  Id., ¶87 (citing Burke, supra, at 90). 
¶69 While the people constitutionally bestow a powerful pen 
on the legislature, the people give the gavel to the judiciary to 
check the exercise of legislative power should it exceed its 
constitutional boundaries.  The adoption of the beyond-a-
reasonable-doubt 
standard 
for 
constitutional 
challenges 
to 
legislative enactments may have been born of a judicial restraint 
that properly respects the people's representatives as the policy-
makers, but if statutory law fails to comport with constitutional 
limits, it is the judiciary's duty to say so.  "Without this, all 
the reservations of particular rights or privileges would amount 
to nothing."  The Federalist No. 78, supra ¶59, at 466 (Alexander 
Hamilton).  "If the judiciary passively permits another branch to 
arrogate judicial power unto itself, however estimable the 
professed purpose for asserting this prerogative, the people 
inevitably suffer. . . . [T]he people lose their independent 
arbiters of the law, the balance of powers tips, and the republican 
form of government is lost."  Gabler, 376 Wis. 2d 147, ¶39.  
Adopting the United States Supreme Court's standard requiring 
those challenging the constitutionality of a statute to make a 
No.  2016AP1982.rgb 
 
18 
 
"plain showing" or a "clear[] demonstrat[ion]" would respect "the 
legislature's constitutional lawmaking function" while ensuring 
judges fulfill their duty as the "bulwarks of a limited 
Constitution against legislative encroachments[.]"  Mayo, 383 
Wis. 2d 1, ¶90 (quoting The Federalist No. 78, supra ¶59, at 469 
(Alexander Hamilton)). 
III 
¶70 "Substantive" due process is a judicial invention with 
no mooring in the text of the Constitution.  The Due Process Clause 
plainly applies to the procedural mechanisms by which the 
government may constitutionally "deprive any person of life, 
liberty, or property" but does not protect substantive rights.  
Because C.S.'s claim is grounded in "substantive" due process, I 
cannot 
join 
the 
majority's 
conclusion 
that 
Wis. 
Stat. 
§ 51.61(1)(g) violates the Due Process Clause.  The United States 
Supreme Court has never recognized an inmate's substantive due 
process right to avoid the involuntary administration of 
medication absent a finding of dangerousness.  While liberty 
interests may be vindicated under the Privileges or Immunities 
Clause or Art. I, § 1 of the Wisconsin Constitution, C.S. did not 
invoke either provision.  I respectfully dissent. 
 
No.  2016AP1982.bh 
 
1 
 
¶71 BRIAN HAGEDORN, J.   (dissenting).  The majority today 
creates a new constitutional right not found in the text of the 
Constitution.  It announces a substantive due process right for 
prisoners who a court has determined are incapable of making 
decisions regarding medication to nonetheless refuse that 
medication unless they have been found dangerous by a court.  When 
wading in the waters of substantive due process, we are toying 
with the constitutional authority the people have given us.  We're 
used to doing this sort of thing now, but we shouldn't be.  Each 
new judicial expansion of substantive due process risks further 
degradation of the constitution's command that policy decisions 
are to be made by the other branches of government, not us. 
¶72 C.S. brings a specific and narrow argument:  whether it 
is unconstitutional, without a determination of dangerousness, to 
involuntarily medicate a prisoner who a court has found not 
competent to refuse medication.  The majority does not purport to 
undertake an original public meaning analysis of any provision of 
the United States or Wisconsin Constitutions.  We are acting as a 
lower appellate court interpreting and applying United States 
Supreme Court precedent, and relatedly, our decisions applying 
that precedent.  Those cases establish that while there is a 
substantive due process liberty interest in being free from 
unwanted medication, the legal test applicable to prison 
regulations impacting constitutional rights is whether the 
regulation is reasonably related to a legitimate penological 
interest, a form of rational basis review.  We have previously 
indicated that the state has a legitimate interest in caring for 
No.  2016AP1982.bh 
 
2 
 
the well-being of inmates who cannot care for themselves.  
Following these guideposts, the statutory provision allowing the 
state to involuntarily medicate prisoners for whom medication is 
in their best interest who are found incapable of making a decision 
regarding medication does not, under the governing precedent, 
violate the Due Process Clause of the Fourteenth Amendment. 
¶73 While the relevant cases haven't changed in recent 
years, somehow our reading of them has.  The majority applies a 
form of heightened scrutiny ordinarily applicable outside the 
prison 
context, 
and 
concludes 
that 
a 
determination 
of 
dangerousness is required.  In so doing, the majority disregards 
the constitutional standard for prison regulations impacting 
constitutionally protected liberty interests, creates its own 
standard, and uses that standard to announce a new substantive due 
process right.  If a new standard is warranted, it is up to the 
United States Supreme Court to create it; we are not permitted to 
disregard what the Supreme Court has said any more than the court 
of appeals may disregard what we say.  Though the state's power in 
this area is not to be taken lightly, the care of mentally ill 
prisoners found incapable of rendering informed consent regarding 
medication is, under the governing law, a policy choice the people 
have reserved to their elected representatives.  I respectfully 
dissent. 
 
I 
¶74 Today's decision is based on the Fourteenth Amendment to 
the United States Constitution, which prohibits states from 
No.  2016AP1982.bh 
 
3 
 
depriving citizens of life, liberty, or property without due 
process of law.  U.S. Const. amend. XIV, § 1.  A student reading 
the constitutional text would no doubt be surprised to find that 
this language has morphed into something entirely unrelated to 
what it actually says.  Rather than ensuring a fair process before 
being deprived of these rights, the Due Process Clause has been 
transformed into the storehouse for a seemingly unlimited supply 
of judicially created substantive protections.  See McDonald v. 
City of Chicago, 561 U.S. 742, 811 (2010) (Thomas, J., concurring 
in part and concurring in judgment) ("The notion that a 
constitutional provision that guarantees only 'process' before a 
person is deprived of life, liberty, or property could define the 
substance of those rights strains credulity for even the most 
casual user of words."); see also Sessions v. Dimaya, 138 
S. Ct. 1204, 1244 (2018) (Thomas, J., dissenting) ("This Court 
also has a bad habit of invoking the Due Process Clause to 
constitutionalize rules that were traditionally left to the 
democratic process.").  The Due Process Clause is now read by 
courts as an invitation to the judiciary to define what we think 
liberty is and how important we think a given liberty interest 
ought to be.  Then we conduct a form of "balancing" that interest 
against the government's interests, and declare a misbalanced law 
an unconstitutional one. 
¶75 We should not miss what's really happening here.  With 
no text as our guide——which distinguishes this from enumerated 
constitutional liberties like the freedom of speech and religion—
—we have assumed the incredible power to make what are 
No.  2016AP1982.bh 
 
4 
 
quintessentially policy decisions, and to call those decisions 
constitutional law.  If the Constitution itself tells us to do 
this, then we must.  But count me skeptical.  This is a dangerous 
business.  The judiciary is, at best, treading on the thinnest of 
authority when striking down an act of the legislature on the 
grounds of substantive due process. 
¶76 That said, this court has an obligation to follow United 
States Supreme Court decisions interpreting the United States 
Constitution.  The federal Constitution states that it is the 
"supreme" law of the land, and that the power to decide cases based 
on the Constitution is vested in a "supreme" court.  U.S. Const. 
art. VI; id. art. III, § 1.  When the highest court authoritatively 
construes the highest law, state courts like ours must follow.  
Therefore, even though I have grave concerns with the compatibility 
of the original public meaning of the Fourteenth Amendment's Due 
Process Clause and current doctrine interpreting it, I believe I 
must faithfully apply those decisions. 
 
II 
¶77 Medicating someone against his will is, by any 
definition, a "substantial interference with that person's 
liberty."  Washington v. Harper, 494 U.S. 210, 229 (1990).  Thus, 
the Supreme Court has said avoiding unwanted medication is a 
substantive liberty interest protected by the Due Process Clause.  
The real question is under what circumstances the state may 
No.  2016AP1982.bh 
 
5 
 
overcome that interest to involuntarily medicate a person.  Two 
types of cases frame the relevant principles. 
¶78 One set of cases involves involuntarily medicating 
criminal defendants to render them competent to stand trial.  These 
unique cases require the court to balance the due process right 
not to be involuntarily medicated with the due process right to be 
tried while competent.  See Medina v. California, 505 U.S. 437, 
453 (1992); Riggins v. Nevada, 504 U.S. 127, 139-40 (1992) 
(Kennedy, J., concurring in judgment) ("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 counsel, 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.").  In 
these circumstances, the Supreme Court has applied a much more 
exacting level of scrutiny.  The Court has required an "essential" 
or "overriding" state interest to justify this significant 
government encroachment on a person's liberty.  This is the 
teaching of Riggins, Sell v. United States, 539 U.S. 166, 178-79 
(2003), and our own decision in State v. Fitzgerald, 2019 WI 69, 
¶13, 387 Wis. 2d 384, 929 N.W.2d 165. 
¶79 But while the state interest must be essential or 
overriding as an ordinary matter, a different analytical framework 
applies in the prison context.  States are given much greater 
latitude in governing prisons due to their different challenges 
and goals.  Constitutional rights of all kinds are restricted in 
prison in a way that would be unthinkable for those outside of 
No.  2016AP1982.bh 
 
6 
 
prison.  The majority elides the difference between these types of 
cases.  It incorporates standards from non-prison cases, applies 
the incorrect legal test, and therefore reaches an incorrect legal 
conclusion. 
¶80 The seminal case governing prison regulations impacting 
constitutional rights is Turner v. Safley, 482 U.S. 78 (1987).  In 
Turner, two constitutional complaints spurred the litigation——the 
first over restrictions on inmate-to-inmate correspondence, and 
the second over restrictions on inmate marriages.  The lower courts 
applied a strict scrutiny analysis and struck down both 
restrictions.  Id. at 83.  The Supreme Court reversed. 
¶81 First, the Court recognized that prisoners retain 
constitutional rights, and courts must discharge their duty to 
protect those rights.  Id. at 84.  Even so, "courts are ill 
equipped to deal with the increasingly urgent problems of prison 
administration and reform."  Id. (quoted source omitted).  Running 
a prison is "peculiarly within the province of the legislative and 
executive branches of government. . . . [A]nd separation of powers 
concerns counsel a policy of judicial restraint."  Id. at 84-85.  
Reviewing prior cases, the Court observed that it had not clarified 
the appropriate standard of review.  Id. at 85-89.   Its task, 
then, was to formulate "a standard of review for prisoners' 
constitutional claims that is responsive both to the 'policy of 
judicial restraint regarding prisoner complaints and [to] the need 
to protect constitutional rights.'"  Id. at 85 (alteration in 
original) (quoted source omitted). 
No.  2016AP1982.bh 
 
7 
 
¶82 Drawing on precedent, the Court defined the proper legal 
test for prison cases:  "when a prison regulation impinges on 
inmates' constitutional rights, the regulation is valid if it is 
reasonably related to legitimate penological interests."  Id. at 
89.  This deferential standard was necessary to ensure prison 
administrators make the difficult institutional decisions, not the 
courts.  Id.  The Court explained that a heightened scrutiny 
analysis would be ill-suited for the unique challenges of operating 
a prison.  Id.  Exacting judicial oversight "would also distort 
the decisionmaking process, for every administrative judgment 
would be subject to the possibility that some court somewhere would 
conclude that it had a less restrictive way of solving the problem 
at hand."  Id.  Inevitably, this heightened scrutiny would result 
in courts becoming "the primary arbiters of what constitutes the 
best 
solution 
to 
every 
administrative 
problem, 
thereby 
'unnecessarily perpetuat[ing] the involvement of the federal 
courts in affairs of prison administration.'"  Id. (alteration in 
original) (quoted source omitted). 
¶83 With the threshold test established, the Court outlined 
four factors to assist in determining the reasonableness of a 
prison regulation.  Id. at 89-91.  First, the prison regulation 
must have a "valid, rational connection" to the legitimate 
government interest proffered by the state, and it must operate in 
a neutral fashion.  Id. at 89-90.  Second, keeping the appropriate 
"measure of judicial deference" in mind, courts must look to 
whether alternative means of exercising the constitutional right 
remain available.  Id. at 90.  The third factor is the effect 
No.  2016AP1982.bh 
 
8 
 
accommodation of the asserted constitutional right will have on 
guards, other inmates, and allocation of prison resources.  Id.  
Courts should be "particularly deferential" when the policy has 
ripple effects on fellow inmates or prison staff.  Id.  The final 
factor is the absence of ready alternatives.  Id. at 90-91. 
¶84 The Court then applied this test and these factors and 
concluded that the rule barring correspondence between inmates 
bore the necessary reasonable relationship to a legitimate 
penological interest, while the marriage restriction did not.  
Id. at 91. 
¶85 In a case released just eight days later, the Supreme 
Court rejected a First Amendment religious freedom challenge to 
certain restrictions affecting Muslim prisoners.  O'Lone v. Estate 
of Shabazz, 482 U.S. 342 (1987).  The Court reaffirmed and applied 
the test from Turner, and discussed the valid penological 
objectives of "deterrence of crime, rehabilitation of prisoners, 
and institutional security."  Estate of Shabazz, 482 U.S. at 348. 
¶86 But perhaps involuntary administration of medication to 
prisoners should be governed under a different standard?  The 
Supreme Court had occasion to answer precisely this question in 
Harper. 
¶87 Prior to the case reaching the Supreme Court, the 
Washington Supreme Court thought the Turner test applied only when 
the First Amendment was invoked.  Harper, 494 U.S. at 223.  
Incorrect, the Supreme Court held.  Id.  The Court reaffirmed that 
"the proper standard for determining the validity of a prison 
regulation claimed to infringe on an inmate's constitutional 
No.  2016AP1982.bh 
 
9 
 
rights is to ask whether the regulation is 'reasonably related to 
legitimate penological interests.'"  Id. (quoting Turner, 482 
U.S. at 89).  This standard, the Court explained, "applies to all 
circumstances" and "in all cases in which a prisoner asserts that 
a prison regulation violates the Constitution."  Id. at 224.  It 
applies "even when the constitutional right claimed to have been 
infringed is fundamental, and the State under other circumstances 
would have been required to satisfy a more rigorous standard of 
review."  Id. at 223.  For "refusing to apply the standard of 
reasonableness," the Washington Supreme Court "erred."  Id.  The 
Court then applied the relevant Turner factors and concluded that 
the prison policy for involuntary medication complied with due 
process 
by 
rationally 
"furthering 
the 
State's 
legitimate 
objectives."  Id. at 224-27. 
¶88 In failing to apply the law the United States Supreme 
Court says to apply, this court errs as well.  It has not escaped 
the attention of courts that plainly unconstitutional restrictions 
outside the prison context may nonetheless bear the requisite 
reasonable relationship to a legitimate penological interest in 
the prison context.1  Prison is different; the Supreme Court and 
lower courts around the country have repeatedly said so.  The 
Turner test is the law governing prison regulations impacting 
                                                 
1 See, e.g., Fraise v. Terhune, 283 F.3d 506, 515 n.5 (3d Cir. 
2002) ("Turner discussed five prior Supreme Court cases involving 
inmate constitutional claims, and in all of those cases the 
challenged 
prison 
regulation 
would 
have 
been 
plainly 
unconstitutional outside the prison context." (discussing Turner 
v. Safley, 482 U.S. 78 (1987))). 
No.  2016AP1982.bh 
 
10 
 
constitutional rights, and it must be followed.2  Involuntary 
medication impacts the constitutional right to due process, and 
Harper has left no doubt as to the proper standard of review for 
the precise issue before us. 
¶89 The argument that subsequent cases have modified this 
test does not withstand scrutiny.  In a 2005 decision regarding 
racial classifications in prison, the Supreme Court discussed the 
broad and varied areas where the Turner test has been held to 
                                                 
2 Turner does not apply, of course, if other statutory 
protections are in place.  See Holt v. Hobbs, 574 U.S. 352, 355 
(2015) (not applying the Turner test in a case covered by the 
Religious Land Use and Institutionalized Persons Act of 2000, 42 
U.S.C. §§ 2000cc to 2000cc-5 (2012)).  But general use of the 
Turner test by the Supreme Court continues unabated.  Subsequent 
Supreme Court cases affirming and applying the Turner test include 
Florence v. Board of Chosen Freeholders, 566 U.S. 318 (2012) 
(applying the Turner test to correctional facility policies 
authorizing strip searches and body-cavity inspections of arrested 
individuals prior to entering the general population of a jail); 
Beard v. Banks, 548 U.S. 521 (2006) (applying the Turner test and 
affirming a prison policy denying newspapers, magazines, and 
photographs to certain inmates); Overton v. Bazzetta, 539 U.S. 126 
(2003) (applying the Turner test to prison regulations restricting 
visiting privileges); and Thornburgh v. Abbott, 490 U.S. 401 
(1989) (applying the Turner test to prison regulations restricting 
incoming publications). 
The federal courts of appeal have also regularly applied 
Turner to prison regulations right up to the present day.  See, 
e.g., Greenhill v. Clarke, 944 F.3d 243 (4th Cir. 2019) (applying 
the Turner test to an inmate's Free Exercise Clause claim); Brown 
v. Collier, 929 F.3d 218 (5th Cir. 2019) (same); Nigl v. Litscher, 
940 F.3d 329 (7th Cir. 2019), petition for cert. filed (U.S. Mar. 
6, 2020) (No. 19-1618) (applying the Turner test to the denial of 
a prisoner's request to marry); Hanrahan v. Mohr, 905 F.3d 947 
(6th Cir. 2018) (applying the Turner test to prison restrictions 
on in-person media interviews with certain prisoners); Crime 
Justice & Am., Inc. v. Honea, 876 F.3d 966 (9th Cir. 2017) 
(applying the Turner test to county jail's commercial mail policy); 
Daker v. Warren, 660 F. App'x 737 (11th Cir. 2016) (applying the 
Turner test to prison policy banning hardcover books). 
No.  2016AP1982.bh 
 
11 
 
apply.  Johnson v. California, 543 U.S. 499, 510 (2005).  The Court 
in 
Johnson, 
although 
making 
an 
exception 
for 
racial 
classifications, affirmed application of the Turner test in other 
areas.  Among the multitude of applications noted was an explicit 
reference to Harper's use of the Turner test to adjudicate the due 
process issues involved in involuntary medication of mentally ill 
prisoners.  543 U.S. at 510.  This decision came after both Riggins 
and Sell were decided.  The Turner test was the law governing 
involuntary administration of medication to inmates, and it 
remains so today. 
¶90 C.S.'s main, and really only, argument in this case is 
that Harper says dangerousness is required.  But this is certainly 
a misreading of Harper.  The Court did conclude that the prison 
policy 
at 
issue, 
"given 
the 
requirements 
of 
the 
prison 
environment," permitted the state to involuntarily medicate an 
inmate with a serious mental illness "if the inmate is dangerous 
to himself or others and the treatment is in the inmate's medical 
interest."  494 U.S. at 227.  But these strictures repeat what the 
at-issue prison policy required, not necessarily what due process 
requires.  Id.  Due process was accorded because the state's policy 
afforded sufficient protections to Harper and constituted a 
reasonable relationship to a legitimate penological interest.3  
                                                 
3 Beyond the dangerousness element, Wisconsin's approach 
provides that any report accompanying a motion for involuntary 
administration of medication must "include a statement signed by 
a licensed physician that asserts that the subject individual needs 
medication or treatment and that the individual is not competent 
to refuse medication or treatment, based on an examination of the 
individual by a licensed physician."  Wis. Stat. § 51.61(1)(g)3. 
(2017-18) (emphasis added). 
No.  2016AP1982.bh 
 
12 
 
Id. at 225-26.  In fact, Harper's "main contention" before the 
Court was that involuntary medication would be permissible only if 
the State found him incompetent, followed by "court approval of 
the treatment using a 'substituted judgment' standard."  Id. at 
226.  The Court rejected this "suggested rule" because it took "no 
account of the legitimate governmental interest in treating him 
where medically appropriate for the purpose of reducing the danger 
he poses."  Id.  In sum, the Harper Court never isolated 
dangerousness as a necessary requirement to satisfy due process; 
reducing the risk of danger was a sufficient penological interest, 
but not a necessary one. 
¶91 Prior to today, this court has read the same cases and 
correctly concluded that due process does not require a 
determination of dangerousness. 
¶92 In 2010, after reviewing the same United States Supreme 
Court cases discussed by the majority in this case, this court 
concluded that dangerousness was not a necessary requirement to 
order involuntary medication of an individual committed after 
being found not guilty of a crime by reason of mental disease or 
defect (NGI).  State v. Wood, 2010 WI 17, ¶4, 323 Wis. 2d 321, 780 
N.W.2d 63.  In Wood, we explained that the state had at least two 
interests in medicating NGI individuals:  first, its interest in 
"treating the underlying mental illness in order to prevent more 
criminal behavior and prepare the individual for conditional 
release and for eventual release from the commitment," and second, 
                                                 
All subsequent references to the Wisconsin Statutes are to 
the 2017-18 version. 
No.  2016AP1982.bh 
 
13 
 
its interest in maintaining institutional safety, security, and 
functionality.  Id., ¶32.  This court determined each interest was 
sufficient to sustain an involuntary medication order.  See 
id., ¶33 (citing Sell for the proposition that "a finding of 
dangerousness is not required where the relevant state interest is 
unrelated to institutional safety and security"). 
¶93 In 2016, we had the opportunity to evaluate the 
involuntary commitment of the same inmate before us today, where 
he similarly argued that his commitment violated substantive due 
process without a determination of dangerousness.  Winnebago 
County v. Christopher S. (C.S. I), 2016 WI 1, 366 Wis. 2d 1, 878 
N.W.2d 109.  We disagreed.  Reviewing the relevant cases, 
especially Harper and Turner, we explained that a prisoner's 
rights, including the significant liberty interest in avoiding 
involuntary administration of antipsychotic drugs, "must be viewed 
in light of his or her 'status as an inmate' and 'the legitimate 
penological objectives of the corrections system.'" C.S. I, 366 
Wis. 2d 1, ¶¶36-42 (quoting Turner, 482 U.S. at 95).  We concluded 
that rational basis review applied to involuntary commitments of 
prisoners.  Id., ¶42.  And applying that test, the statutory scheme 
allowing involuntary commitment without a determination of 
dangerousness 
was 
"facially 
constitutional 
because 
it 
is 
reasonably related to the State's legitimate interest in providing 
care and assistance to inmates suffering from mental illness."  
Id., ¶57. 
¶94 Following the Supreme Court's direction, as we must, we 
are duty-bound to apply the test the United States Supreme Court 
No.  2016AP1982.bh 
 
14 
 
has 
established 
to 
govern 
prison 
regulations 
impacting 
constitutional rights.  The test is not whether a determination of 
dangerousness has been made, but whether the statutory provisions 
allowing involuntary medication of inmates are reasonably related 
to a legitimate penological interest. 
 
III 
¶95 To conduct the analysis, we need to put this case in its 
relevant statutory context.4  As a default rule, inmates who have 
been committed "have the right to exercise informed consent with 
regard 
to 
all 
medication 
and 
treatment." 
 
Wis. 
Stat. 
§ 51.61(1)(g)3.  But this rule comes with two narrow exceptions. 
¶96 The first exception is when "a situation exists in which 
the medication or treatment is necessary to prevent serious 
physical harm to the individual or others."  Id.  To highlight, 
this exception is narrow, triggered only when "necessary" to 
prevent harm that is both "serious" and "physical."  By definition, 
modest physical harm would not satisfy; neither would serious 
mental or emotional harm. 
¶97 Taking the statutory text at its word, an inmate who 
would suffer immense mental and emotional anguish due to a bout of 
schizophrenic hallucinations would——assuming no serious physical 
harm was in play——not be covered within the exception.  This is 
                                                 
4 We review the constitutionality of a statute de novo.  
Winnebago County v. Christopher S. (C.S. I), 2016 WI 1, ¶33, 366 
Wis. 2d 1, 878 N.W.2d 109.  When a statute has been challenged as 
unconstitutional on its face, the challenger is required to 
establish 
that 
the 
law 
cannot 
be 
enforced 
"under 
any 
circumstances."  Id., ¶34. 
No.  2016AP1982.bh 
 
15 
 
true even if the inmate, due to a schizophrenic episode, was found 
by a court to be incapable of making an informed decision regarding 
whether medication would help. 
¶98 But the legislature also created a second exception to 
the default informed consent rule:  when a court determines "that 
the individual is not competent to refuse medication or treatment."  
Id.  An individual is not competent to refuse when a court 
determines either that he is (1) "incapable of expressing an 
understanding of the advantages and disadvantages of accepting 
medication 
or 
treatment 
and 
the 
alternatives"; 
or 
(2) 
"substantially incapable of applying an understanding of the 
advantages, disadvantages and alternatives to his or her mental 
illness, developmental disability, alcoholism or drug dependence 
in order to make an informed choice as to whether to accept or 
refuse medication or treatment."  § 51.61(1)(g)4.  In other words, 
a court must determine the inmate simply does not have the capacity 
to express an understanding of the underlying information 
necessary to exercise informed consent, or the inmate lacks the 
capacity to apply the information in a way that fulsomely 
constitutes informed consent.  In layman's terms, this is a finding 
that the inmate does not have the ability or power to meaningfully 
exercise informed consent. 
¶99 Applying the proper test, the question is whether 
involuntarily medicating an inmate who a neutral arbiter (the 
court) has concluded lacks the ability or power to exercise 
informed consent is reasonably related to a legitimate penological 
interest.  The Turner factors inform our analysis. 
No.  2016AP1982.bh 
 
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¶100 First, the policy must have a valid, rational connection 
to the legitimate government interest proffered by the state, and 
operate in a neutral fashion.  Turner, 482 U.S. at 89-90.  The 
state interest put forward here is the "care and assistance to 
non-dangerous inmates who are mentally ill and in need of treatment 
in the form of medication, but are not competent to refuse such 
treatment."  Without question, the state has a legitimate interest 
in caring for those who are unable to care for themselves.  This 
is known as the parens patriae power.5  Significant swaths of state 
government are devoted to protecting those who, by reason of age, 
illness, or incapacity, are unable to care for themselves. 
¶101 And as relevant to this case, the prison environment 
uniquely raises these concerns.  As the Supreme Court has 
                                                 
5 See State v. Dennis H., 2002 WI 104, ¶36, 255 Wis. 2d 359, 
647 N.W.2d 851 ("The state has a legitimate interest under its 
parens patriae powers in providing care to its citizens who are 
unable to care for themselves." (quoting Addington v. Texas, 441 
U.S. 418, 426 (1979))); Lenz v. L.E. Phillips Career Dev. Ctr., 
167 Wis. 2d 53, 76 n.9, 482 N.W.2d 60 (1992) ("Parens patriae 
literally means 'parent of the country' and refers to the role of 
the state as guardian of persons under legal disabilities, such as 
juveniles or incompetent persons.  Under the theory of parens 
patriae it is the right and duty of the state to step in and act 
in what appears to be the best interests of the ward." (citation 
omitted)). 
The majority suggests that invoking parens patriae power here 
amounts to a "limitless" assertion of the state's power.  Majority 
op., ¶¶43-44.  Quite the contrary.  The majority misses the 
principle that prison is different, and the legitimate purposes 
that might support prison regulations do not automatically equate 
to the compelling interest and narrow tailoring that might be 
required to justify the same action outside the prison context.  
For example, upholding a prison regulation banning certain books 
does not mean the government may ban books outside of prison.  The 
same logic applies here. 
No.  2016AP1982.bh 
 
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recognized, "[a]n inmate must rely on prison authorities to treat 
his medical needs; if the authorities fail to do so, those needs 
will not be met."  Estelle v. Gamble, 429 U.S. 97, 103 (1976).  
Government has a constitutional "obligation to provide medical 
care for those whom it is punishing by incarceration."  Id.; see 
also Harper, 494 U.S. at 225 ("We confront here the State's 
obligations, not just its interests.  The State has undertaken the 
obligation to provide prisoners with medical treatment consistent 
not only with their own medical interests, but also with the needs 
of the institution."). 
¶102 Providing needed medical care to those the state has an 
obligation to care for, and who are unable to render informed 
consent regarding their own care, constitutes a legitimate 
penological interest.  Helping rehabilitate and stabilize a 
prisoner's mental health when he is unable to help himself is part 
of the rehabilitative aims of prison and constitutes a legitimate 
penological interest.  The policy here is certainly rationally 
related to these legitimate interests. 
¶103 This is precisely the same reasoning we used just a few 
terms ago in C.S. I, 366 Wis. 2d 1.  Caring for those unable to 
care for themselves is a legitimate exercise of government power.  
Id., ¶44.  And in the prison context, we determined this interest 
was "particularly strong."  Id., ¶45.  Looking again to Harper, we 
explained that caring for inmates under custody of the state "is 
not just an interest; it is an obligation."  Id. (citing Harper, 
494 U.S. at 225).  Therefore, we concluded that involuntarily 
committing prisoners is rationally related to a legitimate state 
No.  2016AP1982.bh 
 
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interest:  "providing care and assistance to those inmates who 
need treatment because they are suffering from a mental illness."  
Id., ¶46.6 
¶104 The second Turner factor is whether alternative means of 
exercising the constitutional right remain available to the 
inmate.7  482 U.S. at 90.  The statutory design in Wisconsin gives 
an inmate the right to refuse medication, thus protecting the 
constitutional 
liberty 
interest 
at 
stake. 
 
Wis. 
Stat. 
§ 51.61(1)(g)1.  The state is not assuming the power to override 
personal medical decisions that prison personnel simply disagree 
with.  The narrow power asserted here kicks in only when inmates 
                                                 
6 In addition to contradicting C.S. I, the court's decision 
today also places us in conflict with courts around the country 
that have concluded involuntary medication may be justified 
through the state's parens patriae power.  The majority's 
determination otherwise is an outlier.  See, e.g., Myers v. Alaska 
Psychiatric Inst., 138 P.3d 238, 249 (Alaska 2006) ("We readily 
agree that the state's parens patriae obligation does give it a 
compelling interest in administering psychotropic medication to 
unwilling mental patients in some situations."); In re Qawi, 81 
P.3d 224, 231-32 (Cal. 2004) ("In California, parens patrie may be 
used only to impose unwanted medical treatment on an adult when 
the adult has been adjudged incompetent."); Rivers v. Katz, 495 
N.E.2d 337, 343 (N.Y. 1986) ("Therefore, the sine qua non for the 
state's use of its parens patriae power as justification for the 
forceful administration of mind-affecting drugs is a determination 
that the individual to whom the drugs are to be administered lacks 
the capacity to decide for himself whether he should take the 
drugs[.]"); Steele v. Hamilton Cty. Cmty. Mental Health Bd., 736 
N.E.2d 10, 18-21 (Ohio 2000) ("A second state interest recognized 
by many courts to be sufficiently compelling to override a mentally 
ill patient's decision to refuse antipsychotic medication is the 
state's parens patriae power."). 
7 The court in Harper declined to consider this factor, 
apparently presuming it to be inapplicable.  Washington v. Harper, 
494 U.S. 210, 224-25 (1990).  I address this factor for the sake 
of completeness. 
No.  2016AP1982.bh 
 
19 
 
cannot make the decision for themselves——a decision made by a 
neutral court, not state officials.8  § 51.61(1)(g)3. 
¶105 The third Turner factor is the effect accommodation of 
the asserted constitutional right would have on guards, other 
inmates, and allocation of prison resources.  482 U.S. at 90.  This 
factor also weighs in favor of the constitutionality of the 
legislature's policy choice.  Inmates whose mental health 
disorders are left uncontrolled could make cooperation, community 
activities, and other necessary treatments very difficult.  An 
inmate incapable of making a decision on medication could result 
in personal distress that might require additional supervision 
resources, or require different living arrangements.  An inmate 
who for example raises only a possible, rather than "serious," 
risk of physical harm to himself or others would no doubt need 
special staff consideration, medical supervision, separation from 
other inmates, and other related expenditures that risk disrupting 
prison order, security, and inmate well-being.  It is not difficult 
to see how the intransigence of a mentally ill inmate incapable of 
making medication decisions could lead to ripple effects on fellow 
inmates or prison staff. 
¶106 The final Turner factor is the absence of alternatives.  
482 U.S. at 90-91.  And once again, this factor weighs in favor of 
the state's policy choice here.  The majority's decision has the 
                                                 
8 As noted above, Wis. Stat. § 51.61(1)(g)3. also provides 
the power to override the consent of an inmate when a court finds 
doing so is necessary to prevent serious risk of physical harm to 
the inmate or others.  This portion of the statute is not an issue 
in this case. 
No.  2016AP1982.bh 
 
20 
 
effect of recognizing and affirming the medical decision of someone 
who a court has found incapable of making that decision.  This 
means prison officials are helpless to help someone who, acting in 
his incapacity, remains steadfastly opposed to medication.  The 
only statutory out to this is the very limited situation where 
overriding the incompetent inmate's decision is "necessary to 
prevent serious physical harm."  Wis. Stat. § 51.61(1)(g)3.  In 
the majority's view, the Constitution requires the state to let 
prisoners suffer——physically, mentally, and emotionally——through 
serious mental health issues so long as the inmate won't seriously 
hurt himself or others.  The legislature has seen fit to provide 
the procedural protection of an independent arbiter, a court, to 
ensure a prisoner's rights are fairly heard and fairly respected.  
Id.  I'm unsure what else the state is supposed to do to help 
suffering, but incompetent, prisoners in its care. 
¶107 Reasoning through these factors, I conclude that the 
state's limited ability to involuntarily medicate inmates in its 
care, whose treatment is in their medical interest and who a court 
has found are incapable of making that decision for themselves, is 
reasonably related to a legitimate penological interest.  C.S.'s 
claim that a showing of dangerousness is required is incorrect 
under the governing precedent, and the state's policy choices 
should stand. 
¶108 The majority's contrary conclusion is predominantly a 
product of its application of the wrong constitutional standard.  
The majority glosses over the difference between protection of 
constitutional rights in the prison context, and protection of 
No.  2016AP1982.bh 
 
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those rights outside the prison context.  This misstep leads to 
application of a form of heightened scrutiny, rather than the 
rational basis-like Turner test that the Supreme Court applied in 
Harper. 
¶109 Applying a heightened-scrutiny framework risks the very 
judicial interference in prison administration the Court in Turner 
warned against.  While I share the general caution about state 
power in this area, the majority's decision also has the 
unfortunate effect of requiring prison officials to allow inmates 
to unnecessarily suffer by empowering them to make a choice a court 
has concluded they are not capable of making.  And even more, the 
court expands the Supreme Court's substantive due process 
doctrines, a disquieting development to say the least. 
¶110 The state's policy of allowing mentally ill inmates 
under its custody, whose treatment is in their medical interest, 
to be involuntarily medicated when found incapable of rendering 
informed consent is reasonably related to the state's legitimate 
penological interest in caring for those inmates.  And getting to 
the heart of this matter, this is a policy choice the people have 
retained for themselves.  They have not asked the judiciary to do 
it for them.  Because this policy choice is not prohibited by the 
Constitution, I respectfully dissent. 
¶111 I am authorized to state that Chief Justice PATIENCE 
DRAKE ROGGENSACK joins this dissent. 
No.  2016AP1982.bh 
 
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