Between madness and death: the medicate-to-execute controversy.

Introduction The evidence is overwhelming that Charles Laverne Singleton stabbed a grocery clerk to death in the course of a robbery. (1) The victim knew him. She told the police officer who first arrived at the bloody scene, as well as the physician who unsuccessfully treated her, that Charles Singleton "came in the store, said this is a robbery, grabbed her around the neck, and went to stabbing her." (2) Singleton was convicted and sentenced to death for the murder. Many years later (far too many), the Eighth Circuit Court of Appeals resolved an intriguing legal issue raised by this sad and deceptively simple case. (3) May the state compel a mentally ill death row inmate to take medicine for his disorder where the beneficial effects of the treatment also make him sane enough to be executed? That is the subject of this essay. For most of his time on death row, Charles Singleton has been taking psychotropic medication. It was first prescribed for anxiety and depression, but when, in 1987, Singleton's mental health began to deteriorate, he was medicated--sometimes voluntarily, sometimes forcibly--to control the symptoms of psychosis. Some of the Eighth Circuit judges described his situation as follows: He started to believe that his cell was possessed by demons and had "demon blood" in it. He reported that his brother would come to his locked prison cell and take him out of it for walks. He was under the impression that a prison doctor had planted some type of device in his right ear and that his thoughts were being stolen from him when he read the Bible. During this time, he sustained a considerable loss of weight. Singleton was diagnosed as likely schizophrenic and placed on antipsychotic medication. He initially took it on his own, but when he refused, he was forcibly medicated. For the next several years, Singleton continued to be treated for his psychosis. His medication was administered voluntarily at times, and at times it was administered forcibly. Whenever he was off his medication, his symptoms would resurface, and he would again experience hallucinations. (4) Two major U.S. Supreme Court decisions set the stage for the instant controversy. In 1986, in Ford v. Wainwright, (5) the Court ruled that a capitally-sentenced inmate who has become "insane" may not be executed. The Court majority did not define "insane," but Justice Lewis Powell, in a concurring opinion, contended that "the Eighth Amendment forbids the execution only of those who are unaware of the punishment they are about to suffer and why they are to suffer it." (6) Singleton filed a Ford claim, seeking to block his execution. Meanwhile, in 1990, the Supreme Court made another decision of great consequence to this case. In Washington v. Harper (7) the Court permitted prison authorities to order forcible administration of antipsychotic drugs on the condition that three requirements were met: the prisoner must have a serious mental illness, he must be dangerous to himself or others, and the treatment must be in the inmate's medical interest. Harper, however, involved a non-death-sentenced inmate. Thus, the question in Singleton's case may be stated as follows: Assuming competency to be executed in accordance with constitutional standards can be achieved, should the Harper involuntary medication rule apply to an inmate who faces execution? Or, as the Eighth Circuit put it, the issues are "whether the State may forcibly administer antipsychotic medication to a prisoner whose date of execution has been set and whether the State may execute a prisoner who has been involuntarily medicated under a Harper procedure." (8) By a 5-4 vote, the Eighth Circuit court answered both questions in the affirmative. (9) At the heart of the court's ruling is the assertion that medication was in Singleton's interests even after the execution date was set and that, in effect, Harper applies to capital inmates. …