Document: 494 U.S. 210 110 S.Ct. 1028 108 L.Ed.2d 178 WASHINGTON, et al., Petitionersv.Walter HARPER. No. 88-599. Argued Oct. 11, 1989. Decided Feb. 27, 1990. Syllabus Respondent Harper has been a ward of the Washington state penal system since his 1976 robbery conviction. Both as an inmate and while temporarily on parole, he received psychiatric treatment, including consensual administration antipsychotic drugs. He engaged in violent conduct, condition deteriorated when did not take On two occasions, was transferred to Special Offender Center (SOC or Center), institute for convicted felons with serious mental illness, where diagnosed suffering from manic-depressive disorder. While at Center, required drugs against will pursuant SOC Policy. The Policy provides, inter alia, that, if psychiatrist orders such medication, may be involuntarily treated only (1) suffers "mental disorder" (2) is "gravely disabled" poses "likelihood harm" himself others; after hearing upon finding that above conditions are met, special committee consisting psychiatrist, psychologist, official, none whom currently involved inmate's diagnosis order involuntary medication majority; right notice hearing, attend, present evidence, cross-examine witnesses, representation by disinterested lay adviser versed psychological issues, appeal Center's Superintendent, periodic review any ordered. In addition, law gives him state-court committee's decision. treatment proceedings were conducted accordance During second stay but before transfer penitentiary, filed suit court under 42 U.S.C. § 1983. trial rejected claim failure provide judicial violated Due Process Clause Fourteenth Amendment. State Supreme Court reversed remanded, concluding Clause, could administer competent, nonconsenting if, which had full panoply adversarial procedural protections, proved "clear, cogent, convincing" evidence both necessary effective furthering compelling interest. Held: 1. case rendered moot fact ceased administering will. A live controversy remains, there no recovered illness; continues serve sentence prison system; strong likelihood again officials would seek Thus, alleged injury likely recur decision Court. Pp. 218-219. 2. permits treat who illness will, dangerous others medical Although liberty interest being free arbitrary comports substantive due process requirements, it reasonably related State's legitimate combating danger posed violent, mentally ill inmate. rational means interest, applies exclusively inmates gravely disabled represent significant themselves administered direction licensed psychiatrist; little dispute profession proper use treating controlling cause behavior. Harper's contention precondition drug must find incompetent, then obtain approval using "substituted judgment" standard, rejected, does account medically appropriate purpose reducing poses. Similarly, shown alternatives physical restraints seclusion accommodate rights de minimis cost valid penological interests. 219-227. 3. Policy's administrative procedures comport process. 228-236. (a) require prisoner insubstantial considered government interests efficacy particular adequately protected, perhaps better served, allowing medicate made professionals rather than judge. It cannot assumed disturbed patient's intentions, substituted judgment approximating those can determined single apart realities frequent ongoing observation. Nor ignored requiring hearings divert scarce resources care inmates. Moreover, risks associated most part ones, best assessed professionals. contains adequate safeguards ensure prisoner's taken into account. particular, independence decisionmaker addressed, members current diagnosis, record devoid staff lack fair hearing. 228-235. (b) satisfy requirements all other respects. provisions mandating specified requirement meaningful opportunity heard, vitiated prehearing meetings between absent resulting bias actual need rules court's standard proof neither nor helpful personnel making An decision, found compiled allow review. deficient counsel, provision independent understands issues sufficient protection given nature made. 235-236. Wash.2d 873, 759 P.2d 358, (1988); remanded. KENNEDY, J., delivered opinion unanimous respect Part II, Parts I, III, IV, V, REHNQUIST, C.J., WHITE, BLACKMUN, O'CONNOR, SCALIA, JJ., joined. concurring opinion, post, p. 236. STEVENS, dissenting part, BRENNAN MARSHALL, joined, 237. William L. Williams, Kenmore, Wash., petitioners. Paul J. Larkin, Jr., Washington, D.C., amicus curiae, supporting petitioners, leave Brian Reed Phillips, Everett, respondent. Justice KENNEDY 1 central question us whether Resolution requires discuss protections afforded 2 * Walter sentenced robbery. From 1980, incarcerated Penitentiary. Most time, respondent housed prison's health unit, consented Antipsychotic drugs, sometimes called "neuroleptics" "psychotropic drugs," medications commonly used disorders schizophrenia. Brief American Psychiatric Association al. Amici Curiae 2-3, n. As court, effect these similar alter chemical balance brain, desired result assist patient organizing her thought processes regaining mind. See App. Pet. Cert. B-7.1 3 paroled 1980 participate treatment. continued receive Harborview Medical Seattle, later sent Western Hospital civil commitment order. December 1981, revoked respondent's parole assaulted nurses hospital Seattle. 4 Upon return prison, 144-bed correctional established Department Corrections diagnose disorders. At psychiatrists first disorder.2 first, gave voluntary consent medications. November 1982, refused continue taking prescribed physician sought over objections, 600.30. 5 600.30 developed partial response this Court's Vitek v. Jones, 445 480, 100 1254, 63 552 (1980). several components. First, determines should consent, subjected himself, others, their property.3 Only approve medication. Second, refuses voluntarily entitled Associate Superintendent be, time diagnosis. If majority vote disorder dangerous, medicated provided majority. 6 Third, certain before, during, least 24 hours' intent convene during medicated. tentative factual basis why believes necessary. attend; witnesses; assistance involved. Minutes kept, copy within hours, decide hours its receipt. B-3. personal restraint petition extraordinary writ. Wash.Rules App.Proc. 16.3 16.17; B-8. 7 Fourth, initial When committee, composed nontreating seven days reapproved prepare report director every 14 continued.4 8 case, met Policy, assisted nurse practitioner another institution. disease disorder, approved appeal, upheld findings. Beginning 23, about one year. Periodic occurred 9 1983, Reformatory. there, took result, deteriorated. retransferred month. subject 600.30, reviews, until Penitentiary June 1986. 10 February 1985, 1983 (1982 ed.) various individual defendants State, claiming Process, Equal Protection, Free Speech Clauses Federal Constitutions, well tort law. damages declaratory injunctive relief. After bench March 1987, held although contained stated Vitek. 11 remanded court. 358 (1988). Agreeing refusing medications, concluded "highly intrusive nature" warranted greater protect stake Wash.2d, 880-881, P.2d, 363. interest.5 Id., 883-884, 364-365. 12 We granted certiorari, 489 1064, 109 1337, 103 807 (1989), we reverse. II 13 contends because moot. disagree. Even confine our attention facts record,6 parties remains. There illness. Since 1976, point order, hospitals. trial, still 15 system, time. Given history, once twice institutions period 1982-1986, reasonable conclude Center. Once holding Court, 16 us, This sufficiently overcomes mootness circumstances precedents. Vitek, U.S., 486-487, S.Ct., 1260-1261. III 17 primary component Clause. phrased issue "a [is] will." 874, 360. however, more establishjudicial determinations different set forth without consent. Instead having prove, presents "serious prove further consider make written findings regarding either desires analogous incompetent person. 365. 18 aspects. axiomatic examined terms stake. But identifying contours remains task distinct deciding what right. "[T]he involves definition th[e] protected constitutional identification competing might outweigh it. concerns minimum Constitution determining individual's actually outweighed instance." Mills Rogers, 457 291, 299, 102 2442, 2448, 73 (1982) (citations omitted). 19 Restated exist will; nonjudicial mechanisms determine sufficient. ruled substance right, guarantees, encompassed grant certiorari.7 address questions beginning one. 20 matter law, itself undoubtedly confers Hewitt Helms, 459 460, 864, 74 675 (1983), Pennsylvania created avoid segregation enacting regulations "used language unmistakably mandatory character, 'shall,' 'will,' 'must' employed, occur predicates—viz., 'the control,' threat disturbance.' " 471-472, 871 similarly character. By permitting wishes creates justifiable expectation unless exist. also 488-491, 1261-1263. 21 have doubt addition possesses avoiding unwanted id., 491-494, 1262-1264; Youngberg Romeo, 307, 316, 2452, 2458, 28 (1982); Parham J.R., 442 584, 600-601, 99 2493, 2503-2504, 61 101 (1979). consideration scheme, recognized 22 mandate override choice refuse factfinder makes he, extent defined context confinement. establish, finding, exists harm treated. reviewing ensures ordered interests, needs institutional confinement.8 These standards, recognize meet demands 23 legitimacy, necessity, considering safety security cases. Turner Safley, 482 78, 107 2254, 96 64 (1987), O'Lone Estate Shabazz, 342, 2400, 282 validity regulation claimed infringe ask "reasonably interests." Turner, supra, 89, 2261. true even infringed fundamental, rigorous 349, 2404-05. declined apply reasoning here distinguishable First Amendment Shabazz. 883, 9, 364, 9. erred reasonableness. Our earlier determination adopt based reconcile longstanding adherence principle retain some despite incarceration recognition authorities equipped difficult decisions administration. 84-85, 2259-60; Jones North Carolina Prisoners' Labor Union, Inc., 433 119, 128, 97 2532, 2539, 53 629 (1977). principles cases asserts violates Constitution, just invokes quite clear adopted implicate rights. 85, 2259 ("Our . formulate prisoners' claims responsive 'policy complaints [to] rights' ") (citation omitted); 2261 ("If Pell [v. Procunier, 417 817, 94 2800, 41 495 (1974) ], Bell Wolfish, 441 520, 60 447 (1979) ] already resolved [Procunier v.] Martinez, [416 396, 1800, 40 224 (1974),] resolve now: impinges inmates' rights, interests"); 2404 ("To courts afford deference officials, judged 'reasonableness' test less restrictive ordinarily applied infringements fundamental rights"). reasonableness imposed severe restrictions marry, 95-96, 2265 (citing Zablocki Redhail, 434 374, 98 673, 54 618 (1978), Loving Virginia, 388 1, 87 1817, 1010 (1967)). precedents application here. 25 factors challenged regulation. Three relevant "First, 'valid, connection' governmental put forward justify it." 2262 (quoting Block Rutherford, 468 576, 586, 104 3227, 3232, 82 438 (1984)). "the impact accommodation asserted guards inmates, allocation generally." 90, 2262. absence ready regulation," mean "have up shoot down conceivable alternative method accommodating claimant's complaint." 90-91, 2262; see 350, 2405. 26 Applying requirements. legitimacy importance presented few person environment, which, "by definition," persons demonstrated proclivity antisocial criminal, often conduct." Hudson Palmer, 517, 526, 3194, 3200, 393 (1984); 132, 2541; Wolff McDonnell, 418 539, 561-562, 2963, 2977-2978, 935 (1974). confront obligations, undertaken obligation prisoners consistent own Prison administrators ensuring staffs personnel, Hewitt, 473, 872, duty measures safety. Hudson, 526-527, 3200-3201. added weight institution, like restricted illnesses. Where disability root population, decreasing necessarily encompasses providing 27 objectives. Its exclusive who, others. psychiatrist. considerable debate potential side effects behavior.9 proffered rejecting forced do demonstrate invalidity policy. Respondent's main standard. suggested rule takes way accommodation, out hand. "alternative[s] fully accommodat[e] 91, Physical short term, resisting inmate, 12, leaving risk putting tending them. Furthermore, failed acceptable substitutes effectiveness toll limited resources.10 29 hold requirements; therefore reject standards Constitution.11 IV 30 Having recognizes refusal preconditions next erroneous discussed above. represented authorization evidence. process, prerequisite A. 31 disagreement decisionmaker. written, Superintendent. None involved, diagnosis; disqualified sitting they past. Superintendent; so desires, 216. 32 reference case. Morrissey Brewer, 408 471, 481, 92 2593, 2600, 33 484 (1972); 472, 871-72; Greenholtz Nebraska Penal Inmates, 2100, 2106, 668 guide established. "Under Mathews Eldridge, 424 319, 335 [96 893, 903, 47 18] (1976), private value Amendment." 872. unwarranted insubstantial. forcible injection person's body represents substantial interference liberty. Cf. Winston Lee, 470 753, 105 1611, 84 662 (1985); Schmerber California, 384 757, 772, 86 1826, 1836-37, 908 (1966). leading changes, intended beneficial, cognitive processes. supra. therapeutic benefits documented, serious, fatal, effects. One identified acute dystonia, spasm upper body, tongue, throat, eyes. minutes through Cogentin. Other include akathesia (motor restlessness, characterized inability sit still); neuroleptic malignant syndrome (a relatively rare lead death cardiac dysfunction); tardive dyskinesia, Finding Fact B-7; Psychological Amicus 6-9. Tardive dyskinesia neurological irreversible cases, involuntary, uncontrollable movements muscles, especially around face. Mills, 293, 2445, respondent, amici sharply disagree frequency occurs, severity, profession's ability treat, arrest, reverse condition. reading suggests proportion patients exhibit symptoms ranges 10% 25%. According Association, studies indicate 60% mild minimal effect, severe. 14-16, 12; 8.12 Notwithstanding "has never neutral detached trier trained officer." Parham, 607, 2506-07. Though doubted societal legal implications, prohibit mechanisms. 607-609, 2506-2508; cf. Youngberg, 322-323, 2461-2462. Particularly disturbed, intentions assess changeable event. Schwartz, Vingiano, & Perez, Autonomy Right Refuse Treatment: Patients' Attitudes Involuntary Medication, 39 Community Psychiatry 1049 history accepting illustrates point. facile assumption clinical observation prior child observations: 34 ". [D]ue informal, traditional investigative techniques. mode procedure diagnostic business judges. 35 36 "Although acknowledge fallibility O'Connor Donaldson, 422 563, 584 [95 2486, 2498, 45 396] (1975) (concurring opinion), accept notion shortcomings specialists always avoided shifting specialist tools science untrained judge officer judicial-type nonspecialist medical-psychiatric Common human experience scholarly opinions suggest supposed adversary proceeding appropriateness emotional illusory real." 2506-2508. 37 ignore resources, money staff's 605-606, 2505-2506. 38 Under asked professional. That inquiries: disorder"; second, whether, property. thehear ing reviews regular type dosage administered, changes. 875, good reason effective, continuous, probing decisionmakers. more. attempt high permitted withstand challenge Adequate addressed satisfaction procedures. moreover, indication biases affected altered specific assaultive behavior doctors attribute disease, met. B-4 B-5, times "with degree care, skill, learning expected prudent acting same circumstances." contrary, willing presume previous involving implicating internal 496, 1265-66; 613-616, 2509-2511.13 Wolff, 570-571, 2981-2982 (prison impartial conduct disciplinary hearings). reasoned connected institution able "unnecessary intrusion judgments." 1265; 2259-60, 2261-62. B respects, arguments contrary. provides notice, witnesses. 494-496, 1264-66. Absent bias, contest position satisfies heard "must manner." Armstrong Manzo, 380 545, 552, 85 1187, 1191, 62 (1965). 494-495, 321-323, 2461. Finally, note writ, nonetheless counsel. "[I]t crystal lawyers available identify possible errors judgment." Walters National Radiation Survivors, 473 305, 330, 3180, 220 (1985) (emphasis original). made, protection. 499-500, 1267-1268 (Powell, concurring). V sum, permissible Constitution. reduce essential us. reversed, inconsistent opinion. 43 44 concurring. I join controversial character illustrated simple respected, knowledgeable, informed professional organizations, pull opposite directions. 46 add caveat. Much difficulty lessened formally committed. occasion seem bother nuisance, move protective concerned, staff, physician, itself. Zinermon Burch, 113, 975, 100. step neglected indications incompetency present. MARSHALL join, part. 48 explanation moot, evaluation merits. undervalued interest; misread misapplied (1987); mock institutionally biased tribunal constitutes "due law." Each merits separate discussion. 49 acknowledges "respondent ante, 221, virtually ignores dimensions They intellectual. Every violation bodily integrity invasion particularly permanent premature death.1 action degrading overrides competent form treatment.2 And drugging mind subject, deprivation literal sense. 50 "The makers undertook secure favorable pursuit happiness. significance man's spiritual nature, feelings intellect. knew pain, pleasure satisfactions life material things. Americans beliefs, thoughts, emotions sensations. conferred, Government, let alone—the comprehensive valued civilized men." Olmstead United States, 277 438, 478, 564, 572, 72 L.Ed. 944 (1928) (Brandeis, dissenting). 51 citizens resist altering arises Nation's basic values.3 Offense (SOC) notes: "Inmate die th[a]n medication."4 opposed psychotropic surprising: acknowledges, "alter brain" fatal effects.5 prolixin injections receiving statement exemplify intrusiveness Prolixin acts "at levels nervous multiple organ systems."6 induce catatonic-like states, electroencephalographic tracings, swelling brain. Adverse reactions drowsiness, excitement, bizarre dreams, hypertension, nausea, vomiting, loss appetite, salivation, dry mouth, perspiration, headache, constipation, blurred vision, impotency, eczema, jaundice, tremors, muscle spasms. prevent exercising functions driving automobile, syndrome, 30% suffer it.7 increases time.8 52 properly equated mind-altering electroconvulsive therapy psychosurgery. agreed Judicial Massachusetts' 'profound effect' 'thought processes' 'well-established adverse effects,' 'in manner psychosurgery therapy.' 878, 362 (1988) re Guardianship Roe, 383 Mass. 415, 436-437, 421 N.E.2d 40, (1981)). doubt, analyzed concluded, deserving highest protection.9 Arguably, three advanced compel submit program punishment crime committed "cure" mechanism maintain prison. today justification. Forced punishment. conclusion follows inexorably (1980), felon population explained: "Appellants range confinement justified imposition sentence, certification qualified defect. agree. holds conviction entitles hospital. Such consequences visited qualitatively characteristically suffered crime. much reflect understanding subjects individual. Baxstrom Herold, 107, 760, 620 (1966); Specht Patterson, 386 605, 1209, 326 (1967); Humphrey Cady, 405 504, 1048, 394 Jackson Indiana, 406 715, 724-725, 1845, 1851-1852, 435 (1972). criminal imprisonment extinguish freedom term authorize classify affording additional protections." 493-494, 1264. 55 measure. Rather, holds: 56 "[G]iven Constitution." Ante, 227 added). 57 Crucial exposition "may treatment," confinement." 226, 222. find, urges, absolute limit whose 58 upholds scheme confers, coextensive conferred 221-222, 227. Whether beneficial custody alone presumptively person, plain reveals terms, constitutionally insufficient. 59 purely environment. benefit requires: "In approved, and/or disabled." Lodging, Book "Likelihood harm," according "means (i) inflicted evidenced threats attempts commit suicide inflict one's self, (ii) caused places fear sustaining harm, (iii) property damage others."10 authorizes long-term appears future people mere behavior, advance interest.11 Use readily admits, serves ease burdens maintaining managing unruly preventing damage.12 focusing property, allows exercise parens patriae authority police unfortunately, simply assertion interest.13 65 sweepingly sacrifices regardless concerns. clearly convenience responding However, "both interests" potentially justifications inmates,14 seriously misapplies announced (1987). "if test, barring inmate-to-inmate correspondence supported 93, 2263-64. unanimously prohibiting marriage, except superintendent circumstances, "exaggerated response" objectives articulated rehabilitation goal. 97-98, 2266. 66 advances justification circumstances. emergency "an imminent others." contrast triggers provisions, general illness-induced damage—evidenced past long-term, management concern magnitude necessity emergencies. Whitley Albers, 475 312, 321-322, 106 1078, 1085-1086, 89 251 (1986). imagine what, any, limits restrain believe environments are, 'by definition,' 'a conduct.' 225 forcing prolonged periods unquestionably concern. 67 marriage "regulation, [was] interests," "obvious, easy alternatives" rebut record. Today concludes impose costs State. establish narrowly drawn policy withdrawing psychotropics consent15 pose harm16 increase marginal sanctions frequently thus new costs. intramuscular psychotropics, Harper, 7, entail tranquilizers.17 suppress violence, achieve results, undermine programs illness.18 68 careful differentiation goals emulated flaw Washington's 600.30—and error today—is divorce each arguably blend emergencies convenient muddled rationale So serving eviscerates mind.19 69 deficient. ever declared approving concerned critical defect reviewed tribunal. 495, 1264-65.20 70 routine prescribe recommend nonemergency consecutive consists SOC, Neither member sustain 7-day 2, 3.B. "long term" lasting days. bar committee. merely file Long-term approval, granted, indefinitely 3.C.21 71 decisionmakers disqualifying conflicts panel work physicians colleagues turn, regularly decisions. in-house pits objects doctor, doctor's colleagues.22 "[n]one diagnosis," 233, overlooks approval. revolving door operated Dr. Petrich 1982 recommended October 1982. 8, Loeken, psychologist Giles, Assistant Stark authorized replaced Loeken Giles Solely authority, throughout following year.23 members, doctor "certain exercised." 321, 2461, (1982). structure be. inquiry bases medical, ultimate turns assessment imposes prescribing wear hats. hybrid function disables decisionmaker's judgment.24 confuses objective inquiry; expertise all. trump dramatized appeals solely Superintendent.25 "[t]here will" "antipsychotic purposes, control discipline patients." 234, 13. unnecessary fails abuse ends. For example, Taractan, drug, noting: goal increased sedate night relieve residents evening [sic] alike burden supervising intensely."26 examination non-SOC indicated prophylactically qualify medication.27 inherent identity unchecked aspects prisoner, Findings severity probability dosages required. And, rests, gratuitously advises unnecessary.28 75 raise fairly completely. capable 'speaking effectively himself' "issues 'complex otherwise develop present' 498, 1266-67 part). doses designed month, very contesting hearing.29 counsel hearings, adviser, appointed SOC. pp. 3-4. advisers, questionable loyalties efficacy, "independent assistance" understand 1266-67.30 "limitable testimony witnesses witnesses," paragraph away reasons "include, things irrelevance, redundancy, reprisals, relating security, rehabilitation." paper objections crucial basis. 76 how convened 660.30 conceivably discover, persuaded overrule, drug. 335, (1976). Institutional infects entire procedure. comparable uniformly implicated drugs.31 agree conclusion. impartial, deficiencies affirm attendant safeguards, remedy 77 "even retains unalienable liberty—at dignity—which ignore." Meachum Fano, 427 215, 451 (1976) (dissenting opinion). aspect Amendment.32 Accordingly, exception respectfully dissent judgment. included Trialafon, Haldol, Prolixin, Loxitane, Mellaril, Navane. B-7. Like category 876, 3, 361, schizo-affective schizophrenic. definitions disorder," disabled," identical statute. "Mental "any organic, mental, impairment volitional functions." Wash.Rev.Code 71.05.020(2) "Gravely disorder: [i]s safety, manifests deterioration functioning repeated escalating actions safety." 71.05.020(1). "either: [a] another, (c) 71.05.020(3). amended Further Thereafter, bi-weekly reports director. end 180 days, Because decided grounds, equal speech claims, immunity, lower relief 885-886, 366. oral argument, back April 1987 September May 1988. Counsel competency unrelated charge, outcome remainder sentence. certiorari mirror division seeking protections" question, assuming "possesses medication," "prove [whether] 'reasonable relation' [482 (1987),] control[s]." i. STEVENS appropriate. 243-245. reasons, condition; facility warehouse ill, felons, recover normal B-2. keeping purpose, it, invoked. Unlike assume patients; indeed, ethics Hippocratic Oath; Principles Ethics With Annotations Especially Applicable Psychiatry, Codes Professional Responsibility 129-135 (R. Gorlin ed. 1986). supports interpretation standards. representations argument anti-psychotic Tr. Oral Arg. 13, 16. 10-11 ("Psychotropic widely accepted community extraordinarily chronic psychoses, schizophrenia"); 6. 11-12; Soloff, Controls: Seclusion Restraint Modern Practice, Clinical Treatment Violent Person 119-137 (L. Roth 1987) (documenting patients). Perhaps suggesting utilization suspect, uses random citations exhibits documents submitted isolated quotations passages records running hundreds pages, presenting one-sided portrait contain. overview extensive materials long reported incidents assaults fellow staff. attributed believed tendencies B-5. opposition premised desire self-medicate street cocaine. Lodging Kenneth Eikenberry, Attorney General July 25, 1984, Progress Report. show recipient painstaking event, portions, records, hearsay, credited relied intend engage interpreted. rely action, [respondent] constituted others," B-8, defendants, Ibid. Contrary STEVENS' cramped last 245, breadth meaning equals language. "discount[ing] drugs." 239, 5. discussion text indicates, aware drugs; disagreements frequency, permanence knowledge What "discount[s]" owed full-time responsibility caring possess, not, requisite admitting illnesses, "all patients," 248, All concede appropriate, sanguine parts practice. Again, defer unchallenged party render decisions, refer patients. 28; 14. here, reasoning. "That practice place affords [Washington's] program," 616, 2511, light practical outside psychiatrist" chimerical. Review literature indicates concur physician's most, all, Bloom, Faulkner, Holm, Rawlinson, Empirical View Patients Exercising Their Treatment, Int'l Law 315, 325 (1984) (independent examining Oregon concurred 95% cases); Hickman, Resnick, Olson, Psychotropic Medication: Interdisciplinary Proposal, Mental Disability Reporter 122, 130 Ohio affirmed recommendation reviewer 100% cases). judges yields results. Appelbaum, Medications: Retrospect Prospect, 145 Am. 413, 417-418 comparison, reveal hardly lackluster suggests. (internal 75% Zito, Lentz, Routt, Panel: Solution Refusal?, Bull.American Academy 349 Minnesota 67% generally Appelbaum Hoge, Research Reveals, Behavioral Sciences 279, 288-290 (1986) (summarizing results patients' noting infrequency refusals allowed, decisionmaker"). Cf., e.g., (surgery); (use "soft" arms "muffs" hands). 294, 4, 16, 2446, (recognizing common-law battery unauthorized touchings drugs); States Stanley, 483 669, 710, 3054, 3066, 550 (1987) (O'CONNOR, part) (the Constitution's promise guarantees compensation violations Nuremberg Military Tribunals "that 'voluntary absolutely moral, ethical concepts' "); Doe Bolton, 410 179, 213, 93 739, 758-59, 201 (1973) (Douglas, concurring) protects "freedom person" deleted) ). adjudged insane incompetent. 882, 364 Stanley Georgia, 557, 565, 1243, 1248, 542 (1969) whole heritage rebels giving power men's minds"). "It obligatory Helsinki signatory states manipulate minds citizens; man conscience God; thoughts expression peaceful action. painfully aware, furthermore, governments systematically disregard nations people." Hearings Abuse Soviet Union Subcommittee Human Rights International Organizations House Committee Foreign Affairs, 98th Cong., 1st Sess., (1983) (Remarks Max Kampelman, Chair Delegation, Plenary Session Commission Security Cooperation Europe). O. (hereinafter Lodging), Jan. 5, Hearing (Harper testified: "Well you want me you've medicating me. Haldol paral[y]zed my body. [Y]ou burning freedom"). includes "books" discovery stipulated "could [Trial] documents." B-1. hereinafter referred number date entry, applicable. "engage debate" 228, illustrate boundaries operation. 229. relies heavily (Psychiatrists' Brief), 214, 227, 10, 230, discount briefs support conclusions reliability Psychiatrists' Brief. (Psychologists' Brief) points increasing alarming rate" 1950-1970 data chance devastating four." Psychologists' 8. Coalition Fundamental Equality Ex-Patients 16-18 (court recent effects); Protection Advocacy Systems 7-16 (same). Psychiatrists entirely experts. psychologists charge: "As '[l]itigation TD [tardive dyskinesia] explode five years. Some minimize seriousness [despite] continual warnings.' R. Simon, Physician's Desk Reference 1639 (43d 1989). 1640; Trial B-7 B-8; Guze Baxter, Neuroleptic Malignant Syndrome, 313 New England Med. 163, 163-164 (1985). Reference, 1639. six years began exhibited dystonia (acute spasms) (physical-emotional agitation). E.g., 28, Aug. 1982; 9-10, avoidance reduction discontinuance ibid., continuous 1986, month spent 8; 4-6, 362. See, Large Superior 148 Ariz. 229, 714 399 (en banc); Riese St. Mary's 209 Cal.App.3d 1303, 243 Cal.Rptr. 241 (1st Dist.1988), dism'd, 259 774 698 (1989); People Medina, 705 961 (Colo.1985) Rogers Commissioner Dept. Health, 390 489, 458 308 (1983); Rivers Katz, N.Y.2d 485, 504 N.Y.S.2d 74, 337 (1986); Health K.K.B., 609 747 (Okla.1980). Schuoler, 500, 723 1103 (right therapy). Revised 620.200, 18, retained definitions. reliance Oath save constitutionality unavailing. 223, binds "medical interest" bearing committees, governed criteria authorizing possibly "treatment" talismanically interest." facilitates physiological overall patient. violence onset 239-241. qualitative preferences. wishes. Petitioners ("Harper's appropriately others"); ("The assists meeting 'unquestioned institution' "). paramount preserving establishing [I]t goes saying significantly amplified prisoners, SOC"). construe served 11-12, shed did—or circumstances" could—order combination 223. conflates analysis "[t]he institution." 225. small fraction years, intermittently them Books Okin, 478 F.Supp. 1342, 1369 (Mass.1979) (only 1,000 institutionalized restraining effect), modified, 634 F.2d 650 (CA1 1980), vacated sub nom. marginal; poorer prognosis cooperative Webster, Assessing Treatability Mentally Disordered Offenders, Behavior 19, 20-21 (1989). notes, used, "one controlling" incurable panacea maintenance shows many (approximately 30%) relapse neuroleptics withdrawn months relapse. Standard strategies, though indisputably group comparisons, inefficient addressing patient." Lieberman Reply Drug Discontinuation Studies Schizophrenia, Archives 387 (1989) (footnotes Indeed, appear produced minor "savings" "medications satisfactory containing worst excesses labile irritable uncooperative Nov. supervisor began: "[D]uring Cabrini yet psychotic. off preoccupation appearance psychosis become assaultive. His problems paradoxical precipitated exacerbation psychosis. Mr. focused psychosomatic per effects, real problem exacerbated medications." 6, lethargy, fatigue, 1126, 1236, 1640, 1755, 1788, 1883 1989), treatment" dangerousness, improving condition, sedating grossly excessive purpose. mixed became dealing him. (Dr. reports: negotiate collectively idea working relationship build external controls"); 26, 1985 "because participation use"). Forcing provoked counterproductive Dec. (Report assault male television "in complaining Overall major management"); (therapist's going destroy unit stopped. recently destroyed inmates['] stereo example this"). (1982), (1979), inapposite. individual; profoundly retarded adult capacity 18-month-old child, 309, 2454-55, J.R. appellees children, 587, 2496. deprivations cases—use institutionalization Parham—fall far Bee Greaves, 744 1387, 1395-1397 (CA10 1984) (forcible security), cert. denied, 469 1214, 334 reach force judge, experts hand other; not. 620.200 required, adds continuing thereafter. bars "susceptible implicit explicit pressure cooperation ('If orders, I'll yours'). instructive year year, 'review' voted medication—despite scientific showing respites advisable compelling." 26-27 (footnote Rates bodies value, course, presumably adjust practices bodies. Jersey's instructive. employed Services resulted discontinuation 59% dosages. moved peer percentage dropped 2.5% Jersey Public Advocate 38-54. prescription entries 20, "per Petrich." encounter committees 7-day, sat 180-day voting January cites "previous [in which] decisionmakers." 233-234. Aside face counterparts Parham. "adequately complex." 1262. essentially medical," 1264-65. understood involve "whether care," emphasizing "[w]hat requires." 614-615, 608, 2510-2511, 2507. accurate institution's positions inside Georgia hospital, charged needs, independence. 4. notes bring writ App.Pro. 16.17, 216, 235. demands—as existence attests liberty, collateral Ingraham Wright, 430 651, 1401, 711 "psychiatric attendant," recorded request attempted guard's food slot. guard "Infraction Report" concluded: "Suggestion: + 1-2, 22, Five later, Petrich, citing incident, Reformatory, Multidisciplinary Advisory found: "To date, presence recurrent tell instituted bad faith; us." 30, ("[T]he inmate[']s self injurious towards documented history"). Addington Texas, 418, 1804, 323 convincing proof, chances inappropriate 427, 1810, factfinders jurors. decanoate, highly potent modifier markedly extended duration effect"; 4-6 weeks. 1641-1642 introduced to, consult with, commencement Hearing. advisers spoke hearings. apparently SOC: Social Worker Hyden (who medication), chaplain, registered nurses, officer. 31, Hearings. Many incompetence, findings, Hosp. Boyd, 403 A.2d (D.C.1979); Commitment M.P., 510 645 (Ind.1987); Jarvis Levine, N.W.2d 139 (Minn.1988); Opinion Justices, 123 N.H. 554, 465 (Okla.1980); ex rel. Gerhardstein, 141 Wis.2d 416 883 218, Amendment, protection, constitutional, courts.

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