DOCKET NO.: 80-1417
DECIDED BY: Burger Court (1981-1986)
LOWER COURT: United States Court of Appeals for the First Circuit
CITATION: 457 US 291 (1982)
ARGUED: Jan 13, 1982
DECIDED: Jun 18, 1982
Richard Wayne Cole - on behalf of the Respondents
Stephen Schultz - on behalf of the Petitioners
Facts of the case
Media for Mills v. Rogers
Audio Transcription for Oral Argument - January 13, 1982 in Mills v. Rogers
Warren E. Burger:
We will hear arguments next in Mills against Rogers.
Mr. Schultz, I think you may proceed when you are ready.
Mr. Chief Justice, and may it please the Court, in argument today I would like to focus on what the defendants believe to be the two fundamental reasons that there is no constitutional right to refuse treatment.
First would be that allowing one patient to refuse treatment is necessarily going to negatively impair the state's ability to perform its legitimate objective of maintaining order in its hospitals, and second of all, of treating those patients who are not themselves refusing treatment.
In other words, what I am saying is that to allow one patient to refuse treatment, there will necessarily be an increase of violence in our institutions.
The First Circuit talks about allowing forced medication for emergency situations, but they simply do not focus on the fact of the unpredictability of violence in mentally ill patients, the impulsivity of violent acts, the fact that mental patients are acting upon irrational thoughts, and that this simply cannot always be predicted.
Well, they did give you a broader mandate than Judge Toro had done, didn't they?
--There is no doubt that the First Circuit opinion in our mind is less wrong than the district court opinion.
I could say that maybe less people will be hurt under the First Circuit opinion than would be hurt under the district court opinion.
I hardly feel that justifies the opinion.
The second point that I want to make as to this first fundamental reason is that if you allow one patient to remain in your hospital in a deteriorated state, this is going to affect the health of other patients, whether or not there is violence.
A hospital is a milieu setting, and if you have patients who are deteriorated, this will set off the illnesses of other patients, and I will talk about this more later.
The second major point that I want to discuss in argument today which we believe to be a second fundamental reason is that we suggest that the original decision to commit an individual against his will for treatment purposes when it is known at the time that the patient is committed that antipsychotic medications are a necessary part of the treatment of the vast majority of the seriously mentally ill acts as a sufficient predicate for the later administration of this medication against the patient's will after the commitment.
In other words, let me just reword what we consider this basic argument to be all about.
There is no determination of incompetency at the time that a patient is committed, yet the state is empowered, despite this lack of a finding of incompetency, is empowered to commit an individual against his will for treatment.
We suggest similarly without any finding of incompetency the state should be empowered to carry out that treatment against the patient's will which was ordered at the time of commitment.
In order to fully understand these two fundamental arguments that we believe necessitate there being a finding of no right to refuse treatment, I think it is first necessary to focus very, very briefly on what exactly is the role of antipsychotic medications in our state hospitals.
The record in this case is clear that antipsychotic medications are a necessary part of the treatment for the vast majority of seriously mentally ill patients.
Do those drugs have a component of tranquilizer in them?
They do, but they are not very good tranquilizers.
You shouldn't use them and it wouldn't be proper practice to use them as a tranquilizer.
They are a poor tranquilizer, and to the extent that they do tranquilize, the sedative effects wear off in two or three weeks.
If you want to tranquilize, there are other drugs which are tranquilizers.
We are talking about a specific group of patients, and it must be recognized, and that group of patients are patients who are so seriously mentally ill that they could be committed, plus it is acceptable medical practice to use antipsychotic medications for those patients.
Mr. Schultz, do you disagree with the district court's findings about the drugs themselves, that they are mind-altering and they have significant side effects and so forth?
I certainly disagree with the finding that they are mind-altering.
What they do is restore a chemical imbalance in the brain to the original balance.
It is the psychosis that is mind-altering, as I think a very cogent article points out.
The non-conformist treated of his illness, the psychotic non-conformist will remain a non-conformist.