Living hell, or a life saved?

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Ian
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Living hell, or a life saved?

Post by Ian »

Wouldn't it be nice if someone from the prosecution offered a deal that spared his life (who wants to kill someone who doesn't even have a grasp on reality and didn't when they committed their crime anyway?) and gave this guy a shot at sanity?
Lori
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Living hell, or a life saved?

Post by Lori »

Came across this in the Miami Herald Online Version - seemed like a tough issue so I thought I'd toss it in here...

Get the guy well enough to sentence him to death? Or keep him locked in a mental and physical prison by denying him treatment? Which end allows for true justice? Doesn't seem to be an easy answer.

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Capitol shooter's untreated mental illness fuels debate
BY ANNE HULL
Washington Post Service


--------------------------------------------------------------------------------
Clean-cut Weston shared nonsensical tale with CIA


WASHINGTON -- The legal definition of ``not competent to stand trial'' is kept in a cell with a slit of frosted glass for a window and an outer door marked ISOLATION. He hides beneath his blanket, picking at sores. He believes the ripening of corn causes the reversal of time.

This is Russell Weston, the paranoid schizophrenic who killed two U.S. Capitol Police officers in July 1998 in a bloody shootout in the marble corridors of the U.S. Capitol.

After the rampage, a judge ordered Weston to a federal psychiatric facility for treatment. The idea was to make him competent for trial. What Weston needed was a course of Risperdal or Haldol or Prolixin.

But when the consent forms were put before him, Weston refused to sign. And when the gurney was on its way to forcibly medicate him, his lawyers stepped in.

For the last 20 months, Weston's lawyers have prevented so much as one drop of antipsychotic drug from hitting their client's brain, bringing the case of United States of America vs. Russell Eugene Weston Jr. to a standoff.

Because Weston could face the death penalty if convicted, lawyers from the federal public defender's office argue that to medicate him for trial is to march him toward the execution chamber.

But this defense is exacting a cruel cost on Weston.

Two court-appointed psychiatrists have testified that his mental condition has worsened. Because Weston has received no treatment and could be dangerous, he has been kept in seclusion for more than two years, an unheard-of period of isolation in modern times.

In the coming days, Judge Emmet G. Sullivan is expected to rule for a second time whether Weston should be medicated.

At the last hearing in November, Weston sat at the defense table, unbarbered and bearded. His blue eyes roamed toward his lawyers as they made the case to preserve his mental rot.

ERA OF SKEPTICISM

Weston's rampage at the Capitol took place in an era of skepticism against the insanity defense. Ever since John Hinckley Jr. shot Ronald Reagan and was found not guilty by reason of insanity, mentally ill defendants have been left with slim cover.

Congress raised the bar for the insanity plea three years after Hinckley's assassination attempt in 1981, and switched the burden of proof from the prosecution to the defense. Many states tightened release rules for those found not guilty by reason of insanity.

``Jurors are more afraid of the mentally ill than mean people,'' said Michael Mears, a death penalty lawyer for the Georgia Indigent Defense Counsel.

Against this landscape, lawyers have scrambled for ways to defend the mentally ill. Weston's defense team embarked on an ambitious strategy, borrowing from blueprints created by death penalty lawyers.

In Ford vs. Wainwright, the Supreme Court ruled that the state cannot execute an incompetent convict. Left unresolved in that ruling, however, was whether the state has a right to medicate the convict against his will to restore competence for his execution.

Weston's lawyers moved this question to a pretrial scenario. Can a defendant be forcibly medicated to become competent for a trial in which he could face the death penalty?

``This is of profound ethical significance to psychiatrists,'' says Richard Bonnie, director of the Institute of Law, Psychiatry and Public Policy at the University of Virginia.

The Weston case, billowing with thousands of pages of briefs and expert witnesses from Ivy League psychiatry departments, is being watched by lower courts across the nation. Neither Federal Public Defender A.J. Kramer nor Assistant U.S. Attorney Ronald L. Walutes Jr. would comment for this story.

The defense's strategy troubles some. ``Keeping him in a florid psychotic condition in seclusion, leaving him as a stark raving madman is not good,'' says Art Caplan, director of the Center for Bioethics at the University of Pennsylvania. ``It's keeping him alive, but the cost is absurd.''

Except that Weston's soured mind is the defense's one hope. The government's evidence is overwhelming.

Even if mentally ill, Weston drove 750 miles to Washington, negotiated its one-way streets, parked his truck, stuffed his pocket with ammo, concealed his weapon, walked through the metal detectors of the U.S. Capitol, aimed his .38 at the back of the head of an officer, pulled the trigger and then went down a hallway and killed another.

``Are his lawyers acting immorally?'' asks Bruce Winick, a University of Miami School of Law professor and the author of The Right to Refuse Mental Health Treatment. ``No. They are trying to save his life. Does it come at the sacrifice of his emotional well-being? Perhaps it does.''

SAD HISTORY

Weston's schizophrenia was in full bloom long before the rampage at the Capitol.

By 1996, he was holed up in a one-room shack in Montana, living on Social Security disability payments. He had paranoias galore, some of which perked the ears of the local Secret Service but were dismissed as a low-level menace.

In the summer of 1996, Weston bought a new suit, a lavish gesture for a man who bathed infrequently and earned the nickname ``Crusty'' from Montana locals. He then drove his truck to Washington.

Weston arrived at the gates of the CIA headquarters in McLean, Va., giving his operative name as ``the Moon.'' Because he said he had a report for the CIA director, he was led to a small conference room. Calmly, Weston launched into 50 minutes of mind-bending expository, all videotaped. Afterward, Weston wasn't detained or arrested because he hadn't threatened the president, an official would later say.

He was involuntarily committed three months later to the Montana State Hospital in Warm Springs after threatening an emergency-room lab worker. Doctors, sensing improvement, released him after seven weeks of treatment. A follow-up appointment was made for him at a clinic in Waterloo, Ill., near his elderly parents' home.

When he showed up, he was bizarre and paranoid, court records state. Clearly, Weston had gone off his medications. When he learned follow-up treatment wasn't court-ordered, he never returned.

Weston's obsession with Washington grew in the meantime. The city was diseased by ``Black Heva.'' He was convinced the override console for his imaginary Ruby Satellite System -- which reversed time -- was kept on the first floor of the U.S. Capitol.

In July 1998, Weston's father came home and found a bucket full of dead cats that Weston had shot with a rifle. He suggested his son find another place to live. After Weston left, his father noticed a .38 revolver was missing.

Just after 3:30 p.m. July 24, Weston approached the ground-floor entrance of the U.S. Capitol on the House side.

Officer Jacob Chestnut, in uniform, was giving directions to a tourist and his 15-year-old son. Weston allegedly barged through the metal detector. He raised his gun to Chestnut's head. The 15-year-old boy was soaked in the officer's blood.

Weston turned left and ran down a short hallway, opened a door marked PRIVATE ENTRANCE and found Special Agent John Gibson, who provided protection for Majority Whip Tom DeLay, R-Texas. Gibson was fatally shot in the chest.

Weston took three bullets. He was given a 50-50 chance of survival and underwent several surgeries. But his mind was left untouched.

UNDER SCRUTINY

Ten weeks after the shooting, the U.S. District Court appointed a forensic psychiatrist to evaluate Weston to assess whether he was competent to stand trial.

Sally Johnson was the chief psychiatrist and an associate warden for the Federal Correctional Institution in Butner, N.C. She'd been the first to examine Hinckley after he shot Reagan. She later examined the Unabomber, Ted Kaczynski.

Johnson found both Hinckley and Kaczynski competent to stand trial.

The legal standard for competence is much lower than the threshold for the insanity defense. Do you understand the role of your lawyer? The judge? The prosecutors? And can you assist your lawyers?

Johnson visited Weston at the Correctional Treatment Facility in the District of Columbia. Johnson's evaluation lasted 20 hours over four days. ``I can explain everything very clearly to you,'' Weston told her.

He recited his theories on the Ruby Satellite System. He described his involvement in the World Summit for Time Reverse Technology. When Johnson asked Weston to explain the role of the defense, he said he was confident his lawyers could explain his concepts of time reversal.

``They didn't just get off the pickle boat,'' Weston said.

Johnson filed her report with the judge: Her opinion was that Weston was incompetent for trial. But, she added, ``with adequate treatment with antipsychotic medication, there is a significant likelihood that competence can be restored.''

MEDICATION ISSUE

Every day in the criminal justice system, mentally ill defendants are sent to psychiatric facilities for ``competence restoration'' -- 90 or 120 days of treatment with antipsychotic drugs. The reasoning is both humane and legally practical: to help a sick person, and to carry out the state's interest in having that person brought to trial.

Weston was packed off to Johnson at the federal prison in North Carolina. But his attorneys had put in place a safeguard: It would take a court order before Weston could be given any drugs.

While Judge Sullivan signed the original order to medicate, the U.S. Court of Appeals for the D.C. Circuit sent the matter back to him, instructing the court to dig into the more thorny implications of medicating a defendant against his wishes.

Would the drugs and their potential side effects interfere with Weston's appearance before a jury, violating his ability to get a fair trial? What if Weston improved on the drugs so much, one judge wrote in his opinion, that the jury would see a completely different person from the one who burst into the Capitol?

Weston's lawyers have said in court that Weston could be medicated immediately if the U.S. attorney's office would back off from seeking the death penalty. But with two federal officers dead, the U.S. attorney's office will not. Sullivan's ruling is likely to be appealed by either side.

Weston, meanwhile, remains secluded at the federal prison in North Carolina.

One of his former lawyers, who worked on the case for 16 months, offers a view different from the psychiatrists and ethicists who have testified over the last two years. Weston isn't tormented in his current state, says former federal public defender Barry Boss. In fact, medication could be the real cruelty.

``When you have complete confidence you are immortal,'' Boss wonders, ``what's going to happen when you're brought back to sanity and you realize what you've done?''
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Panther
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Living hell, or a life saved?

Post by Panther »

Here's a different angle and it doesn't really discuss the greater issue of should we even have the death penalty...

Go ahead and have a trial for Weston. Present him just as he is, along with his time reversal theories, etc. However, don't allow the jury to consider a verdict of "innocent by reason of insanity". Com'on! He did the crime and that is not in dispute! Sooooo, instead allow the jury to spare him the death penalty by giving them the possibility of a verdict of "guilty, but insane". Since it is a criminally violent insanity, he gets life (and it means life). At that point, he and his lawyers can think about medication and help, but it wouldn't mean parole or release for him, just a different mental state.
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Living hell, or a life saved?

Post by Panther »

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR>Originally posted by Ian:

He's not likely to repeat the offense--if continued treatment is mandated, and I would make that a condition of release.

(snip)

What good does the prison sentance do anyone?<HR></BLOCKQUOTE>

It insures that the person will stay on the medication or that if they chose to stop taking the medication, they won't be in a position to harm anyone again if they revert.

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote
I also discussed earlier the fact that I could make anybody psychotic if I got them sick enough--and it's not their fault. Panther, if you went into the hospital for heart surgery and got a serious infections and a bunch of deliriogenic medications, then became convinced your nurse was an alien assassin and tried to kill her--I mean really tried to kill her--and you might wake up the next day your usual sweet self with no recollection of the event.
Hmmmm... Interesting... How about this...

You're brought into an emergency room in extreme pain from some injuries you've suffered in a, well, say a "traumatic encounter". For various reasons, say to help ease the pain or in order to operate, they "put you under". When coming out of it, you are half awake and half in a dream/nightmare state... the nightmare is a situation/continuation of the "traumatic encounter" and as part of that, when someone grabs you, you respond (as much as possible)... But wait... there's a difference. You are 1) at least partically incapacitated from the reasons you're in the recovery room in the first place, 2) there are some pretty big and strong orderlies who know how to handle you with care, yet keep you from hurting yourself or others, and 3) given the situation, you don't have the opportunity or "mindset" to conciously go out and obtain a weapon to inflict harm. (Though all those neat things on the ER counter are pretty menacing... still there's a snowball's chance in July of getting to them before those orderlies descend. Anyway, a good looking and compassionate nurse has always been able to turn me into a big teddy-bear mush-ball. Image Image )

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote
Let's say you were then charged with attempted murder and sentanced to years in prison. Would you be happy about being punished for being ill?
No I wouldn't be, but I see the circumstances as being different. In this example the person is having issues either because of taking some medication or suffering some trauma, while in the case of Weston, he was having issues because of NOT taking some medication. It is far easier for someone to avoid a medication than it is for them to be insured of taking a medication.
<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote
What function does that prison sentance serve?
If I were shown to have the propensity for this criminally violent behaviour, it would protect others from me.

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote
Punishment--for doing something unintentionally?
Ever heard of "Negligent Homicide" or "Involuntary Manslaughter"? People get punished all the time for doing things "unintentionally".

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote
To cause regret--though you'd have it already?
Most people who have been convicted of causing negligent harm have regret and remorse. They still serve the sentence.

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote
Rehabilitation--from illness??
I honestly don't know... Perhaps a way to help someone achieve the enlightenment to make more intelligent decisions in the future.
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Living hell, or a life saved?

Post by Ian »

Panther, you have previously stated (or played devil's advocate by stating) that a cirminal whose time has been served should be able to return to society with his/her debt paid. The idea is, I assume, the time has served its purpose and the person has learned the lesson. He or she has changed, at least in theory.

Say we jail and treat this guy. It's possible that he may become a normal person, a sane one, under treatment. If this happens, the guy is totally changed. He becomes nicer than the average Joe, realizes what he did and regrets it. He's not the same person that committed the crime. He's not likely to repeat the offense--if continued treatment is mandated, and I would make that a condition of release. Keeping him in jail would be like my holding someone responsible for murders in a prior life that person has no recollection of. But let's say I could prove it happened. What good does the prison sentance do anyone?

I also discussed earlier the fact that I could make anybody psychotic if I got them sick enough--and it's not their fault. Panther, if you went into the hospital for heart surgery and got a serious infections and a bunch of deliriogenic medications, then became convinced your nurse was an alien assassin and tried to kill her--I mean really tried to kill her--and you might wake up the next day your usual sweet self with no recollection of the event.

Let's say you were then charged with attempted murder and sentanced to years in prison. Would you be happy about being punished for being ill? What function does that prison sentance serve? Punishment--for doing something unintentionally? To cause regret--though you'd have it already? Rehabilitation--from illness??
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Post by Ian »

"It insures that the person will stay on the medication or that if they chose to stop taking the medication, they won't be in a position to harm anyone again if they revert."

Reasonable, but... there are other ways to ensure taking medication that don't compromise the patients liberty... as much. The patient can be closely followed and subject to mandatory sessions with their local mental health agency, and required to take their medication, the results or the actual taking being observed at the clinic. There are also long acting injectable antipsychotics. With these other options, I don't see the need to confine the patient.

(The other question is, if we require those who have commmitted crimes while insane to have continued forced therapy or confinement because they represent a potential danger (let's clarify, beyond the sentance a san criminal would serve) what stops the state from determining that ANY mental patient is a potential danger and mandating therapy or confinement indefinitely)

Re: reduced likelihood of killing/harming somone when a confused patient... well, perhaps that makes the event less likely, BUT, it doesn't say anything about whether prosecuting the act once it occurs makes sense. YOUR intent is the same whether or not there are orderlies, so even if there is no completed act, there could still be the attempted murder. Which I would NEVER charge you with if you weren't yourself when you made the attempt.

Incidentally, hospital workers are #2 to police if not #1 with respect to risk of being attacked at work, and there usually AREN'T big orderlies around to grab people unless the problem is foreseeable.

"In this example the person is having issues either because of taking some medication or suffering some trauma, while in the case of Weston, he was having issues because of NOT taking some medication. It is far easier for someone to avoid a medication than it is for them to be insured of taking a medication."

Depends. How can Weston be culpable for going insane? It happened to him, he didn't cause it. How could he be culpable, then, for thinking medications were poisonous and not taking them? And if we look less harshly at insanity because of medications, vs because of their absence, that'd mean less culpability for PCP influenced attacks or alcoholic crashes. And some people NEED drugs that make them crazy (Steroids to save the life of an asthmatic CAN make them INSANE temporarily; so can many drugs needed for the acutely ill, or elderly, especially if both at once) and others cannot avoid them (addicts). In any case, how can the ease of preventing a future event speak to culpability for a current event? (You tried to kill, why does it matter if we can try to avoid steroids for you in the future?).

"If I were shown to have the propensity for this criminally violent behaviour, it would protect others from me."

What if treatment removed the propensity? What if you had a propensity but had done nothing--life confinement then? What's the difference, if the confinement is not for the individual but for society at large?

"They still serve the sentence."

But for other reasons, no? Like, they were responsible because they were sane. So there must be another reason to confine our patient... is he a danger? Keep him until he is not. Then what?

"Ever heard of "Negligent Homicide" or "Involuntary Manslaughter"? People get punished all the time for doing things "unintentionally."

Doesn't one also need to be sane and capable of recognizing one's duties to be "negligent" by not performing them?
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Living hell, or a life saved?

Post by Panther »

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR>Originally posted by Ian:

Reasonable, but... there are other ways to ensure taking medication that don't compromise the patients liberty... as much. The patient can be closely followed and subject to mandatory sessions with their local mental health agency, and required to take their medication, the results or the actual taking being observed at the clinic. There are also long acting injectable antipsychotics. With these other options, I don't see the need to confine the patient.<HR></BLOCKQUOTE>

What do you do if the patient doesn't show up for the appointment? Other than that, I don't have any real issues with it. Then again, I believe in personal defense. Image

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote
(The other question is, if we require those who have commmitted crimes while insane to have continued forced therapy or confinement because they represent a potential danger (let's clarify, beyond the sentance a san criminal would serve) what stops the state from determining that ANY mental patient is a potential danger and mandating therapy or confinement indefinitely)
Excellent observation... It holds true in so many ways. In fact, currently the State has that power. Image

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR>Re: reduced likelihood of killing/harming somone when a confused patient... well, perhaps that makes the event less likely, BUT, it doesn't say anything about whether prosecuting the act once it occurs makes sense. YOUR intent is the same whether or not there are orderlies, so even if there is no completed act, there could still be the attempted murder. Which I would NEVER charge you with if you weren't yourself when you made the attempt.

Incidentally, hospital workers are #2 to police if not #1 with respect to risk of being attacked at work, and there usually AREN'T big orderlies around to grab people unless the problem is foreseeable.<HR></BLOCKQUOTE>

Hmmmm, interesting point. I didn't realize that hospital workers were at such a high risk of being attacked at work. Startling if true.

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote
How can Weston be culpable for going insane? It happened to him, he didn't cause it. How could he be culpable, then, for thinking medications were poisonous and not taking them? And if we look less harshly at insanity because of medications, vs because of their absence, that'd mean less culpability for PCP influenced attacks or alcoholic crashes. And some people NEED drugs that make them crazy (Steroids to save the life of an asthmatic CAN make them INSANE temporarily; so can many drugs needed for the acutely ill, or elderly, especially if both at once) and others cannot avoid them (addicts). In any case, how can the ease of preventing a future event speak to culpability for a current event? (You tried to kill, why does it matter if we can try to avoid steroids for you in the future?).
Excellent! Image

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote
What if treatment removed the propensity? What if you had a propensity but had done nothing--life confinement then? What's the difference, if the confinement is not for the individual but for society at large?
Good, good...

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote
But for other reasons, no? Like, they were responsible because they were sane. So there must be another reason to confine our patient... is he a danger? Keep him until he is not. Then what?
Uh-huh...

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote
Doesn't one also need to be sane and capable of recognizing one's duties to be "negligent" by not performing them?
Fantastic!

If I may recap... (Correct me if I get this wrong)

1) There are ways to insure a person with a mental problem that can be corrected through medication takes the medication. These methods allow the person to retain their freedoms and liberties while helping them maintain there ability to function "normally".

2) The State currently has the ability to detain and force treatment/medication on anyone deemed to be a danger to themselves or others. The very definition of that danger is subjective and controlled by those in power and there is the potential for abuse of that power.

3) You wouldn't prosecute (and convict and inprison) someone who committed a violent act because of forces beyond their control, but would seek mental health (or whatever is needed) help for that individual in order to help them regain (or gain) the ability to function "normally" and with a clear frame of mind. Additionally, once the person has (re)gained their rationality, you wouldn't incarcerate them as further punishment.

4) There is a certain amount of sanity that is required to understand negligence and malicious intent.

Do I have that about right?



[This message has been edited by Panther (edited February 07, 2001).]
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Post by Ian »

Do you have this about right... let's see...

1) There are ways to insure a person with a mental problem that can be corrected through medication takes the medication. These methods allow the person to retain their freedoms and liberties while helping them maintain there ability to function "normally".

As normally as possible. In my area at least, there is a program called PACT (program for affirmative community action) in which a team of mental health workers meets, tailors a program to the needs of an individual, and puts it in motion to help many mentally ill people live in the community when they might otherwise spend most or all of their time in a hospital. I'm not positive, but I think it also saves money. I do NOT know what the actual laws are re: mandatory treatment of individuals declared NGBROI and released after they regain their faculties. I will say I personally believe that if a team of mental health professionals believes a patient requires a medication to remain in the community safely, and that patient is out only because s/he's NGBROI and would otherwise be serving a sentance, it should be mandatory. (We'll let you off, but only if you want to avoid repeating this by staying sane on this medicine). I'm not sure what I would say about people beyond the expected sentance for the crime--but I'm leaning toward allowing the competent to make their decisions like everyone else. Then as always, if they deteriorate they'd be under the observation of the police, social workers, psychiatrists, etc and could be brought for evaluation, found to be a danger to self or others, and briefly confined until a judge (see below) authorizes or denies a plan to confine or confine and treat them with or without their consent.

2) The State currently has the ability to detain and force treatment/medication on anyone deemed to be a danger to themselves or others. The very definition of that danger is subjective and controlled by those in power and there is the potential for abuse of that power.

(There is potential for abuse of any power.)Yes, the state may detain and forcibly medicate the mentally ill. In Va, which is all I can speak to, this decision has to be agreed upon by a resident and attending, an independent mental health agency, and a judge who authorizes the treatment after hearing evidence in a hearing provided by the doctors and the counsel for the patient. In my experience, which is by no means all encompassing, the use of this force has been astonishingly beneficial to the treated patient.

3) You wouldn't prosecute (and convict and inprison) someone who committed a violent act because of forces beyond their control, but would seek mental health (or whatever is needed) help for that individual in order to help them regain (or gain) the ability to function "normally" and with a clear frame of mind. Additionally, once the person has (re)gained their rationality, you wouldn't incarcerate them as further punishment.

Depends. Sometimes the violent mentally ill get lucky and end up in a hospital instead of a courtroom. But in general, people who commit crimes ought to be prosecuted, and if they are declared NGBROI, which is NOT easy to do, then they should be treated not punished. Note: treatment frequently takes as long or longer. It's not a vacation.

Example: being completely insane, seeing the devil, yada yada is not a get out of jail free card. One must show the illness lead to the crime. For example, the patient's counsel might prove the patient had longstanding hallucinations that the devil had inhabited his children and that by killing them he might free their souls, and by actually killing them, he meant to help not hurt. This guy oughta be NGBROI.

Sometimes you treat them SO they can stand trial. This is what W's lawyers are fearing. The man who sees the devil everywhere needs to be sane to stand trial for robbing someone, even if the devil had nothing to do with the crime and will not be an excuse. And its good to put normally in quotes. There is quite a range of behavior walking around freely at this moment. I'm sure we have all passed people talking to phone booths or looking at things that aren't there. If they're functional in the community, all's good, in a sense.

4) There is a certain amount of sanity that is required to understand negligence and malicious intent.

Certainly.

In sum, I agree with the above in general. It's not perfect, its not all encompassing, its not detailed enough to take into account all situations, but its a good start.
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Post by Panther »

OK, let me recap again with more detail...

#1) The person maintains their freedom and liberty as long as they remain "mentally healthy". The fact that they were "insane", but have now regained their sanity will be enough for the person to realize the horrendous acts that they have committed in the "insane" state and the punishment of guilt and remorse will come from that fact.

#2) While there is always the possibility for abuse whenever power can be exerted over an individual, in many (most) cases (especially the ones that you know of personally) the use of that power (force) has been beneficial to the individuals in question.

#3) Getting treatment rather than incarceration after a finding of NGBROI isn't an easy out. How about changing the finding to "Guilty, but Insane"? That finding of NGBROI is difficult to obtain.

#4) I got it right on #4...

Is this a better synopsis?
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Post by Ian »

Re # 1 + 3, I don't feel a need to punish anyone who wasn't responsible for what they did when out of their gourd. No one can exercise any control over having or not having schizophrenia. Sometimes people with this disorder or others can control their actions and whenever they can, they should be held accoountable for wrongdoing. But when they cannot control their actions, I don't think the focus should be punishment but treatment, and the safety of patient and others. Punishing is pointless.

I believe the abilities to understand that an action is wrong and to exercise control over whether one does or does not do it is a prerequisite for guilt. Hence, NGBROI, not, Guilty but Insane. This is why animals are not guilty or innocent; rather they are dangerous or not. Young children cannot be guilty of murder if they do not know what death means. If an illness causes an action, I don't blame the sick person, whether delirious sane person or insane person.

Think of it this way: I have a mind control device that makes you kill or even want to kill someone, then post crime a pill makes you able to resist the mind control device. Are you now guilty but insane/controlled? No, you're not guilty, because *I* made you do it. Plus it'd have to be "guilty, but WAS insane" in some cases. If psychosis made you do it instead, you aren't any more culpable, but then there is no one to blame. But that's life. Sometimes blame is not the issue.

Re #2, I will just speak to what I saw, which was benefit to the patient. I don't know any national trends. Benefit is a tricky word too. Some people of all the ethical values place autonomy highest. They would release a person from a hospital and say they benefitted if they are possibly homeless, or estranged from family, unemployed, perhaps using substances, if they are doing what they say they prefer. Others would value beneficence higher and commit that person if s/he could not integrate into society well, and say they benefitted ebcause they're on good terms with family again, employed in the hospital shops, sheltered, well groomed, dressed, illicit drug free, but always a little irritated at not being able to go crazy if they want to go off their meds.

It's a continuum of opinion, and there is no easy answer to where we ought to fall.
Gene DeMambro
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Living hell, or a life saved?

Post by Gene DeMambro »

I came across this information, which is particularly relevent to this case.

In the 1990 Washington vs. Harper case, the Supreme Court ruled that a convicted inmate's refusal to accept antipsychotic medication could be overriden. The court reasoned that because of the high frequency and often alarming nature of side effects due to these medications, the 14th Amendment liberty interest required an "overriding justification and determination of medical appropriateness" need be present before antipsychotic medication can be given. Also, Harper's due process rights were protected by the prison's internal review system. This case's citation is 494 US 210[1990].

In 1992, the Supreme Court ruled on the right of a criminal defendant to refuse antipsychotic treatment. In the Riggins v. Nevada case, the court ruled that the prosecution had to prove that the thioridazine (the medication to be given -Ed) was medically appropriate and essential for the safety of the defendant and others. The court actually reversed a conviction and death sentence for murder and robbery with a deadly weapon in this case. The court did not address the issue of whether a criminal defendant would be allowed to refuse antipsychotic treatement if that would make him/her otherwise incompetent to stand trial (this issue was not presented at trial). However, Justice Kennedy wrote in a concurring opinion that "synthetic competence" leaves an evidentiary burden that is unlikely for states to satisfy.

It appears in the Riggins case that the court applied a strict scrutiny test, and balanced the state's interest to see Riggins tried versus Riggins own right to refuse medical treatment, as well as his due process rights. Unless the state can prove that medication is essential to protect the accused's safety or the safety of others, the state can't compel treatment. Again, the court did not address the issue of whether a state can compel treatment if that treatment will make him competent to stand trial. This case's citation is 112 S.Ct. 1810 [1992]

Recently, the 8th Circuit, US Court of Appeals, reduced a sentence of death to life inprisonment for a convict who was incapable of understanding his punishment unless forced to take drugs. The court ruled in Singleton v. Norris that states may not involuntarily medicate an otherwise incompetent prisoner and then execute him if the medication renders him competent. I don't have the citation, but the decision was filed on Oct. 12, 2001 and can be seen (among other places) on http://www.ca8.uscourts.gov/opndir/01/10/001492P.pdf (I got there by going to http://www.law.cornell.edu/ ). I don't know if the decision will be appealed by the State of Arkansas (i.e. Norris).

Since criminal defendants have more due process rights that prison inmates, and the standard for determining competent to stand trial is much higher than the fitness for execution, it seems doubtful that courts will allow states to medicate defendants in order to make them fit for trial, nor will the courts allow those convicted and sentenced to death be executed if they are "synthetically competent", and would be incompetent otherwise.

I liberally used information from, "Right of a defendant to refuse antipsychotic medication during a criminal trial", written by Karl G. Williams as published in the American Journal of Hospital Pharmacy, 1993, Volume 50, pages 1937-1939.

Gene
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Living hell, or a life saved?

Post by Guest »

[QUOTE]Originally posted by Ian:
Re # 1 + 3, I don't feel a need to punish anyone who wasn't responsible for what they did when out of their gourd.

Yes & No......so commit the criminally insane and treat them,no choice no appeals fix them for the protection of society.

Out of their gourd not their fault,if they are sick you are right it's not their fault and as wards of the state hopefully we can help them,no matter how long it takes.

The other side of the coin......Out of their gourd because of recreational substance abuse. I remember a case in Canada were some guy got off for a rape he committed because "he was too drunk to know what he was doing". (This is justice?)

So what about the patient who stops taking medication because he doesn't like the side effects and then gradually gets worse and then commits a crime? The choice to stop medicating was made while competent. Is the patient accountable for the actions after they become ill as a result of there own decisions?

Interesting thread!

Laird
Gene DeMambro
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Living hell, or a life saved?

Post by Gene DeMambro »

"Out of their gourd not their fault,if they are sick you are right it's not their fault and as wards of the state hopefully we can help them,no matter how long it takes."

In the Riggins v. Nevada concurring opinion Justice Kennedy wrote that an accussed murderer who is incompetent will probably not be released because of the magnitude of the crime, but neither will they be allowed to stand trial. This creates a "limbo", which Justice Kennedy thinks requires keeping incompetent defendants in mental health facilities. He thinks this "is a burden that must be borne by society to protect the integrity of the trial process."

If competent, then trial.

If incompetent, and medications are not compelled, then no trial until competency can be shown.

If incompetent, and medication is compelled, then still non trial, unless competency can be shown without medications.

Excerpts from "Right of a defendant to refuse antipsychotic medication during a criminal trial", written by Karl G. Williams as published in the American Journal of Hospital Pharmacy, 1993, Volume 50, pages 1937-1939.

Gene
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Living hell, or a life saved?

Post by LeeDarrow »

VERY interesting thread!

My comments interspersed - with **'s to note them.

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR>Originally posted by Panther:

OK, let me recap again with more detail...

#1) The person maintains their freedom and liberty as long as they remain "mentally healthy". The fact that they were "insane", but have now regained their sanity will be enough for the person to realize the horrendous acts that they have committed in the "insane" state and the punishment of guilt and remorse will come from that fact.

**Obviously, you have not dealt intimately with someone who has gone through rehab, AA or the like. Many are in denial of responsibility for bad acts committed when they were "using." Sorry to disagree, but IME, this is far more the norm than your statement. Also, clinical diagnoses in mental health situations are often based on an individual interpretation of the DSM-IV(r) or newer standards. There is no concrete gauge to determine mental health. See any trial where NGBROI is used and you will find as many different opinions on sanity as there are expert witnesses.

#2) While there is always the possibility for abuse whenever power can be exerted over an individual, in many (most) cases (especially the ones that you know of personally) the use of that power (force) has been beneficial to the individuals in question.

** Really? In Illinois we just released some 27 people from death row who were PROVEN not to have committed the crime they were convicted of based on DNA or other evidence. This does not measure up. Abuse of power exists and, in some systems, runs rampant, especially in the mental health field. See the Dr. Bennett Braun case on "recovered memory" for details of that one. APA's Man of the Year got nailed for patient abuse in alleged "satanic abuse conspiracy" matter which was disproven in court. Patient (not initially showing severe symptomology) wound up being forcibly removed from her home state, put through drug and hypnotic and electroconvulsive therapy to get her to "remember" abuse at the hands of a non-existant satanic cult. Other cases in that area abound.

#3) Getting treatment rather than incarceration after a finding of NGBROI isn't an easy out. How about changing the finding to "Guilty, but Insane"? That finding of NGBROI is difficult to obtain.

**Is this a legal ruling that is applicable? Student? Sounds like a very reasonable alternative and could allow the court to mandate in-patient treatment that might allow some recovery.

#4) I got it right on #4...

Is this a better synopsis?

<HR></BLOCKQUOTE>


Respectfully,

Lee Darrow, C.Ht.
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Living hell, or a life saved?

Post by Ian »

"The other side of the coin......Out of their gourd because of recreational substance abuse. I remember a case in Canada were some guy got off for a rape he committed because "he was too drunk to know what he was doing". (This is justice?)"

Complicated issue. This refers to a comment I made meant to refer only to the psychiatrically ill, that is, nutz by no fault of their own. People who voluntarilly get stoned take responsibility for their actions.

However, I've always found it weird that the punishment is NOT for what you had control over.

For example, Mr Ed gets drunk and drives, and so does Mr. Fred. The former hits a tree, the latter hits a crowd fulla schoolgirls. The wrongness of the act isn't any different, ust the wrongness of the outcome.

"So what about the patient who stops taking medication because he doesn't like the side effects and then gradually gets worse and then commits a crime? The choice to stop medicating was made while competent. Is the patient accountable for the actions after they become ill as a result of there own decisions?"

That's another tough question. The side effects from these drugs are pretty incapacitating at times. I knew this one guy who required a drug called clozaril to function on the outside. It caused him terrible sedation and made him pretty dumbed down and uncreative. That, and he needed to get a blood test weekly to see if it was causing the potentially fatal reaction its known for causing. He'd go off the stuff while "competent," but without insight. That is, he wasn't ever convinced he needed it, or was ill. that's a big part of the illness many of these people have. Then he'd decompensate and get brought back in. On one such visit he assaulted a med student. He's nuts when he did it, and in my opinion, not culpable for stopping the med, although technically he was competent at the time he stopped. If he MEANT to get ill and harm people, that'd be another story entirely, and I wager, a new court precedent to be set.

"Really? In Illinois we just released some 27 people from death row who were PROVEN not to have committed the crime they were convicted of based on DNA or other evidence. This does not measure up. Abuse of power exists and, in some systems, runs rampant, especially in the mental health field. See the Dr. Bennett Braun case on "recovered memory" for details of that one. APA's Man of the Year got nailed for patient abuse in alleged "satanic abuse conspiracy" matter which was disproven in court. Patient (not initially showing severe symptomology) wound up being forcibly removed from her home state, put through drug and hypnotic and electroconvulsive therapy to get her to "remember" abuse at the hands of a non-existant satanic cult. Other cases in that area abound."

--posted in response to something panther wrote about something i wrote. Of note, that something i wrote specified that I was referring to my personal experience, and panther echoed that caveat and addecd teh statement referrred only to "most" patients. Like I said earlier, all powers get abused, and whether that happens ever is only part of the equation when it comes time to decide if they should still have them. Not sure what the DNA evidence on some criminals has to do with this part of the thread, since these people aren't being convicted of a crime but diagnosed with some illness. People diasgree about the exact diagnosis or whether its established or just likely, but usually there's no argument about whether the person has SOMETHING or not. Setting the limits for what constitutes grounds for forced therapy is TOUGH and subjective. Again, of all the ones i meet, I thought they were clearly nutty and benefitted from their treatment, although it was impossible to say that, for example, they on their last day of confinemet/ treatment before release weren't better off than people who just made it under the threshold for being confined or treated at all. Tough.
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