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WASHINGTON, Oct. 6 — The Supreme Court today let stand a ruling by a federal appeals court that Arkansas officials may force a convicted murderer to take drugs to make him sane enough to be executed.
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EU
Statement on Death Penalty in the US State of Arkansas (Charles Laverne
Singleton) OSCE Permanent Council: EU Statements The European Union is opposed to the death penalty in all cases and accordingly aims at its universal abolition, seeking a global moratorium on the death penalty as a first step. The EU has learnt that Mr. Charles Laverne Singleton, who is on death row, is being forced to take antipsychotic medication in order to make him sane enough to be executed. Without drugs Mr. Singleton could not be put to death under a U.S. Supreme Court decision that prohibits the execution of the insane. The Union strongly believes that forced medication in order to make a person sane enough to be executed is contrary to widely accepted human rights norms and the minimum standards of human rights set forth by the United Nations. The EU urges the appropriate authority in Arkansas to grant Mr. Singleton relief from his death penalty. The Acceding Countries Cyprus, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, the Slovak Republic and Slovenia and the Associated Countries Bulgaria, Romania and Turkey align themselves with this statement. source:
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The court also let stand a ruling by the South Carolina Supreme Court upholding a murder conviction for a woman who used crack cocaine and then delivered a stillborn baby.
The court opened its fall term this morning by listing dozens of cases from lower courts that the justices had reviewed over their summer recess and chose not to reconsider. Although they did not rule directly on the Arkansas and South Carolina cases, both represent an acceptance of expansions of state authority.
In the Arkansas case, the appeals court based in St. Louis had ruled, 6 to 5, that the Constitution's prohibition against cruel and unusual punishment would not be violated if the authorities forcibly administered antipsychotic medication to the inmate, Charles Laverne Singleton.
The appeals court rejected arguments by Mr. Singleton's lawyers that giving him the drugs was not medically useful to him, as the only purpose would be to facilitate the ending of his life.
The Supreme Court ruled in a pair of cases in 1986 that executing the insane was prohibited by the Eighth Amendment's edict against cruel and unusual punishment. In one of the cases, Justice Lewis F. Powell set out the standard, saying 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."
But until the Singleton case, no appeals court nor the Supreme Court, had ruled on whether a prisoner may be forcibly medicated in order to be made sane enough to be executed.
Mr. Singleton killed a grocery clerk in Arkansas in 1979 and was sentenced to death that year. His mental health began to deteriorate in 1987; he said he believed his prison cell was possessed by demons and that the authorities had planted a device in his ear. He insisted that his victim, whom he had known at the time of the murder, was still alive.
The appeals court judges were in sharp disagreement over what should be done when they ruled in February. Judge Roger L. Wollman, writing for the majority, said that the court had a choice "between involuntary medication followed by execution and no medication followed by psychosis and imprisonment."
Judge Wollman went to some lengths to note that Mr. Singleton's guilt was not in doubt, even though the issue was not before the court.
Judge Gerald W. Heaney, in dissent, said the authorities should have allowed the prisoner to be medicated without the consequence of execution. "I believe that to execute a man who is severely deranged without treatment, and arguably incompetent when treated, is the pinnacle of what Justice Marshall called `the barbarity of exacting mindless vengeance.' "
Scholars in medical ethics have said the notion of medicating people to improve their mental health to the point where they may be executed can present formidable obstacles for doctors. In practice, that could mean allowing nonmedical personnel to administer the drugs.
The case of the mother convicted of murder after her baby was delivered stillborn is the latest development in the the issue in South Carolina, where officials have been especially determined to make pregnant women responsible for their behavior.
The South Carolina Supreme Court first upheld the practice of state officials' treating a fetus as a person in connection with the prosecution of pregnant women who used drugs.
The case at issue today involved Regina McKnight, who was described in court documents as having low intelligence and who was helped with her everyday needs by her mother until 1998. Her lawyers said that after her mother was killed in a hit-and-run accident, Ms. McKNight "quickly spiraled downward, becoming homeless, addicted to cocaine and marijuana — and pregnant."
After she delivered a stillborn female, nurses took samples from her and the baby and sent them to the authorities under a procedure put in place by the state. Both tested positive for cocaine.
The state had previously prosecuted women for abuse if their delivered babies showed traces of cocaine, but Ms. McKnight's was the first drug-related case to be tried and convicted for murder under the "homicide by abuse" law.
source: http://www.nytimes.com/2003/10/06/politics/06CND-SCOT.html?tntemail0=&pagewanted=print&position= 6oct03
As if dealing with the ethical aspects of treating patients was not difficult enough, a recent decision by a U.S. appeals court could, if upheld by the Supreme Court, put some medical doctors into an especially precarious moral position. The U.S. Court of Appeals for the Eighth District in St. Louis ruled with the narrowest possible margin of 6 to 5 that a psychotic death row inmate, Charles Laverne Singleton, should receive antipsychotic medication to avoid being a threat to himself and others. Mr. Singleton, who was found guilty of killing a grocery store clerk, became psychotic in prison.
"Eligibility for execution is the only unwanted consequence of the medication." --Judge Roger L. Wollman
Since the Supreme Court ruled in 1986, however, that it is against the law to execute insane prisoners, medicating Mr. Singleton would also provide a legal basis for executing him.
The majority of judges argued that it was a better choice to force Mr. Singleton to be medicated because the drugs were generally beneficial to him. Furthermore, it was reasoned that the court did not need to consider the ultimate result of medicating the prisoner: "Eligibility for execution is the only unwanted consequence of the medication," wrote Judge Roger L. Wollman for the majority.
The Down Side
There are likely sound legal reasons for these arguments, but while a judge may not be obligated to consider long-term consequences of a verdict, a physician cannot ignore how a treatment will affect a patient in the long run. As it stands, the court's decision asks physicians--in its ultimate consequence--to treat a patient so he can be killed. From a legal point of view, there are only a few circumstances under which a person can be ordered to undergo a medical procedure against his will. A driver who shows evidence of intoxication may be ordered to give a blood sample. In this case, the interest of society in preventing and punishing the dangerous behavior of one of its members outweighs the individual's right of refusal to undergo a minor test.
In the case of Charles Singleton, however, there is no likely immediate or future danger to others if he remains imprisoned. Furthermore, the medical procedure, while very likely beneficial to the patient in the short term, leads to the gravest possible outcome.
Doing No Harm?
Physicians base their actions on what is in the best interest of their patients and on their patients' wishes. The oath that many medical students take upon graduation reflects these principles. The oath of the Class of 2002 at Harvard Medical School and the Harvard School of Dental Medicine contained the passage "To my patients: I will commit myself to healing, whenever possible, and comforting always, with hope and honesty ... I will respect my patients' autonomy and dignity, in living and in dying...." Without doubt the court's decision, if confirmed by the Supreme Court, will not directly affect many physician-patient relationships, but it seems to me, a medical layperson, that it touches the ethical foundation this relationship is built on. I also wonder whether the burden the ruling places on physicians in the penal system is acceptable to the profession.
--Jan Schmollinger, an HMS research associate in medicine at the Dana-Farber Cancer Institute
The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.
source: http://webweekly.hms.harvard.edu/archive/2003/2_24/student_scene.html 6oct03
MAY I interrupt the conversation about weapons of mass destruction for just a moment to talk about weapons of individual destruction? Can we turn our thoughts briefly from the fate of innocent civilians to the fate of convicted criminals? To the times when the logic of law leads, one step at a time, to the lunacy of law?
Such is the case of Charles Laverne Singleton, madman and resident of death row in Arkansas. Earlier this month the 8th Circuit Court ruled that Singleton could be forcibly medicated in order to make him sane enough to be executed. In a courtroom drama that turned into theatre of the absurd, the judges said he must be cured to be killed.
Here are two undisputed facts about Singleton: He is a murderer, and he is psychotic.
He stabbed a grocery clerk to death in 1979, three years after the Supreme Court reinstituted the death penalty. He descended into raving, delusional mental illness in 1987, one year after the same Supreme Court ruled that states couldn't execute a crazy person.
In the case of Ford vs. Wainwright, the justices declared it was "cruel and unusual punishment" to execute someone who was mentally incompetent - so incompetent that he didn't understand his fate or the meaning of death or why he was condemned.
The decision was welcome but the standard was so low that even Rickey Ray Rector passed the so-called Ford test in 1992 - when Bill Clinton famously came off the campaign trail to authorize his death. Rector, it should be remembered, went off to his execution, leaving some of his last meal, a piece of pecan pie to have "later."
Today, the insanity defense is notoriously unsuccessful. But the courts have heard a rash of cases about mental competency, mental illness, medication, and legal rights. At this moment, Russell Eugene Weston Jr., is being forcibly medicated so that he can stand trial in the 1998 fatal shooting of two guards in the US Capitol. Meanwhile the Supreme Court has decided to hear the appeal of dentist Charles Sell, asking whether it's legal to forcibly medicate a mentally ill man so he can face a civil trial, in this case for Medicaid fraud.
This is an age when mental illness often seems like a matter of chemistry. In the judicial system, there are many reasons to force medication on a delusional defendant: How can an irrational man make rational decisions about his treatment, let alone his trial?
There are reasons to worry about it as well: What happens when a defendant comes to court "cured" and the jury sees a "different person" than the one who committed a crime?
But the ethics of treating a patient and defendant for mental illness get far more compelling when the death penalty is involved.
When Singleton first was diagnosed as psychotic - possessed by demons - he was under a stay of execution. It could be said that he was medicated for his own good. Sometimes he took the medication voluntarily, sometimes forcibly; sometimes it helped, sometimes it didn't. But when the stay was lifted and he was back on track for execution, defining "his own good" became a much dicier proposition.
In the Circuit Court opinion, one of the judges wrote that "eligibility for execution is the only unwanted consequence of the medication," as if execution were a mere side effect of the drugs like, say, dry mouth. But if it's unethical, by AMA standards, for doctors to participate in executions, how can it be ethical to treat someone if the cure is, literally, more deadly than the disease?
Singleton's case, which will be appealed to the Supreme Court, is part of the chaos and uncertainty and unease swirling around the death penalty.
In the past year, it became unconstitutional to execute the mentally retarded. But we can still execute juveniles. Since arriving in office, Attorney General John Ashcroft has ruled 28 times that local district attorneys must pursue the death penalty, against their own judgment, in the name of "consistency." But leaving office, Illinois Governor George Ryan commuted death sentences for 164 men and three women, saying, "Our capital system is haunted by the demon of error - error in determining guilt and error in determining who among the guilty deserves to die."
Much of the controversy over the death penalty is, as it should be, about guilt and innocence and error. But the way we deal with the mentally ill, the incompetent, strikes at the moral heart of the matter.
Singleton faced a bizarre choice between a lifetime sentence of insanity or the cure of a death sentence.
As for those who believe that the death penalty can be reasonable and fair? The story of Charles Laverne Singleton has ended that delusion.
The federal appeals court in St. Louis ruled yesterday that officials in Arkansas can force a prisoner on death row to take antipsychotic medication to make him sane enough to execute. Without the drugs, the prisoner, Charles Laverne Singleton, could not be put to death under a United States Supreme Court decision that prohibits the execution of the insane.
Yesterday's 6-to-5 decision is the first by a federal appeals court to allow such an execution. "Singleton presents the court with a choice between involuntary medication followed by an execution and no medication followed by psychosis and imprisonment," Judge Roger L. Wollman wrote for the majority in ruling by the United States Court of Appeals for the Eighth Circuit.
Judge Wollman said the first choice was the better one, at least when the drugs were generally beneficial to the prisoner. He said courts did not need to consider the ultimate result of medicating the prisoner.
"Eligibility for execution is the only unwanted consequence of the medication," he wrote.
Judge Gerald W. Heaney, in dissent, said there was a third choice. He would have allowed Mr. Singleton to be medicated without fear of execution.
"I believe," he wrote, "that to execute a man who is severely deranged without treatment, and arguably incompetent when treated, is the pinnacle of what Justice Marshall called 'the barbarity of exacting mindless vengeance.' " Judge Heaney added that the majority's holding presented doctors with an impossible ethical choice.
Mr. Singleton killed a grocery store clerk in Arkansas in 1979 and was sentenced to death that year. His conviction was affirmed in 1981 by the Arkansas Supreme Court.
In 1986, the United States Supreme Court held in an opinion by Justice Thurgood Marshall, that the execution of the insane was barred by the Eighth Amendment, which prohibits cruel and unusual punishment.
Mr. Singleton's mental health began to deteriorate in 1987. He said he believed his prison cell was possessed by demons and that a prison doctor had implanted a device in his ear.
In December 2001, he wrote to the appeals court to inform it that he did not believe his victim was dead and that she was "somewhere on earth waiting for me -- her groom."
Based on extensive medical evaluations describing Mr. Singleton as psychotic, his lawyers have argued that he is mentally incompetent and thus cannot be executed. Drugs alleviate his symptoms, however, and Judges Wollman and Heaney differed yesterday on whether they rendered Mr. Singleton sane or merely masked his psychosis.
The Supreme Court has held that prisoners may be forced to take antipsychotic medications in some situations. Prisoners who are forced to take medications to ensure that they are competent to stand trial are entitled to a hearing to consider the medical appropriateness of the treatment, the risk the defendant poses to himself and others, and the drug's effect on the defendant's appearance, testimony and communications with his lawyer.
The Supreme Court has not ruled on whether prisoners may be medicated in order to make them competent to be executed.
Over the years, Mr. Singleton has sometimes taken antipsychotic medication voluntarily and has sometimes been forced to take it. Arkansas officials argued that Mr. Singleton must be medicated because he posed a danger to himself and to others.
Mr. Singleton's lawyers responded by saying, in Judge Wollman's characterization, that forcible medication "becomes illegal once an execution date is set because it is no longer in his best medical interests."
The majority decision yesterday said Mr. Singleton's interest in being free of unwanted medication must be balanced against society's interest in punishing criminal offenders. It overturned a ruling by a three-judge panel of the court, which had commuted Mr. Singleton's death sentence because he could not understand his punishment without being medicated.
Judge Heaney, in dissent, noted that the majority's decision gave doctors hard choices.
"Needless to say," he wrote of the majority's holding, "this leaves those doctors who are treating psychotic, condemned prisoners in an untenable position: treating the prisoner may provide short-term relief but ultimately result in his execution, whereas leaving him untreated will condemn him to a world such as Singleton's, filled with disturbing delusions and hallucinations."
Judge Heaney's opinion was joined by three other judges. Judge Diana Murphy dissented on a different ground. She said the record was not clear on whether Singleton was psychotic and that it was premature to take up the case.
The American Medical Association's ethical guidelines prohibit giving medical treatment that would make people competent to be executed, said Dr. Howard Zonana, who teaches psychiatry and law at Yale.
"You can't treat someone for the purpose of executing them," he said.
Jeffrey Marx Rosenzweig, Mr. Singleton's lawyer, said that he was considering asking the United States Supreme Court to hear the case, which he said presented an important question of constitutional law.
"To what extent," he asked, "can a government take invasive, involuntary action using medical personnel who are sworn to heal, save and treat when the result of their medical application and experience is not healing, treating and saving but instead has the result of causing execution?"
Kelly Kristine Hill of the Arkansas attorney general's office, who represented the state, said the court's ruling was limited and correct.
"The ethical decisions involving doctors are difficult ones," she acknowledged, "but they are not ones for the courts."
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