No, a prison doesn't need a judge's permission. Forcing someone to take medicine is serious, but prisons have to keep everyone safe. If the prison's rules make sense for safety and the medicine helps the sick prisoner, it's okay. The prison's meeting process was fair - they told Harper ahead of time, let him speak up, and had people who weren't his doctors make the decision. Doctors know more about medicine than judges do, so it makes sense to let them decide.

I agree with the main decision. But it would be better if there was an official court process first to say the person can't make their own decisions. That would protect everyone and make things clearer.

The prison should need a judge's permission. Forcing someone to take these strong medicines is really serious - the medicines can change how people think and have bad side effects that might never go away. The prison's meeting isn't really fair because everyone there works for the prison. They might care more about making their jobs easier than what's best for the prisoner. This isn't a real fair hearing - it's fake.

I believe that prisons can force a mentally ill prisoner to take psychiatric medicine if the prisoner is dangerous and a doctor says the medicine is necessary for the prisoner's health. This is because prisons have to keep prisoners and staff safe. The prison has to give the prisoner medical treatment that is in his best interest and also meets the prison's needs. The prison rule is okay because it only applies to mentally ill prisoners who are very sick or dangerous, the medicine can only be given for treatment and under a psychiatrist's direction, and there is a fair process including a hearing. The hearing process in the prison's rule is enough to make sure the decision isn't arbitrary or wrong.

I agree with the Court's opinion, but think it would be better if a mentally ill prisoner was formally committed by a court when they seem incompetent. This would be more protective for everyone involved.

I disagree with the Court's decision. I think they didn't give enough importance to the prisoner's right to refuse medicine. The prison's rule allows forced medication even when it's not medically necessary, just for the prison's convenience. This goes too far. Also, the decision is made by doctors who work for the prison, so they aren't impartial. I would have upheld the lower court's decision requiring a hearing with more protections for the prisoner.

There is "a significant liberty interest in avoiding the unwanted administration of antipsychotic drugs under the Due Process Clause of the Fourteenth Amendment."

The court held that "the Due Process Clause permits the State to treat a prison inmate who has a serious mental illness with antipsychotic drugs against his will, if the inmate is dangerous to himself or others and the treatment is in the inmate's medical interest

—prisoner has liberty interest under the Due Process Clause in freedom from involuntary administration of psychotropic drugs

Concluding that Plaintiff has a protected liberty interest in avoiding the involuntary administration of medication

The forcible injection of medication into a nonconsenting person's body represents a substantial interference with that person's liberty

—and the idea that "[t] he extent of a prisoner's right under the [Due Process] Clause to avoid the unwanted administration of antipsychotic drugs must be defined in the context of the inmate's confinement,"

The Supreme Court has held that "the standard of review adopted in Turner applies to all circumstances in which the needs of prison administration implicate constitutional rights."

Persons opposed to the involuntary administration of psychotropic medication argue that these drugs have "serious, even fatal, side effects."

In support, they cite numerous Supreme Court cases holding that individuals have a fundamental right to refuse unwanted medical treatment,

No. The Due Process Clause does not require a judicial hearing before a state may involuntarily medicate a mentally ill inmate with antipsychotic drugs, provided the state's policy is reasonably related to legitimate penological interests. An inmate possesses a significant liberty interest in avoiding the unwanted administration of antipsychotic drugs, but this interest must be evaluated in the context of incarceration. The proper standard of review, established in Turner v. Safley, is whether the prison regulation is 'reasonably related to legitimate penological interests.' The State has a legitimate and important interest in prison safety and security, as well as an obligation to provide medical care to inmates. The policy here is reasonably related to these interests as it applies only to inmates who are mentally ill, dangerous to themselves or others, and where the treatment is in the inmate's medical interest. The administrative hearing procedure, which provides for notice, a hearing before independent staff, the right to present evidence, and the assistance of a lay adviser, adequately protects the inmate's due process rights under the Mathews v. Eldridge balancing test. Allowing medical professionals, rather than a judge, to make these treatment decisions is an appropriate and constitutional way to balance the competing interests.

I join the Court's opinion. The difficulty of this issue would be lessened if, in appropriate cases, the mentally ill patient is formally committed. A formal commitment proceeding would be a protective measure for all parties involved—the inmate, the institution, the staff, the physician, and the state—and should not be neglected when there are significant indications of incompetency.

The Due Process Clause requires greater procedural protections than the state's policy provides, and a judicial hearing is the appropriate remedy. The majority gravely undervalues the fundamental liberty interest in avoiding forced, mind-altering drugs that have severe and potentially irreversible side effects. The Court misapplies the Turner standard; the state's policy is an 'exaggerated response' to security concerns and allows medication for institutional convenience rather than being narrowly tailored to the inmate's medical interests. The administrative hearing is a 'mock trial' before an institutionally biased tribunal whose members, as prison employees, have a conflict of interest between the inmate's medical needs and the prison's administrative goals. The procedural safeguards are inadequate and fail to provide the impartial review necessary to protect such a significant liberty interest.

I hold that, given the requirements of the prison environment, the Due Process Clause permits the State to treat a prison inmate who has a serious mental illness with antipsychotic drugs against his will, if the inmate is dangerous to himself or others and the treatment is in the inmate's medical interest. This is because the State's interest in combating the danger posed by a person to both himself and others is greater in the prison environment. The State has undertaken the obligation to provide prisoners with medical treatment consistent with their medical interests and the institution's needs. Policy 600.30 comports with the Due Process Clause because it applies exclusively to mentally ill inmates who are gravely disabled or represent a significant danger to themselves or others as a result of their illness, the drugs may be administered only for treatment and under the direction of a licensed psychiatrist, and there are procedural protections including the right to a hearing. The administrative hearing procedures set by the SOC Policy are sufficient to ensure the decision is neither arbitrary nor erroneous.

I join the Court's opinion, but add a caveat that much of the difficulty will be lessened if, in any appropriate case, the mentally ill patient is formally committed. This may seem a bother or nuisance, but it would be protective for all concerned when significant indications of incompetency are present.

I disagree with the Court's evaluation of the merits. The Court has undervalued respondent's liberty interest, misread the State's Policy, misapplied the standard from Turner v. Safley, and concluded that a mock trial before an institutionally biased tribunal constitutes due process of law. A competent individual's right to refuse psychotropic medication is a fundamental liberty interest deserving the highest order of protection under the Fourteenth Amendment. Policy 600.30 permits forced drugging absent a determination that it is medically appropriate, and instead allows treatment to be ordered for security and institutional concerns. This is an exaggerated response under Turner. Finally, the procedures of Policy 600.30 are constitutionally deficient because the decision is made by non-impartial medical professionals who lack independence. I would affirm the decision of the Washington Supreme Court requiring greater procedural safeguards.

Washington v. Harper

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