Public Health Law Map - Beta 5 - Medical and Public Health Law Site

diagnosis and treatment of their medical conditions. The correctional staff should
not be in the position of dictating medical care decisions. Under no circumstances
should access to proper medical care be used as a disciplinary tool. The prison
officials do have the right to ensure that prisoners do not use untreated illness to
avoid prison discipline and that prisoners’ medical conditions do not interfere with
prison order.
b) Right To Refuse Medical Care
Prisoners have a liberty interest, protected by the Fourteenth Amendment, in not
being treated against their will. The extent of this liberty interest was defined in
Washington v. Harper, [Washington v. Harper, 110 S. Ct. 1028 (1990).] a case
arising from a prisoner’s objection to being given antipsychotic medications. The
Washington prison system provided elaborate administrative protections before an
inmate could be medicated against his will. The Washington Supreme Court
rejected these administrative protections as inadequate and required that an inmate
be given a full adversarial hearing before being treated against his will:
The [Washington Supreme] Court concluded that the “highly intrusive
nature” of treatment with antipsychotic medications warranted greater
procedural protections.… It held that, under the Due Process Clause, the
State could administer antipsychotic medication to a competent,
nonconsenting inmate only if, in a judicial hearing at which the inmate had
the full panoply of adversarial procedural protections, the State proved by
“clear, cogent, and convincing” evidence that the administration of
antipsychotic medication was both necessary and effective for furthering a
compelling state interest. [Washington v. Harper at 1035.]
Mr. Harper, the prisoner who brought this action, claimed that the prison
authorities could not medicate him unless he was found to be mentally incompetent
in an adversarial hearing. He further alleged that even if he was found to be
incompetent, he could be medicated only if the fact finder determined that he
would have consented to the medication had he been competent. The U.S. Supreme
Court rejected these claims, finding that the prison’s policy was constitutionally
adequate. The Court’s rationale for endorsing the prison’s policy is relevant to the
general problem of prison health because it accepts expert decision making as a
substitute for adversarial decision making.
The Court reviewed the Washington Supreme Court’s decision to determine what
facts would support a decision to force antipsychotic medication on a prisoner and
what procedural protections were necessary to determine those facts. It agreed that
Harper had a liberty interest in not being medicated against his will. However, the
Court held that this liberty interest was sufficiently protected by the prison’s
administrative proceeding, which required that a psychiatrist certify the treatment’s
appropriateness.
The Court’s acceptance of expert decision making as a substitute for an adversary
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