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Sometimes the black letter law passed by the legislature is unclear. The legislature can’t anticipate every possible fact scenario when they pass a law, so it lay to the courts to interpret the law and give guidance to what it means. This interpretation is called case law. When the court decides a certain meeting to the law it essentially answers a legal question. Lawyers and other courts then can rely on that ruling when they have a similar issue in their case. The following case answers the question above.

Rogers v. Okin, 634 F.2d 650 (1st Cir. 1980).

This case answers the following question:

When, if ever, may state officials force a mental health patient to take antipsychotic drugs?

This case arises under the Fourteenth Amendment’s guarantee of due process, particularly, the “interest in being left free by the state to decide for [one’s] self whether to submit to the serious and potentially harmful…administration of antipsychotic drugs.” Id. at 653. This interest, however, must be balanced against the interests of the state, including protecting the public from the mentally ill. Id. at 654. Ultimately, the court determined that the decision to forcibly administer such medications must be determined on a case-by-case basis, balancing the “state’s purpose in administering drugs…to further its police power interest” with the individual’s right to refuse, using procedures whereby the necessary determinations can be made with due process.” Id. at 656.

This case is an appeal from a collective action by “voluntary and involuntary psychiatric patients at Massachusetts state mental health facilities.” Id. at 653. The defendants included the “Commissioner of Mental Health” and others responsible for the care of the plaintiffs. Id. The action stems from forced medication procedures, which are applied uniformly without regard the circumstances of individual patients and without any emergency need. Rogers v. Okin, 478 F. Supp. 1342, 1352 (D. Mass. 1979). More specifically, “defendants routinely employed seclusion as a treatment modality, and not merely as an emergency restraint.” Id. at 1353.

The defendants had offered two justifications for its policies and practices: (1) the need to control those patients which are dangers to themselves and others; and (2) the parens patriae power over those deemed incompetent. Rogers, 634 F.2d at 654. Concerning the police power, the defendants contend “the state has a legitimate interest in protecting persons from physical harm at the hands of the mentally ill.” Id. The District Court had found that the appropriate test to be finding that “substantial likelihood of physical harm” exists before forcibly medicating. Id. at 655. The Court of Appeals, however, found this test inappropriate. Id. “In the first place, a unitary standard assumes that there is only one kind of probability to be tested.” Id. Instead, this issue offers competing interests that may alter the circumstances of which outweighs which, is best suited by having “the professional judgment-call required in balancing these varying interests” let to individualized estimation. Id. The court left the exact procedures to be used an issue to be determined on remand, but made clear that this should be a case-by-case analysis. Id. at 656-57.

Concerning the argument of parens patriae powers, the state certainly has “a legitimate interest under its parens patriae powers in providing care to its citizens who are unable to care for themselves.” Id. at 657. However, the court notes that the key to this argument is an individual “lacks the capacity to decide for himself whether he should take the drugs.” Id. Essentially, the fact that an individual has been committed to the care of the state does not, without more, automatically mean the individual is incompetent to make his or her own choices regarding medications. Id. at 659.

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