232inmate following a court hearing at which time the state was required to show that the
medication was both necessary and effective. The Washington Supreme Court held that
under the Fourteenth Amendment a state prisoner's interest in avoiding the groundless
administration of antipsychotic drugs is not insignificant, since the forcible injection of
medication into an unwilling person's body represents an indisputable interference with
that person's freedom. Antipsychotic drugs can have serious, even fatal, side-effects, such
as a severe involuntary spasm of the upper body, tongue, throat, or eyes; motor restless-
ness, a condition which can lead to death from cardiac dysfunction; and a neurological
disorder characterized by involuntary, uncontrollable movements of various muscles.
The Washington Supreme Court's ruling was reversed and remanded in 1990 when
the U.S. Supreme Court decided that the constitution does not require a court hearing
prior to a prisoner being involuntarily medicated. The Court held that the Fourteenth
Amendment Due Process Clause permits the state to treat a prison inmate who has
a serious mental illness with antipsychotic drugs against his will, it he is dangerous to
him- or herself or others and the treatment is in his medical interest. The Center's
policy agreed with due process requirements because it protected others from potentially
dangerous mentally ill inmates. The U.S. Supreme Court held that the (.'.enter's policy-
was acceptable because it applied exclusively to potentially dangerous mentally ill inmates
who were gravely disabled or posed a threat to others. The Court held that the drugs
could be given only for treatment and under the direction of a licensed psychiatrist.
Therefore, the Due Process Clause did not require a judicial hearing before the state
could treat a mentally ill prisoner with antipsychotic drugs against his or her will.
In the case of Kncclit i>. (lilliihin (1973), the court questioned the extent to which in-
jections of the drug apormorphme could be used as an unwilling stimulus. The injections
were oftentimes administered by a nurse without the presence of a doctor or specific
authorization from a doctor. The United States District Court for the Southern District
of'Iowa, Central Division, dismissed the complaint and Knecht appealed. The Court of
Appeals held that administering a drug which induces vomiting to nonconsenting mental
institution inmates on the basis of alleged violations of behavioral rules constituted cruel
and unusual punishment.
Written consent from the inmate, however, may obviate this situation s unconstitu-
tionality. This applies if the written consent specifies the nature of treatment, purpose,
risk, and effects as well as advises the inmate of his or her right to terminate consent at
any time. The inmate must also be given the opportunity to cancel consent at any time,
and the injection must be authorized by a physician and administered by a physician or
nurse. Also, the tact that civil rights statutes do not specify the scope of judicial relief
available in actions successfully sustained under them does not preclude federal courts
from fashioning an effective equitable remedy.Literature Review
One way to consider the issue of the right to refuse treatment is to examine the
problems occurring with experimental drugs and involuntary treatment on inmates.
For example, behavior modification is one such program that centers on the mod-
ification of an offender's actions (Allen & Simonsen, 1989). One type of behavior
modification is aversive conditioning for deviant sexual behavior. Territo (1989)
indicates that aversive conditioning is the reduction or elimination of behavior pat-
terns by associating them with unpleasant stimuli. Nausea-inducing drugs were used