Mentally incompetent, i.e., insane or severely disabled, people cannot be forced to stand trial.  The Due Process Clause of the 14th Amendment guarantees criminal defendants a fair trial and protects the defendant’s liberty interests.  It is fundamentally unfair to try or convict an insane person, since that person does not have the necessary guilty mental state needed to commit a crime. 

However, in many cases it may be possible to render a defendant sane by the forced administration of antipsychotic drugs.  Courts have made clear that the right of the insane not to stand trial may be overridden by legitimate governmental interests.  Chief among such interests is the “medical appropriateness” of the drug – the defendant’s dangerousness to himself or others, and the benefits the defendant will receive through use of the drug. 

In a recent Supreme Court decision, the court confirms this view, not requiring a mentally ill defendant to take psychiatric medication where his crime was serious although nonviolent.  The Supreme Court emphasized that the antipsychotic treatment must be medically appropriate in light of the defendant’s extreme dangerousness and chance of grievous harm to herself or others. 

Courts must also consider less intrusive alternatives, such as psychotherapy before and after the trial.  The treatment must also be necessary to further important government penal interests, i.e., imposing a fair punishment for the crime.  Also, the medication must be unlikely to induce side effects that may worsen the demeanor of the person, thus causing an unfair trial. 

If the defendant refuses to take the drugs, thus causing her to be confined in an institution or subject to further punishment or incarceration, then courts may also take this into account.  The Supreme Court confirmed that involuntary administration of drugs will be relatively rare.