1. MEMORANDUM
To: Jonathan Schiffman, Esq.
From: Lenna Babigian Janick, Senior Paralegal
Re: United States v. Nelson
Involuntary Administration of Antipsychotic Medications
Date: November 17, 2014
ISSUE
Under the United States Constitution can the Government
administer antipsychotic medications to a severely mentally ill individual
against his will in order to render him competent to stand trial when it
will be known to cause severe side effects and there is only a twenty
percent likelihood that the medications will be effective?
ANSWER
No. Under the U.S. Constitution the Government cannot
administer antipsychotic medications to a severely mentally ill individual
against his will in order to render him competent to stand trial unless
certain criteria are met and there is a statistically significant likelihood
that the medications will be effective and the risk of debilitating side
effects is low.

2. FACTS
Our client, Jason Nelson (Nelson), is being charged with
manslaughter by the Federal Government. Nelson is severely mentally ill
and is currently confined in a mental institution. Due to the illness,
Nelson cannot assist in his defense and is not competent to stand trial.
The prosecutor in this case had filed a motion asking the court to forcibly
administer antipsychotic drugs to Nelson to render him able to stand
trial. Medical experts have determined that if Nelson receives the
medication the state intends to administer there is an approximately
twenty percent chance of Nelson being rendered competent to stand trial.
Nelson is vehemently opposed to receiving such drugs, primarily because
he has suffered significant and debilitating side effects from these drugs
when he has taken them in the past. The side effects include
drowsiness, lethargy and confusion.
DISCUSSION
Under the Due Process clause of the U.S. Constitution, See U.S.
Const. Amend. V, Amend. XIV, the privileges and immunities of citizens
and persons within the jurisdiction of the United States are protected.
Sell v. United States, 539 U.S. 166 (2003) is considered the landmark
decision regarding due process and the involuntary administration of
antipsychotic medications to a person who lives with a severe mental
illness in order to render them competent to stand trial. The Supreme

3. Court set forth four factors that must be met before “involuntary
administration of drugs solely for trial competence purposes” will be
allowed, supra at 179. In brief, these factors are as follows. The court
must: (1) Find that important governmental interests are at stake; (2)
Conclude that involuntary medication will significantly further those
concomitant state interests. (3) Conclude that less intrusive treatments
are unlikely to achieve substantially the same result. (4) Conclude that
the administration of the drugs is medically appropriate, being in the
best medical interest of the patient given his medical condition. When
these four standards are met, then the courts may deem it permissible to
administer antipsychotic medications against a patient’s will.
Sell, supra, applies directly to the Nelson case. Medical experts
who assessed Nelson conclude that there is a twenty percent chance that
antipsychotic medication will render Nelson competent. The medical
experts make no recommendation for alternative medications that could
provide the same or better effect for Nelson with fewer side effects.
Having committed manslaughter there is a concern that governmental
interests are at stake. As Nelson is already confined in a psychiatric
institution indefinitely he is not a danger to society or to governmental
interests. The four factors presented in Sell, supra, are not met in
Nelson’s case.
The case of United States v. Ghane, 392 F.3d 317, 320 (8th Cir.,
2004) is also applicable to Nelson’s case. Analysis by medical experts

4. determined that there was five to ten percent likelihood that
antipsychotic medication would render Ghane competent to stand trial.
Also citing Sell, supra, the circuit court denied the motion to medicate
Ghane against his will. “A five to ten percent chance of restored
competence cannot be considered substantially likely under any
circumstances.”
In the case of United States v. Gomes, 305 F.Supp.2d 158, 165 (D.
Conn., 2004), the court determined that the four “Sell factors” had been
met. The medical experts in the Gomes case “… testified that the
appropriate treatment to restore Gomes to competence was treatment
with anti-psychotic medications. The experience of the Bureau of
Prisons in treating defendants with psychotic disorders similar to Gomes’
is at least a 70 percent rate of success in restoring defendants to
competence ... even when treated involuntarily.” In this case there is a
significantly higher statistical likelihood that the individual will regain
competence than in the Nelson case.
It is also noted that even if the antipsychotic medications were to
render Nelson competent to stand trial, the side effects that are produced
by the medication would inhibit Nelson from being able to competently
testify. There is a significant likelihood that the above-referenced side
effects will interfere with Nelson’s ability to communicate with counsel.
It is anticipated that the prosecution will cite the case of
Washington v. Harper, 494 U.S. 210 (1990) in their argument. It is

5. believed that the Harper, supra does not apply to the case before
because, in short, it addresses medicating Harper, a convicted prisoner
in Washington State, for the purpose of maintaining order in the prison.
Harper has already been tried and convicted. This case is not relevant as
the facts are significantly different from the facts in the Nelson case.
Referring to Harper, supra, the Justices in the Sell case, supra, state that
a court can rule on the justification of medication against one’s will
without using the four trial competence factors discussed above if there
are strong reasons for which to forcibly administer medication is, such as
to quell the individual’s dangerousness or if that person’s health is at
risk without the medications. This is not the case for Nelson as the
question here is when the involuntary administration of medication is to
render the defendant competent to stand trial, therefore to further a
particular government interest. Use of the four trial competence factors
is warranted.
CONCLUSION
There is plain evidence that the involuntary administration of
antipsychotic medication to Nelson is not reasonable in this case. The
severity of side effects caused by the medication and the substantially
low likelihood that the medication will render Nelson competent to
communicate with counsel or to stand trial do not warrant medicating
the client against his will.

6. Memorandum of Law
by Lenna Babigian Janick
Legal Research
Part-time Evening, Fall Term
Jonathan Schiffman, Esq.
November 17, 2014