Can a convicted killer suffering from a serious mental illness be forced to take medication that might make him well enough to go to the electric chair?
That is the issue in a case that reached the Supreme Court last month and is not settled yet.
Michael Owen Perry, 36, is on Death Row in Louisiana for murdering his parents, two cousins and his nephew seven years ago. His doctors agree that he suffers from a form of schizophrenia with symptoms that include hallucinations and delusions of being God.
The linchpin of the legal dispute is a 1986 Supreme Court ruling that executing the insane violates the Eighth Amendment's ban on "cruel and unusual punishment."
Louisiana courts have approved the state's order that Perry be forcibly injected with Haldol, an antipsychotic drug. His right to refuse treatment was "extinguished" by the death sentence, state authorities said. But Perry's attorneys argued that the state is forcing him to take the medicine "solely as a means to groom Michael for execution."
In a one-sentence ruling last month, the Supreme Court sent the case back to state judges and ordered them to consider the effect of a high court ruling last year that mentally ill prisoners could be medicated against their will only if they are gravely impaired and dangerous to themselves or others. That ruling involved prisoners who were not on Death Row.
The American Medical Association and the American Psychiatric Association filed briefs supporting Perry's appeal before the Supreme Court and recommending that his sentence be commuted to life imprisonment. Both groups also oppose any participation by doctors in carrying out the death penalty.
"The physician's serving the state as executioner, either directly or indirectly, is a perversion of medical ethics and of his or her role as healer and comforter," the APA has declared.
But in a case like Perry's, that guideline itself gets "pretty murky," said Howard Zonana, associate professor of psychiatry at Yale University School of Medicine who chairs the APA's Commission on Judicial Action.
If the prisoner needed an emergency appendectomy, Zonana said, probably no doctor would have qualms about treating him, even against his will. But the state has argued that without psychiatric medication, Perry would not remain "competent" to be executed.
"Clearly, physicians are being asked to help maintain someone's competence so he can be executed," Zonana said. "That's the bind for psychiatrists."