Murderer can be forced to take medication to become sane enough to be executed

BMJ 2003; 327 doi: (Published 16 October 2003) Cite this as: BMJ 2003;327:889
  1. Scott Gottlieb
  1. New York

    The US Supreme Court has let stand a ruling by a federal appeals court in February that officials in the state of Arkansas had the right to force a convicted murderer to take drug treatment to make him sane enough to be executed.

    Embedded Image

    Charles Singleton


    In 1986 the Supreme Court proclaimed it illegal to execute people unless they understood that they were being put to death and why.

    An appeals court based in St Louis ruled in February this year that the constitution's prohibition against cruel and unusual punishment would not be violated if the authorities forcibly gave antipsychotic medication to the inmate, Charles Laverne Singleton. It was this decision that was upheld by the Supreme Court last week.

    The fate of Singleton has veered back and forth since he was convicted of murder and sentenced to death in 1979. He became seriously mentally ill in 1987 and in October 2001, a panel of the 8th circuit put a permanent stay on his execution, ruling that he be sentenced to life in prison without the possibility of parole.

    The state appealed, and the St Louis court reversed that ruling in February, saying that it was acceptable to give Singleton the drug treatment to make him sane enough to be executed (BMJ 2003;326: 415).

    Six of the 11 judges on the St Louis based panel said that because Singleton wanted to receive medication for his mental illness and the state had an interest in having sane prisoners, the fact that the drugs had the “side effect” of making him sane should not affect his fate. The four dissenting judges said it would be wrong to execute Singleton, who becomes paranoid and delusional when not receiving medication, and is sometimes still psychotic even when taking medication. One of the judges abstained.

    Singleton's defence had argued that the Arkansas inmate was in a precarious situation: taking antipsychotic medication was in his interest–but not if the resulting sanity put him on the path to the death chamber.

    The Supreme Court last week rejected arguments by Singleton's lawyers that giving him the drugs was not medically useful to him, as the only purpose would be to facilitate the ending of his life.

    The Supreme Court ruled in a pair of cases in 1986 that executing insane inmates was prohibited by the eighth amendment's edict against cruel and unusual punishment. But until the Singleton case, no appeals court or the Supreme Court had ruled on whether prisoners may be forced to take medication in order to be made sane enough to be executed.

    Singleton was convicted of stabbing grocer Mary Lou York to death in a 1979 robbery. Before dying, she identified him as her attacker. His mental health began to deteriorate in 1987; he said he believed his prison cell was possessed by demons and that the authorities had planted a device in his ear. He insisted that his victim, whom he had known at the time of the murder, was still alive.

    The Supreme Court has halted executions of inmates with severe learning difficulties but has refused such protection for mentally ill inmates.

    View Abstract

    Sign in

    Log in through your institution

    Free trial

    Register for a free trial to to receive unlimited access to all content on for 14 days.
    Sign up for a free trial