After years of hearing and reviewing legal arguments over whether the mentally ill suspect in the Capitol Hill shootings should be involuntarily medicated, a Washington, D.C., judge has agreed with the government that Russell Weston should be forced to take antipsychotic drugs.

Ever since July 1998, when Weston opened fire and killed two police officers in the dignified marble halls of the House side of the U.S. Capitol, prosecutors have been urging the court to order that Weston be medicated in the hope that his schizophrenia improves enough for him to stand trial for the two murders. He has a history of psychosis going back at least 20 years, and through most of that time he has refused to take any psychoactive medications, according to court testimony.

His defense attorneys have insisted that his right to refuse to take the medication should be paramount, even if it means that his delusions and hallucinations go untreated. If the forced medication makes him mentally competent enough to stand trial, the result could be the death penalty. Weston’s attorneys have argued that the law cannot force him to get well if doing so means he is cooperating in his possible execution.

The U.S. Supreme Court has ruled that convicted felons cannot be forcibly medicated to make them well enough to understand that they are facing the death penalty and the reasons for it—the standard that must be met before an execution can proceed. It has not weighed in, however, in the issue in Weston’s case, namely, whether a felony suspect who has been convicted of nothing can be forced to take medication so that he or she is mentally competent enough to understand the issues and assist in his or her defense at trial.

The stakes in the judge’s decision are particularly high in Weston’s case because the ultimate legal penalty is at issue. In addition, as in past cases where similar issues were argued, the sensational nature of the crime and the overwhelming amount of media coverage have heightened interest in the case’s disposition and meant that all sides are aware that the force of public opinion cannot be completely ignored. High-profile mentally ill defendants are still suffering from the negative fallout that ensued from the successful insanity plea by would-be presidential assassin John Hinckley almost 20 years ago.

Weston has been confined in the psychiatric unit at the Federal Correctional Institute in Butner, N.C., since soon after the shootings. For much of that time he has been kept in an isolation cell where he has continued to deteriorate mentally and physically, according to testimony during the hearings. Psychiatrists who have examined Weston have told the court that he suffers from paranoid schizophrenia, a diagnosis that the prosecution does not question.

Forensic psychiatrist Sally Johnson, M.D., who is chief psychiatrist at the Butner prison and evaluated and testified about Weston’s mental state for the court, has had considerable experience in evaluating high-profile criminal suspects. At the courts’ request she examined Hinckley and Ted Kaczynski, the so-called Unabomber.

Her first contact with Weston was a 20-hour evaluation in the Washington, D.C., jail soon after his arrest. She told the judge, Emmet Sullivan of U.S. District Court for the District of Columbia, that Weston was incompetent to stand trial, but that medication might make it possible for him to regain sufficient competency to participate in and understand his defense. Without medication, she said, there was little if any chance his schizophrenia would remit.

He was examined again by another psychiatrist at the prosecution’s request, and that psychiatrist reached a similar conclusion.

Weston told the psychiatrists that he came to Washington from his parents’ home in Illinois to save the world from cannibals and that he shot the police officers because they were interfering with his ability to retrieve a satellite stored in the Capitol that had the capability of fighting disease and reversing time.

Judge Sullivan originally agreed with the government and ordered that Weston be forcibly medicated, in part to reduce the chances that he could be dangerous to others or to himself. Defense attorneys immediately appealed, and the appeals court put the order on hold, telling Sullivan to go into more depth on the complex issues involved in involuntarily medicating a mentally ill suspect. After still more hearings, the judge came down on the side of forced medication and at least an attempt to improve Weston’s mental state. He stated in his ruling that failing to medicate Weston with antipsychotics amounts to "simply the warehousing of Weston in a psychotic state."

Psychiatrist Jeffrey Metzner, M.D., chair of the APA Council on Psychiatry and Law, agreed that the judge made the appropriate ruling in this case. While it would be unethical to medicate a convicted felon to make him competent enough to be executed, he said, "there is a big difference" between that situation and the one with which the judge was faced in Weston’s case. It is ethical to treat a psychotic, deteriorating individual, Metzner said, even if the result is that he can then stand trial. It is certainly possible that the medication may relieve the person’s pain, Metzner noted, and medicating the patient may even be in his or her best legal interest, leading perhaps to a verdict of not guilty by reason of insanity or even to an acquittal. While he has not evaluated Weston, Metzner pointed out that "[you] do not do a person with severe psychosis any favors when you leave him untreated."

Weston’s attorneys have vowed to fight this latest medication order unless the government agrees to forego the possibility of asking for the death penalty. Prosecutors have refused to make that concession, so the legal wrangling could continue for several more months as Weston’s mental state deteriorates even further.

On March 20 an appellate court in Washington, D.C., delayed Sullivan’s order until it could hear oral arguments. It has not set a date for those arguments, but said it wanted the two sides to submit legal briefs this month. ▪