Fifth Amendment:

No person shall be held to answer for a capital, or otherwise infamous crime, unless on a presentment or indictment of a Grand Jury, except in cases arising in the land or naval forces, or in the Militia, when in actual service in time of War or public danger; nor shall any person be subject for the same offence to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use, without just compensation.

In multiple decisions, the Supreme Court has recognized that the Due Process Clause subsumes a constitutionally protected right to refuse medical care.1 The Court has maintained, however, that this right must be balanced against relevant state interests, including protection of public health, safety, and human life.2 In Jacobson v. Massachusetts, the Court upheld a Massachusetts law allowing local public health officials to require vaccination against smallpox.3 While the petitioner in Jacobson argued that the compulsory vaccination law infringed upon his right “to care for his own body and health in such way as to him seems best,” the Court explained that the state’s interest in protecting communities against the spread of disease was “of paramount necessity.” 4

The Supreme Court has also addressed the scope of an incarcerated individual’s right to reject antipsychotic medication.5 For instance, in Washington v. Harper, the Court considered an inmate petitioner’s constitutional challenge to a state prison policy that, under certain conditions, permitted involuntary psychotropic drug treatment for inmates with mental illness.6 While acknowledging the petitioner’s “significant liberty interest” in refusing these drugs under the Fourteenth Amendment’s Due Process Clause, the Court’s majority nevertheless concluded that the policy was constitutional.7 Relying on a “standard of reasonableness” articulated in earlier cases involving prisoner rights, the Court explained that the policy conformed with substantive due process requirements, as the state had a legitimate interest in prison safety and security, and the state’s forced medication policy was a rational means of advancing these penological interests.8 The Court further held, in light of the requirements of a prison setting, the Due Process Clause “permits the State to treat a prison inmate who has a serious mental illness with antipsychotic drugs against his will, if the inmate is dangerous to himself or others and the treatment is in the inmate’s medical interest.” 9

In Cruzan v. Director, Missouri Department of Health, the Court considered whether an incompetent individual has a constitutional right to decline lifesaving nutrition and hydration.10 The case involved the substantive due process rights of a woman in a persistent vegetative state and her parents’ request to terminate use of the feeding and hydration equipment that kept her alive.11 At issue before the Court was whether it was constitutional for Missouri to require the family members to provide “clear and convincing evidence” of the woman’s desire to withdraw life support before honoring the family’s request.12

Although a majority of Supreme Court Justices signaled that the Due Process Clause protects a competent person’s right to refuse life-sustaining medical interventions, the Court, in a 5-4 decision, upheld the state’s imposition of evidentiary requirements under the circumstances presented in the case.13 In its majority opinion, the Court emphasized the legitimacy of the state’s interest in preserving human life and concluded that Missouri was not required to follow the family’s judgment or “anyone but the patient” in making this health care treatment decision.14

Footnotes

1

See, e.g., Cruzan v. Dir., Mo. Dep’t of Health, 497 U.S. 261, 278–79 (1990). For a discussion of due process rights and physician-assisted death, see infra Amdt5.4.6.10.2 Physician Assisted-Death.

2

See generally Cruzan, 497 U.S. at 279 (citing Youngberg v. Romeo, 457 U.S. 307, 321 (1982)).

3

197 U.S. 11, 35 (1905).

4

Id. at 26–27. See also Zucht v. King, 260 U.S. 174 (1922) (local ordinance requiring vaccinations for schoolchildren held constitutional). Additionally, various federal, state, and private entities instituted Coronavirus Disease 2019 (COVID-19) vaccination requirements that have generated numerous legal challenges. For analysis of these requirements and related litigation, see Wen W. Shen, Cong. Rsch. Serv., R46745, State and Federal Authority to Mandate COVID-19 Vaccination (2022), https://crsreports.congress.gov/product/pdf/R/R46745.

5

The Supreme Court has also examined the due process rights of patients with mental illnesses to refuse antipsychotic medications in the context of civil commitment. See, e.g., Mills v. Rogers, 457 U.S. 291 (1982). For a discussion of these cases, see infra Amdt5.4.6.10.3 Civil Commitment and Treatment.

6

494 U.S. 210 (1990). For a discussion of Supreme Court jurisprudence involving involuntary administration of antipsychotic medication for incarcerated individuals and procedural protections of the Due Process Clause, see supra Amdt5.4.5.6.4 Prisoners.

7

Harper, 494 U.S. at 221–22. See also Vitek v. Jones, 445 U.S. 480, 487–94 (1980) (prisoner’s involuntary commitment to a mental illness hospital and mandatory behavior modification treatment implicated liberty interests under Fourteenth Amendment’s Due Process Clause).

8

See Harper, 494 U.S. at 223–27 (citing Turner v. Safley, 482 U.S. 78 (1987); O’Lone v. Estate of Shabazz, 482 U.S. 342 (1987)).

9

Id. at 227. Relying in part on the Harper decision, the Supreme Court has concluded that in limited circumstances, the Constitution permits a state government’s forced administration of antipsychotic drugs to render a mentally ill criminal defendant competent to stand trial for serious criminal charges. See Sell v. United States, 539 U.S. 166 (2003); Gomes v. United States, 539 U.S. 939 (2003) (judgment vacated and case remanded to appellate court in light of Sell). See also Riggins v. Nevada, 504 U.S. 127 (1992).

10

See Cruzan v. Dir., Mo. Dep’t of Health, 497 U.S. 261, 269 (1990).

11

Id. at 266–68.

12

Id. at 277, 280.

13

In Cruzan, the Court’s majority opinion did not directly analyze the scope of an individual’s liberty interest in rejecting life-sustaining treatment, but rather “assume[d]” that “a competent person [has] a constitutionally protected right to refuse lifesaving hydration and nutrition.” Id. at 279. However, in concurring and dissenting opinions, a majority of the Justices declared that such a liberty interest exists. See id. at 287 (O’Connor, J., concurring) ( “I agree that a protected liberty interest in refusing unwanted medical treatment may be inferred from our prior decisions . . . and that the refusal of artificially delivered food and water is encompassed within that liberty interest.” ); id. at 302 (Brennan, Marshall, and Blackmun, JJ., dissenting) ( “Nancy Cruzan has a fundamental right to be free of unwanted artificial nutrition and hydration, which right is not outweighed by any interests of the State.” ); id. at 331 (Stevens, J., dissenting) ( “[A] competent individual’s decision to refuse life-sustaining medical procedures is an aspect of liberty protected by the Due Process Clause of the Fourteenth Amendment.” ).

14

Id. at 280–82, 286.