Michael Owen Perry's medicine could restore his sanity, but it has one enormous side effect: It could speed his death. Perry is a prisoner on Death Row, and his fate will be argued Tuesday before the U.S. Supreme Court. The state of Louisiana wants to force him to take psychiatric medication; if he is legally sane, he can be executed. Perry's lawyers argue that forcible medicating would be a cruel and unusual punishment that ignores Perry's rights to avoid unwanted medication. The American Medical Association and the American Psychiatric Association say treating Perry to aid in his execution would turn the healing art on its head. Perry's sentence should be commuted to life in prison, they suggest. ``We're saying the cost here, which is really a fundamental realignment of the role of medicine, is a very high cost, and the state's interest in the difference between capital punishment and life imprisonment without parole doesn't justify that cost,'' said attorney Joel Klein. The state says giving him the drug is simply a necessary step for carrying out a death sentence, a justifiable limitation on a condemned man's liberties much like strapping him into the electric chair. Besides, the state is required to provide medical care, and the medicine is good for him, Louisiana says. Perry, 35, suffers from schizoaffective disorder, causing him delusions, hallucinations and disordered thinking. He was sentenced in 1985 for shooting his parents and three other family members to death. Louisiana's supreme court affirmed the conviction and the sentence but suggested a review of Perry's mental competence to be executed. There is a tradition in Anglo-American law that people should not be executed while insane. This doctrine, which dates back to medieval times, was adopted by the U.S. Supreme Court in a 1986 decision. ``Insanity'' is a legal term, not a medical one. In this case it refers to mental illness so severe that the prisoner is not aware of the impending punishment and why he is to suffer it. The Louisiana court ruled Perry was sane, but only while on medication. It also ordered that Perry be medicated even over his objection. After the state supreme court refused to hear a challenge to that decision, Perry's lawyers appealed to the federal high court. Lawyers for both sides declined to be interviewed on the record, but their Supreme Court briefs lay out their arguments in detail. Lawyers for Louisiana say the death sentence wiped out any legal power Perry would have to refuse the medication. Forced medication would not be a ``cruel and unusual'' punishment because Perry would benefit medically from it, the state says. ``Common sense dictates that the State does not violate the Eighth Amendment by doing something good for a prisoner.'' In fact, Louisiana is required to medicate Perry because the Supreme Court has declared that deliberately ignoring a prisoner's serious medical need itself constitues cruel and unusual punishment, the brief says. Perry's attorneys say the forced medication would be unconstitutional punishment rather than treatment. The court order gives no consideration to Perry's medical needs nor physician judgment, they say. The order also ignores the ``very real'' prospect of serious side effects, raising the prospect of taking a ``drooling, incontinent and tremulus'' man to the execution chamber, they wrote. In any case, Perry's lawyers say, Perry's response to medication is sporadic and unpredictable, making it impossible to say whether he would be competent on the day of his execution. ``With this instability and unpredictability, how is Michael's execution to be carried out?'' the lawyers asked. ``Can the state wait until a `good day' and execute Michael? Can Michael be executed if his `good days' outnumber his `bad days' by some amount? What amount? And what happens if the date set in the death warrant is a `bad day?' '' The AMA and psychiatric association, meanwhile, say the death sentence does not outweigh Perry's interest in avoiding unwanted medication, an interest especially great ``when the injection sets the prisoner directly on the road to execution.'' Involuntary medication was not part of Perry's sentence, nor is it generally authorized by confinement, the associations argue. Prior court decision support the idea that involuntary medical treatment is not permitted if it runs against a person's medical interests and is not necessary to treat a condition that may harm other people, they say. As for the argument that the medication would help Perry, any benefit ``would be both fleeting and purchased at the cost of his life,'' the associations said in a brief. Outside observers are split on their reaction to the case. Dr. Gary Glass, an associate psychiatry professor at Temple University and lecturer in law at Villanova University, said he personally hopes that the court would not allow execution of a person who is incompetent when not treated. But his ``utilitarian, practical'' answer is that nobody should be allowed to make a competent decision to avoid execution by becoming legally incompetent, he said. If a death sentence is imposed, ``people ought not to be able to use their mental health and illness to manipulate that decision,'' he said. Arthur Caplan, director of the Center for Biomedical Ethics at the University of Minnesota, calls it ``fundamentally wrong for any health care professional to give anybody psychiatric medication against their will for a non-therapeutic purpose.'' If authorities are intent on executing a man while he is sane in such cases, they should specify medication as part of the sentence and not pretend it is medical treatment, he said.
