Loughner Medication Ruling Throws Ethical Issues Into Spotlight

A federal appeals panel upheld a decision this week to deny authorities permission to forcibly medicate Jared Lee Loughner, the suspected gunman in the Tucson shooting that killed 6 people and injured 13, including US Rep. Gabrielle Giffords, with antipsychotic drugs, raising the spotlight on ethical issues surrounding the treatment of criminal defendants experiencing psychosis.

Loughner, who, according to court papers, has been diagnosed as schizophrenic, had an outburst in his first court appearance and had reportedly shown aggressive conduct, including throwing chairs in his cell, lunging at his attorney, and, on one occasion, spitting at his attorney before being declared mentally ill and unfit to stand trial by a judge on May 25.

He has since been in federal custody for hospitalization at the US Medical Center for Federal Prisoners in Springfield, Missouri.

Prior to the 9th US Court of Appeals’ issuance of a temporary stay against forcibly medicating him against his will on July 1, Loughner had been prescribed the antipsychotic drug risperidone and, if necessary, the forcible injection of the first-generation antipsychotic haloperidol (Haldol, Johnson & Johnson).

Loughner’s attorneys argued that the forced medication was intended by the court to try to make him fit to stand trial, not just representing a violation of Loughner’s constitutional rights but posing the risk for “irreparable physiological harm” and causing changes to the chemical balance in the brain that can have “serious, even fatal, side effects,” according to court documents.

“Each additional day of involuntary medication not only intensifies the brain-altering changes Mr. Loughner does not desire, but also increases the risk that Mr. Loughner will develop serious, and sometimes irreversible, physiological side effects,” the defense attorneys argued.

The drugs are standard in the treatment of schizophrenia, however, and, although not entirely free of adverse effects, they are widely considered to be safe and effective, according to psychiatrist Stephen R. Marder, MD.

“These are some of the most widely used drugs in all of medicine,” explained Dr. Marder, who is with the University of California, Los Angeles, Desert Pacific Mental Illness Research, Education, and Clinical Center in the Semel Institute for Neuroscience….

By Nancy A. Melville
Medscape Medical News

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