RUPERT MURDOCH is alleged to have once told a neophyte editor caught dithering over a story: 鈥淣ews is when somebody makes a pill to make madmen sane.鈥� Given that advice, the ongoing debate in the US over the blurred borders of law, criminal behaviour and psychopharmacology should be front-page news.
The tale is set to become a classic case study for future ethics seminars. A dentist called Charles T. Sell was charged with massive Medicaid fraud five years back. Additional charges followed his original arrest and release on bail. But before his case came up, Sell contracted a psychotic illness. Such is his delusional state, according to his defence, that he is not fit to plead.
But the federal prosecutors in St Louis, Missouri, are attempting to force Sell to take anti-psychotic medication to render him competent for trial. The case has prompted a legal storm that goes from the local appeal court right up to the Supreme Court in Washington DC. It raises profound issues of personal responsibility, civil liberties, human rights and the relationship between brain chemistry and behaviour.
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In the US, the law has found itself all too often on the wrong end of arguments over brain chemicals and mitigation pleas. It is 25 years now since Dan White, a former police officer, walked into City Hall in San Francisco and shot dead the mayor, George Moscone, and supervisor Harvey Milk. White was found guilty of involuntary manslaughter after his legal team argued that his actions were caused by the consumption of a large number of sugar-laden Twinkie cupcakes. White walked free because the jury accepted the defence鈥檚 argument that linked hyperglycaemia with loss of impulse control. Since then, there have been many similar pleas based on modern neuroscience.
Now the prosecutors are beginning to fight back. If we accept, they are saying, that the imbibing of one mind-altering substance can render a sane individual insane and therefore incompetent, why should we not be allowed to administer another substance to render an insane individual sane and therefore competent? In 2001, the US government succeeded in forcing drug treatment on Russell Weston, a schizophrenic man convicted of murdering two police officers at Capitol Hill in 1998, to render him sane enough to be executed within the law.
The issues are both fascinating and alarming. One concern, raised in the legal wrangle over the current case involves a catch-22 conundrum: to take the drug Sell must be sane enough to give his consent; but if he is competent enough to make that decision why should he need the drug in the first place? Another consideration, urged by the Association of American Physicians and Surgeons, is whether someone鈥檚 sanity can really be restored by taking a drug. Would not Sell be the recipient of no more than an artificial semblance of competence rather than the real thing?
Lawyers I have canvassed in Britain tend to say that the authorities should be allowed to give Sell the injection. He is currently being detained indefinitely in a mental hospital, and they argue that any harm the drug might cause to his health could not make his situation any worse. A more worrying and broader aspect of the case is where to draw the line on medical interventions and criminal behaviour.
I recently attended a conference on neuroscience and the law where a biochemist reported on a little-known clinical trial conducted in a British prison. Convinced that criminal behaviour is caused by lack of zinc in food, the biochemist had been granted permission to conduct double-blind trials to test his theory. He reported to the delegates that prisoners fed a zinc supplement proved less likely to reoffend than those deprived of it. So does this mean, the biochemist asked, that prisoners should be given compulsory zinc supplements to reduce their recidivist tendencies?
If impulse control and neuropharmacology were found to be strongly linked, the temptation to apply neuroscientific techniques to the problem of criminal behaviour as opposed to medical welfare could become irresistible. A recent essay in Nature (vol 410, p 296) suggests that it is now possible to identify psychopaths by means of PET and MRI scans. Since government proposals for reforming Britain鈥檚 Mental Health Act consider detaining psychopaths before rather then after they have offended, it is clear where these kinds of connections could take us. A distinguished forensic psychologist suggested to me that should such a psychopathic screening become obligatory, 90 per cent of his colleagues would be put away.
The problem, of course, is that criminality, like intelligence and sanity and happiness, is not easy to quantify. But the medicalisation of criminal behaviour is already creating a trend that is substituting pharmacological solutions for social ones. Failing to draw the line might well end in us being forced to drink zinc, Ritalin and Prozac along with fluoride in our drinking water.