*1 O’CONNOR v. DONALDSON Arguеd January 15, No. 74-8. 1975—Decided June *2 Raymond Attorney Oearey, W. General Assistant pro hac vice. petitioner argued the cause Florida, Shevin, Attorney were Robert L. him on With the briefs Attor- Dearing, and Daniel Special Assistant General, ney General. Ennis, Jr.,
Bruce J. respondent. the cause for argued brief was Morton Birnbaum.* With him on opinion Me. Justice of the delivered the Stewaet Court. civilly Donaldson,
The Kenneth com- respondent, was patient mitted to confinement as a mental in the Florida January Hospital at Chattahoochee in 1957. custody nearly kept against He was in there his will for years. The Dr. petitioner, O’Connor, J. B. was hospital’s superintendent during period. most of this Hyland, Attorney Stephen Skillman, General,
*William F. Assist- Attorney General, Joseph ant Maloney, Attorney and T. Deputy General, Jersey filed a brief for the State of New as amicus curiae urging reversal. by urging
Briefs of amici affirmance E. Barrett curiae were filed Prettyman, Jr., Psychiatric by Assn.; Francis M. the American Shea, Ralph Moore, Jr., Rich, J. F. John Townsend James Fitz- patrick, Neimark, Melchior, Harry Rubin, L. Kurt W. J. Sheridan Zwerdling and A. L. De- for the American Association on Mental ficiency; and June Resnick German and Berman for Alfred Hygiene New Bar Assn. Committee on Mental York State Brotan, Attorney General, Andrew Ruzicho and J. and J.
William Rouse, Attorneys General, filed a brief for the Barbara J. Assistant State of Ohio as amicus curiae.
Throughout but his confinement Donaldson repeatedly, he unsuccessfully, claiming demanded his release, dangerous mentally ill, one, he was that, any rate, hospital and providing was not February treatment supposed Finally, illness. Donaldson brought this lawsuit under 42 C. U. S. § United States District Court for the North- ern District of Florida, alleging that O’Connor, and other hospital members of the staff named had defendants, intentionally maliciously deprived and him of his con- liberty.1 four-day stitutional After trial, jury returned assessing a verdict compensatory both punitive against damages codefendant. for the Fifth Court Circuit affirmed *3 judgment, 2d granted 493 F. 507. peti- We O’Connor’s impor- tion for 419 of U. S. because the certiorari, 894, questions tant seemingly presented. constitutional
I by Donaldson’s father, commitment was initiated his thought who his son suffering was from “delusions.” county After hearings judge County, before a of Pinellas Donaldson Fla., was found to from suffering “para- be schizophrenia” noid and was committed for main- “care, original complaint Donaldson’s was filed class be as a action on patients half himself and all his department fellow in an entire Hospital the Florida State In to Chattahoochee. addition claim, damages complaint corpus Donaldson’s also asked for habeas release, ordering relief his as well the as release of all members of sought declaratory injunctive further class. Donaldson and relief requiring provide hospital adequatе psychiatric to treatment. After Donaldson’s release and after the District Court dismissed suit, as a complaint, action Donaldson filed class an amended repeating compensatory his punitive damages. claim and Al- though complaint prayer declaratory the amended retained the injunctive relief, request and was eliminated from case 507, prior F. 2d to trial. See 493 512-513. statutory to Florida pursuant treatment” tenance, law The state repealed.2 been have since provisions necessary grounds specifying clear in less than to 394.22 pursuant proceedings were judicial § commitment provided: Code, (11) Health which Public of the State adjudged incom- any person has been who “Whenever self-injury prevent or restraint petent requires confinement person judge be direct that such others, shall the said violence to hospital, state of a Florida superintendent delivered to forthwith regu- under been authorized mentally ill, after admission has for the institutions, by of state the board of commissioners approved lations 394.09, treatment, provided in sections care, maintenance, and as disposition 394.27, other 394.24, 394.25, or make such 394.26 by Fla. Laws 1955— may permitted law of him as he be 1, p. Sess., 62. Extra. c. § days adjudged “incompetent” earlier several had been Donaldson any finding provided (1), which for such a under §394.22 person who was drunkenness, illness, sickness,
“incompetent reason of mental physical drugs, insanity, condi- mental or use of or other excessive managing caring tion, incapable for himself or that he is so property likely dissipate or become property, or lose his or is designing persons, harm on himself or inflict the victim of 29909, 3, p. c. 831. others Fla. Laws Gen. § (a) (11) contemplated that invol- appear 394.22 It would that § “incompetent” only untary imposed on those would commitment prevent self- persons “require confinement or restraint who [d] certain, for this is not 394.22 injury others.” or violence to But § adjudicate judge (11) (c) could provided that *4 guardian upon him a a find- incompetent” and release to “harmless prevent ing require to self- confinement or restraint that he did “not injury that treatment in the Florida State or violence to others and unnecessary per- be without benefit to such Hospital or would 3, p. (emphasis c. son Fla. Laws Gen. § “Order noteworthy Donaldson’s added). regard, In this it is Hospital Mentally Delivery Incompetent” to the Florida State for prevent self- required or restraint provided “confinement that he (Em- others, proper treatment.” injury or to insure violence to pro- rate, statute added.) any the Florida commitment phasis At whereby incompetent could one still judicial procedure vided no and commitment, scanty the record is as to Donald- son’s condition at the time judicial hearing. are, These matters however, irrelevant, for this in- case challenge volves no to the initial but commitment, focused, instead, upon nearly years of confinement that followed. sit hospital evidence the trial showed that power
staff had the patient, dangerous to release a not himself even if he ill remained others, lawfully and Despite many had been committed.3 re- quests, O’Connor power refused to allow that to be ground secure his release on the longer dangerous that he was no to himself or others. provided “right
Whether the Florida statute to treatment” for involuntarily patients open dispute. committed Under also (11) (a), prevent self-injury “to or violence to commitment §394.22 care, Recently maintenance, others” was “for and treatment.” totally revamped Florida its civil law and now has commitment provides statutory right receive individual medical treatment. Fla. Stat. Ann. 394.459 § statutory procedure required judicial rein The sole release patient’s competency.” statement of a “mental Public Health Code (15) (16), 1955, 29909, 3, pp. 394.22 Fla. Gen. Laws c. 838- §§ § procedure hospital 841. But this be initiated staff. could Indeed, finally it was at the staff’s initiative that Donaldson was liberty, immediately competency, after restored to almost superintendency. O’Connor retired from the hospital always addition, had had its In witnesses testified that the visits,” releasing procedure patients “home “trial own —for discharges” though “furloughs,” visits,” or “out of state —even judicially competency. patients been restored to Those had not merely permanent, hospital became and the conditional releases often deny patient. did on the trial closed its books power patients; he conceded that it was to release that he had the hospital “duty” superintendent “to determine whether hospital was in condi- having once reached the such patient request he be considered for release from as to tion hospital.” *5 trial, At the case. in Donaldson’s
exercised would Donaldson had believed indicated that he adjustment out- “successful to make a been unable have for recall the basis could not institution,” but side the superintendent retired that conclusion. O’Connor there- A months filed. few shortly this suit was before release secured his Donaldson trial, and before the after, sup- with the competency, restoration of judicial and a port hospital staff. con- demonstrated, without testimony the trial danger to others posed had that Donaldson
tradiction, any point indeed at confinement, or during long his per- that he had no himself conceded his life. O’Connor had ever knowledge that Donaldson sonal or secondhand no evidence that There was dangerous committed a act. likely or been thought ever been suicidal Donaldson had code- himself. One O’Connor’s injury upon to inflict Donaldson could have earned acknowledged fendants He had done hospital. his own so living outside the immediately years commitment, some 14 his before responsible job in hotel upon his release he secured administration. release frequent requests
Furthermore, Donaldson’s persons willing to supported responsible had been In provide any might him need on release. care he Helping Hands, Inc., a example, representative ask- halfway wrote O’Connor patients, house for mental ing request him to its care. The to release Donaldson letter from the Min- accompanied by supporting was Neurology, which a neapolis Psychiatry Clinic of codefendant clinic.” O’Connor “good conceded was a rejected offer, replying Donaldson could be re- only apparently parents. leased That rule making. time, own At the Donaldson was O’Connor’s parents Donaldson’s years old, and, knew, as O’Connor *6 elderly were too infirm responsibility to take for him. Moreover, his continuing correspondence Don- with aldson’s parents, O’Connor never informed them Helping Hands In separate offer. on addition, four occasions between 1964 Lembcke, a col- John lege classmate of family Donaldson’s longtime and a friend, asked O’Connor to release Donaldson his care. On each occasion O’Connor refused. The record shows that Lembcke was a and responsible person, serious who was willing and able to assume responsibility for Don- aldson’s welfare.
The evidence showed that Donaldson’s confinement simple regime of care, enforced custodial not a program designed to alleviate or cure his ill- supposed ness. Numerous witnesses, one including of O’Connor’s codefendants, testified that Donaldson had noth- received ing but custodial care hospital. while describеd Donaldson’s treatment therapy.” as “milieu But witnesses from the hospital that, staff conceded in the context case, of this therapy” euphemism “milieu was a for confinement in the hospital.4 “milieu” of a mental For periods, substantial simply kept Donaldson was in a large many room housed 60 patients, of whom were under criminal commitment. requests Donaldson’s ground occupational privileges, training, oppor- and an tunity his to discuss case with O’Connor or other staff repeatedly members were denied.
At trial, O’Connor’s principal defense was that he in good had acted faith and was therefore immune from any liability monetary damages. His position, short, was that law, state which he had believed valid, Donaldson, There was some evidence that who is a Christian Scientist, occasion refused to judge on take medication. The trial jury damages any period instructed to award of con during which Donaldson had finement declined treatment.
had authorized indefinite custodial confinement of the “sick,” they even if were not given treatment and their release could harm no one.5 judge
The trial instructed the members of the they should find that O’Connor had violated Don- aldson’s constitutional liberty they found that he had
“confined against will, knowing that [Donaldson] he was not ill or dangerous or knowing that *7 mentally if ill he was not receiving treatment his alleged mental illness.
“Now, purpose involuntary hospitalization is treatment and not mere custodial or punish- care if patient ment a is not a danger to himself or others. Without such treatment there is justification no from a stand-point constitutional for continued confine- you ment unless should also find [Donaldson] dangerous was to either himself or others.” 5At the close of chief, Donaldson’s case in O’Connor moved for a ground directed verdict on the that state law at the time of Donaldson’s confinement authоrized institutionalization men tally they ill posed even if danger to themselves or others. This was motion denied. At evidence, the close of all the O’Connor jury asked that be instructed that "if pur defendants acted suant to a statute which was not declared unconstitutional at the time, they cannot be held accountable for such action.” The Dis give trict requested Court declined to instruction. 6The District Court defined treatment as follows: “You are instructed that involuntarily civilly who is com- hospital mitted to a mental right have a does constitutional to re- give ceive such as will him opportunity treatment a realistic improve cured or to (Emphasis added.) mental condition.” argues suggests that this statement patient that a mental by has a to treatment even if confined dangerousness reason of to himself or others. But this is to take paragraph the above out context, by paragraphs making for it is bracketed clеar the trial judge The trial further instructed that O’Con- nor was immune from damages if he
“reasonably good believed in faith that detention of judge’s theory that constitutionally treatment required only if alone, danger mental illness others, rather than to self or reason for thought confinement. If O’Connor had the instructions ambiguous point, objected on this he could have to them and re- quested a clarification. He did not accordingly do so. We have no occasion here persons to decide grounds whether committed on dangerousness enjoy “right to treatment.” pertinent part,
In the instructions read as follows: throughout “The Plaintiff claims period in brief that of his hospitalization mentally he was dangerous ill or to himself or others, and claims ill, further that if he mentally or if Defendants ill, believed he was Defendants withheld from him the treat- ' necessary improve ment his mental condition. brief, “The claim, Defendants that Plaintiff’s detention was legal рroper, legal his detention proper, was not mistake, was the result of without malicious intent. prove “In order Rights Act, his claim under the Civil upon burden is pre- Plaintiff in this case to establish ponderance following the evidence this case the facts: *8 will, “That the against Defendants confined Plaintiff his know- ing mentally that he dangerous was not ill or or knowing that if mentally receiving ill he was not alleged treatment for his mental illness. deprived acts and of Defendants’ conduct Plaintiff
“[T]hat right deprived his Constitutional not to be denied or of his Federal liberty process phrase without due of law as that is defined and explained in these instructions .... involuntarily civilly person
“You a who are instructed that is right hospital committed to a mental does have a constitutional give opportunity as him a to receive such treatment will realistic improve mental condition. be cured or his “Now, involuntary hospitalization treatment and purposе of danger punishment patient a care a is not not mere custodial justifica- is no to himself or such treatment there others. Without length of time he for the proper was
[Donaldson] was so confined .... give which do not
“However, mere intentions good lawfully belief that to a reasonable detention rise confinement justify required cannot [Donaldson’s] Hospital.” Florida in the State against verdict Donaldson The returned a of damages and a and awarded codefendant, including punitive damages.7 $38,500, $10,000 judgment affirmed the The Court with “the far- opinion dealing Court District a broad Amendment reaching question whether Fourteenth persons involuntarily right a to treatment guarantees 493 F. civilly hospitals.” 2d, committed mental to state in Don- appellate when, The court held at 509. that case, the rationale for confinement aldson’s requires patient treatment, is in need of Constitution minimally provided. treatment adequate in fact be Id., expressed that, The further the view at 521. court involuntary civil commit- regardless grounds against confined his will at a state mental ment, receive such has “a constitutional institution give op- him individual treatment as will a reasonable improve be mental condi- portunity to cured or to his Id., opinion tion.” 520. the court’s Conversely, constitutionally permissible it is for a implied that person against ill his will in order to confine his illness ren- illness, regardless to treat whether stand-point tion from constitutional continued confinement you dangerous the Plaintiff either unless should also find that to himself or others.” judge punitive damages had instructed should trial only if De awarded “the act or omission the Defendant *9 injury proximately caused fendants which to the Plaintiff was maliciously oppressively wantonly done.” or id., him dangerous ders to himself or others. See at 522-527.
II We have concluded that the difficult issues of con- by stitutional law dealt with the Court are by not presented present this case in its posture. Spe- cifically, there is no reason now to whether decide men- tally persons ill dangerous to or to themselves others have a right to upon compulsory treatment by confinement or whether State, may compulsorily confine a ill nondangerous, mentally purpose individual for the treatment. it, As we view this case single, raises a rela- tively simple, important but question nonetheless con- cerning every man’s right liberty. constitutional
The jury found that Donaldson dangerous was neither to himself nor dangerous others, that, also found mentally ill, Donaldson had not received treatment.8 That verdict, based on evidénce, abundant makes the issue before Court a narrow one. We need not decide whether, when, by mentally what ill procedures, a may person by any be confined the State on grounds which, contemporary under statutes, gen- are erally justify involuntary advanced to confinement of person such a prevent injury to the public, to ensure —to supra, jury instructions, possible Given the see n. 6 it is jury only went far as to find so that O’Connor knew that Don not aldson was harmless to himself and others but also that he was found, permitted not ill all. If by it so against regardless instructions to rule of the nature of provided. jury’s the “treatment” If we were to construe verdict fashion, in that there would remain no substantial issue in case: wholly That sane and innocent has a constitutional physically confined the State when his freedom will pose danger seriously neither to himself nor others cannot be doubted.
574 his or cure safety,9 or to alleviate or survival
his own
Indiana,
736-737;
715,
406 U. S.
Jackson v.
See
illness.
jury
the
509. For
Cady, U.
S.
Humphrey
v.
con-
for continued
grounds
the above
that none of
found
case.10
in Donaldson’s
present
finement was
justification
was left as
findings, what
jury’s
Given
The
confinement?
in continued
Donaldson
keeping
confinement
may have authorized
law
fact
state
that
con-
not
establish a
mentally ill does
itself
harmless
for the confinement.
See
stitutionally adequate purpose
Direc-
McNeil v.
Indiana, supra,
Jackson v.
720-723;
Institution,
Nor
tor,
Patuxent
248-250.
was
original
Donaldson’s
confinement
enough
is it
that
“dangerous
himself.”
phrase
judge’s instructions used the
self-injury
course,
or
is
foreseeable risk of
Of
even if there
no
physical
literally “dangerous
if for
suicide, person
to himself”
is
helpless
the hazards of freedom either
other
he is
to avoid
reasons
willing family
members
through
own efforts or with
aid of
his
judge’s
might
argued
instructions
friends.
it
that
While
point, O’Connor raised no
could have been more detailed on this
clearly
objection
them, presumably
showed
because
evidence
broadly
“dangerous
himself”
that Donaldson was
however
phrase might be
defined.
argues that,
jury’s verdict,
despite
the Court
receiving
must assume
Donaldson was
treatment sufficient to
justify
confinement,
adequacy
because the
of treatment
is a
“nonjusticiable” question
that must be left to the discretion of
psychiatric profession.
argument
unpersuasive.
That
Where
ground
depriving
is the sole
“treatment”
asserted
liberty,
plainly unacceptable
suggest
it
the courts are
ground
present.
powerless to determine whether the asserted
Indiana,
party objected
Jackson v.
A finding of “mental justify illness” alone a cannot person up a locking State’s against keeping his will and indefinitely him in simple custodial confinement. As- suming that term given reasonably can be precise content “mentally and that the ill” can be identified with reasonable accuracy, is still no there constitutional basis confining persons such involuntarily they if are dan- gerous one and can safely live in freedom.
May the State mentally confine the ill to en- merely superior sure them a living standard they enjoy in private community? the That the has a proper State interest in providing care and assistance to the unfor- goes tunate without saying. But presence mere of mental illness does not disqualify a person from preferring his to the home comforts of an institution. Moreover, may while the arguably State confine a him to save harm, from rarely incarceration is if ever a necessary condition for raising living standards of capable those safely of surviving in on freedom, their own or with help family of or friends. Shelton Tucker, v. 479, S. 488-490.
May fence harmless solely ill to save its citizens from exposure to those ways whose are different? might One well ask the State, public avoid unease, could incarcerate all physi- who are cally socially unattractive or eccentric. Mere public in- animosity tolerance or cannot constitutionally justify deprivation of person’s physical liberty. g., See, e. Cohen California, v. 15, U. S. 24-26; Coates City v. of Cincinnati, York, Street New S. v. 615; U. Moreno, Dept. U. 576, 592; Agriculture cf. U. S. v. 413 U. S. 534.
In short, constitutionally State cannot with- confine out a nondangerous more individual who capable safely in surviving freedom help himself or with the willing family and responsible members friends. upon Since the found, ample evidence, O’Con- nor, agent as an State, knowingly did so confine Donaldson, properly concluded that O’Connor violated Donaldson’s constitutional to freedom.
Ill any contends that event he should not be personally held liable monetary damages because his decisions were made in “good Specifically, faith.” *12 O’Connor argues pursuant that he was acting to state law which, he authorized of the believed, confinement mentally ill even when their would not release com- promise safety their or constitute danger others, to and that he could reasonably expected not been have to know that the state law as he understood it was consti- tutionally A proposed invalid. instruction to this effect rejected by the District Court.11
The District Court did instruct
jury,
without ob-
jection,
monetary damages could not be assessed
against O’Connor if he had believed reasonably and in
good
faith
Donaldson’s continued confinement was
supra.
During
years
n.
his
of confinement, Donaldson
unsuccessfully
petitioned
the state and federal courts
release
from the
Hospital
Florida State
on a number of occasions. None
of these claims was ever
merits,
resolved on its
evidentiary
hearings were ever held. O’Connor has not contended that he
relied on these unsuccessful court actions as an independent
inter
vening reason for continuing Donaldson’s
confinement,
and no
requested.
on this
instructions
score were
punitive damages
and that
“proper,”
could be awarded
or
only
“maliciously
wantonly
O’Connor had acted
oppressively.” of Appeals approved
Court
those
instructions. But
court did
consider whether
it was error
judge
for the trial
refuse
additional
instruction
claimed
on
concerning O’Connor’s
reliance
state law as authorization for Donaldson’s
con-
continued
finement.
neither
the District Court nor
Further,
of
Court
acted with the benefit of this Court’s
most recent
scope
qualified
decision on the
immu-
nity possessed by state officials under 42 U. S. C. 1983.
§
Wоod v. Strickland,
Under that relevant question decision, is whether O’Connor reasonably “knew or should have known that the action he took within sphere offi- responsibility cial would violate the constitutional rights or if he [Donaldson], took the action with the mali- cious deprivation intention to cause a of constitutional rights injury other Id., at [Donaldson].” 322. See Rhodes, also Scheuer v. 247-248; v. Wood Strickland, supra, at (opinion J.). For Powell, purposes of this question, an official has, course, no duty anticipate unforeseeable develop- constitutional Strickland, ments. Wood v. supra, at 322. Accordingly, we vacate the judgment of the Court of Appeals and remand the case to enable that court consider, in of Wood v. light Strickland, whether the Dis- trict Judge’s failure to instruct with regard to the effect *13 of O’Connor’s claimed reliance on state law rendered inadequate the instructions as to liability O’Connor’s for compensatory punitive and damages.12
It is so ordered. 12Upon remand, Appeals only Court of is to consider question whether is be monetary to held for liable dam ages violating right liberty. Donaldson’s constitutional
Mr. Chief Justice Burger, concurring. I Although join opinion the Court’s judgment and in case, it seems to me that several merit factors more emphasis than it I gives them. therefore add the follow- ing remarks.
I respect With to the remand to Appeals the Court of on the issue of immunity official liability from for mone- tary damages,1 it seems to entirely me not irrelevant there was substantial evidence that Donaldson consist- ently refused treatment that was claiming offered to him, that he was not ill and needed no treatment.2 jury found, on substantial adequate instructions, evidence and under deprived that O’Connor Donaldson, dangerous who was neither to himself provided nor to others and was treatment, of the con- liberty. stitutional 8, supra. Cf. n. finding That needs no further If consideration. the Court of holds that a remand to the necessary, only District Court is issue be determined in that court will be liability whether O’Connor is immune from monetary damages. necessity Of vacating judgment our decision of the Court of Appeals deprives opinion precedential effect, leaving court’s opinion judgment this Court’s and as the law sole of the case. See Munsingwear, United States v. 36. S.U. difficulty understanding
1 I have immunity how the issue of can be very resolved on this record likely and hence it is a new trial may required; on this issue be hope that is case I would these important sensitive and issues would have the benefit of more effec presentation tive petitioner. articulation on behalf of 2The Court’s reference therapy,” ante, to “milieu 569, may disparaging construed as concept. True, being capable it is simply used to cloak official indifference, reality but is that some respond mental abnormalities to no known Also, treatment. patients some mental respond, persons suffering variety as do from a physiological ailments, loosely to what called “milieu treat- ment,” e., keeping i. comfortable, them nourished, well protected environment. It say baffling us field psychiatry therapy” always that “milieu pretense.
579 The Court appropriately takes notice of uncertainties psychiatric reported and and the diagnosis therapy, with replete divergence cases are evidence of the g., medical in this E. Greenwood opinion vexing area. States, (1956). v. United 350 U. S. also Missouri, Drope v. 162 (1975). Nonetheless, agreement one of the few areas of among behavioral specialists uncooperative is that an patient cannot bene- fit therapy from and that the step first effective treat- acknowledgment ment by patient that he is suffering from an abnormal See, g., condition. е. Katz, Right to Treatment —An Enchanting Legal Fiction? 36 U. Chi. L. Rev. (1969). 768-769 Donaldson’s adamant refusal to do so should taken into account in considering petitioner’s good-faith defense.
Perhaps important more to the issue of immunity is a only obliquely factor referred to in the Court’s opinion. On numerous during occasions the period of his confine- ment Donaldson unsuccessfully sought release in the courts; indeed, Florida the last of these proceedings was only terminated a few months prior to the bringing of this cert, action. 2d 114 See 234 (1969), denied, So. 400 U. S. Whatever reasons the state courts’ repeated relief, regardless they denials of whether correctly resolved issue tendered to them, petitioner and the other members staff the medical at Florida Hospital surely would justified have been in con- judicial sidering each such decision as an approval of continued confinement and an independent intervening continuing сustody. reason for Donaldson’s Thus, this inescapably fact is related to immunity the issue of by must be considered the Court of on remand on and, a new trial is ordered, issue Dis- trict Court.3 petitioner’s failed That counsel to raise this issue is reason
II ante, n. points 6, As Court at the District out, 570 part Court instructed the in “a that who involuntarily civilly hospital committed to a mental does a constitutional right have receive such treatment as give will him he opportunity (em- a realistic cured” phasis Appeals and the of unequivocally Court added), approved this a phrase, standing alone, correct state- of ment 493 507, (CA5 1974). law. F. 2d opinion Court’s no plainly gives approval holding to that makes clear that the parties binds neither this nor case the courts of Fifth Circuit. ante, See importance n. 12. in 577-578, light of its for Moreover, in litigation emphasized future it should be area, the Court of Appeals’ analysis basis has no in de- of cisions this Court.
A There сan involuntary be doubt that commitment to a mental like involuntary an hospital, confinement of any individual for deprivation is a reason, liberty of accomplish which the cannot process without due Patterson, Specht law. v. 386 U. 605, (1967). S. Gault, InCf. re 12-13 1, (1967). Commitment justified must be on legitimate the basis state inter and the est, reasons committing particular individ ual must be established in an appropriate proceeding. Equally important, confinement must cease when those no longer Director, reasons exist. McNeil v. Patux Institution, ent 407 U. S. 249-250 (1972); Jackson v. Indiana, 406 IT. S.
The Court purported to be applying these principles in first developing the of its theories support- why respect it should not be considered with immunity light holding preserved of the Court’s the defense appellate review.
ing constitutional to treatment. It first identi- fied it perceived what to be the traditional bases civil physical dangerousness to oneself or commitment — or a need for others, treatment —and stated: ''[W]here, as in case, Donaldson’s the rationale for confinement is the ‘parens patriae’ rationale that patient is in need of treatment, process the due clause requires that minimally adequate treatment fact provided. . . . deprive any 'To citizen liberty her upon theory the altruistic is for therapeutic the confinement humane reasons *16 provide and then fail to adequate treatment violates ” very the process.’ fundamentals of due F. 2d, at 521.
The Court of Appeals
explain
did not
its conclusion
the
respondent’s
rationale for
commitment was that
he needed treatment.
The Florida statutes
in effect
period
during the
of his confinement did not
require
who
been adjudicated
had
incompetent and
ordered committed either
provided
be
with psychiatric
or released,
treatment
and there was no such condition in
respondent’s order of
Cf.
Cam-
commitment.
Rouse v.
eron, 125 U. App.
D. C.
That not descriptive of the traditionally power exercised States this area. Historically, and for a period considerable of time, subsidized custodial in private care foster homes or boarding houses was the benign pro- most form of care vided incompetent or mentally persons ill for whom the States responsibility. assumed Until well into 19th century the majority vast persons simply such were restrained in poorhouses, jails. almshouses, or A. Deutsch, Mentally 111in 38-54, America 11A- (2d 1949). ed. The few States that established institutions mentally for the ill during early period were primarily concerned with providing more humane place of confinement only secondarily with “during” persons id., sent there. See at 98-113.
As the trend toward state care of ill ex- panded, eventually leading present to the statutory schemes protecting such persons, the dual functions of institutionalization continued to recognized. While one of goals of this movement provide was to medical treatment to those who could benefit it, from it was ac- knowledged that this could not be done in all cases and that there was a large range of mental illness for which no known “cure” existed. In time, providing places for the custodial confinement of the so-called “de- pendеnt again insane” emerged major as the goal of the *17 programs States’ in this area and remained so well century. id., into this See at 228-271; D. Rothman, The Discovery Asylum of the 264-295 (1971).
In short, the idea may that States not confine the except ill for the purpose of providing them with very treatment is of recent origin,4 and there is no historical basis for imposing such a limitation on state power. Analysis of the sources of the civil commitment power likewise support lends no to that notion. There can be little doubt that police exercise of power its Editorial, Right, A See New 46 A. (1960). B. A. J. 516 may solely protect a State confine individuals society from the dangers significant antisocial acts com- municable disease. Cf. Minnesota ex rel. Pearson v. Pro- Court, bate 309 U. 270 (1940); S. Jacobson v. Massa- chusetts, (1905). 197 U. S. 25-29 Additionally, States are vested with the parens patriae historic power, duty including protect “persons legal under disa- bilities to act for themselves.” Hawaii v. Standard Oil Co., 405 U. (1972). also Mormon Church See States, v. United 136 U. 1,S. 56-58 The classic example of this is a role when State undertakes to act as “ general guardian 'the of all infants, idiots, and luna- ” Co., tics.’ Hawaii v. Standard Oil supra, 257, quot- ing 3 W. Blackstone, Commentaries *47.
Of course, an inevitable consequence exercising parens patriae power is that personal the ward’s freedom substantially will be a restrained, guardian whether appointed to property, placed control his he is in the cus tody private of a third in party, committed an stitution. Thus, power implemented, however the due process requires indiscriminately. it not be invoked At minimum, particular protection scheme for mentally ill legislative must rest upon determination compatible with best interests of the affected class and its members are unable to act for States, supra. themselves. Cf. Mormon Church v. United Moreover, protеction may the use of alternative forms of considerations, justifi motivated different and the may cations for one not be invoked to rationalize another. Indiana, Jackson v. S., Cf. at 737-738. also Mentally Foundation, American Bar Disabled and (S. 1971). the Law 254-255 Brakel & R. Rock ed. However, process the existence of some due limitations parens patriae power justify on the does not the further may be exercised conclusion that it to confine a mentally *18 584 only
ill purpose of the confinement Despite many treatment. recent advances in medical knowledge, it remains stubborn are fact there many forms of mental illness which are not under stood, some which are in the untreatable sense that no yet therapy effective has been discovered for and them, generally of “cure” rates are Schwitzgebel, low. See Right The to Effective Mental Treatment, Calif. (1974). L. Rev. 941-948 can There be little re sponsiblе debate regarding “the uncertainty diag nosis in this field and the professional tentativeness of judgment.” States, Greenwood v. United S., at 375. also Ennis & Litwack, Psychiatry See Presumption Expertise: Flipping Coins in the Court room, 62 L. Rev. 693, (1974).5 Calif. 697-719 Sim ilarly, previously observed, universally recog nized as fundamental to therapy patient effective that the acknowledge his illness and cooperate with at those give to tempting treatment; yet the failure of large proportion ill persons to do so is common phenomenon. supra, Katz, See L. U. Chi. Rev., It may 768-769. be that some persons in either of these categories,6 may and there be others, are unable in society function and will suffer real harm to them provided selves unless with care in a sheltered environ See, Cameron, ment. e. g., Lake v. 124 U. App. D. C. 5 Indeed, there concerning is considerable debate the threshold questions of what constitutes “mental disease” and “treatment.” Szasz, Right Health, 57 Geo. L. J. 734 6 Indeed, respondent may have shared both of these characteris illness, paranoid His schizophrenia, notoriously tics. unsusceptible treatment, Livermore, see Malmquist, Meehl, & On Justifi Commitment, Civil cations for 75, 93, L. U. Pa. Rev. n. (1968), reports and the Hospital Florida State staff which expressed were introduced into evidence the view he un was willing acknowledge his illness and generally uncooperative. *19 270-271, 657, (1966) (dissenting 364 F. 2d 663-664 264, say I that a very least, At the am not able to opinion). powerless judg- is to make that kind of legislature state States, supra. Greenwood v. United ment. See B that, it a Fourteenth Alternatively, argued has been involuntarily right to treatment confined Amendment many the patients derives from fact that of mental the present are not in process the criminal safeguards of Appeals of described this civil commitment. The Court theory follows: to treatment is based on process right due
a[A] central principle that when three limitations to detain-—that deten power government's on the specific offense; for a be in retribution tion and term; permitted a fixed that it be be limited to proce fundamental where the proceeding after a there observed—are absent, are safeguards dural by pro quo extended quid govern be a must quid pro And the justify to confinement. ment commonly provision quo recognized most 2d, F. at 522. treatment.” rehabilitative permit a theory may be read to To the extent willing because it is simply an individual confine ability subject's regardless provide treatment, con- gravest it raises society, in function I the Court have no doubt and problems, stitutional justification this score. As a agree on would quid treatment, to such a constitutional defects. equally serious from theory suffers quo pro discus- require extended well established It is too concept. not an inflexible process due sion particular are determined requirements its Rather, inter- accommodating the identifying instances society. g., Morrissey ests individual and e. See, Brewer, v. McNeil v. (1972); 408 U. 480-484 S. Director, Patuxent Institution, 249-250; S., U. McKeiver v. Pennsylvania, 545-555 (1971) (plurality opinion). Where claims that the State acting the best interests of said to an individual are justify procedural reduced safeguards, substantive *20 they require “candidly Court’s decisions that ap Gault, In praised.” re 387 at S., 21, U. 27-29. How ever, doing in so are not to judges private free read their public policy public notions of health into the Consti Nebraska, Olsen tution. v. 246-247 quid pro quo theory sharp departure is a from, process cannot coexist with, principles. due theory As an initial the matter, presupposes essen- that tially the same in every interests are involved situation where a State seeks confine an individual; that as- sumption, It however, elementary is incorrect. is that justification the process the criminal unique and the deрrivation of liberty which impose it can requires that it only be invoked specific commission offense prohibited by legislative enactment. Powell v. Texas, 392 U. S. (1968) 541-544 (opinion of J.).7 Black, But it would be incongruous, for example, to apply the quarantine same limitation when imposed is by the protect State to public from highly com- municable disease. Massachusetts, See Jacobson v. U. S., at 29-30. imply accept I This is Appeals’ all the Court of regarding upon
conclusions limitations power States’ persons detain who commit example, crimes. For the notion that confinement must be a fixed square “for term” is difficult with practice the widespread sentencing, of indeterminate least where at upper limit a life sentence.
A more troublesome quid quo feature of the pro theory would elevate a concern for essentially proce- dural into safeguards a new substantive constitutional right.8 Rather thаn strict inquiring whether standards proof periodic patient’s redetermination aof condition are in required theory civil confinement, accepts absence of such but safeguards insists that the pro- which, vide benefits the view of court, are adequate “compensation” for confinement. In light of the wide opinion of medical divergence regarding the diagnosis of proper therapy mental abnormalities, pros- pect especially troubling this area and cannot be squared with the principle may that “courts not sub- for the judgments stitute their legislators own under- standing public welfare, but must instead concern with validity themselves under the Constitution of legislature the methods which the has selected.” In re Gault, S.,U. 71 (Harlan, J., concurring and dis- *21 senting). Of course, questions regarding adequacy the procedure power of and the of a to par- State continue ultimately ticular confinements are for the aided courts, by expert opinion to the extent that helpful. found But I persuaded am not that should we abandon the judicial traditional limitations on the of scope review. C I sum, In accept reasoning cannot the the Court equating and can discern no basis for an involuntarily patient’s unquestioned committed mental right proc- constitutional not to be confined without due 8 right quid Even of a have criticized advocates treatment the g., pro quo theory ground. Developments on this E. in the Law— Mentally 111, 1190, the Civil Commitment of 87 Harv. L. Rev. 1325 (1974). n. 39
588
ess of law with a constitutional to treatment.9 present Given the state medical knowledge regarding abnormal human treatment, things behavior and its few would be fraught more with peril irrevocably than to condition a power State’s protect the ill upon the providing of “such give treatment as will a [them] 9 pointed It should be out that several issues which Court upon has touched in other are contexts here. invоlved As opinion the Court’s plain, per makes is not case of seeking son’s release he because has been confined “without ever obtaining judicial determination that such confinement war Director, ranted.” Institution, McNeil v. Patuxent 407 U. S. (1972). Although 249 respondent’s alleged complaint amended that hearing his County 1956 before procedurally the Pinellas Court was ignored necessity defective and relating various factors commitment, persons allegations applied to whom those were process either by not served with or dismissed District Court prior Respondent sought to trial. has not review of the latter rulings, rights this case does not involve of a in an competency proceeding. initial or commitment Cf. Jackson v. Indiana, 406 (1972); Specht Patterson, U. S. 738 v. 386 U. S. (1967); Court, Minnesota ex rel. Pearson Probate 309 U. S. v. (1940). Further, alleged respondent singled was not was out for discriminatory Hospital treatment staff Florida State patients privilеges generally at institution were denied persons Thus, available other under commitment in Florida. question justify whether different bases for commitment differences litigation. conditions of confinement not involved in this Cf. Indiana, 723-730; v. supra, Herold, Jackson Baxstrom v. U.
Finally, respondent there was no evidence whatever that was Hospital abused mistreated at Florida or that the failure to aggravated provide him with treatment There condition. *22 general testimony regarding quality hospital, of life but respondent’s was not asked to consider whether confinement being “punishment” ill. was in effect The record provides concluding, therefore, respondent basis by Eighth rights secured denied Fourteenth Amendments. California, Cf. Robinson v. I accept Nor can cured.” to be opportunity
realistic an individual may lawfully confine theory deprivation justify to need treatment thought Our some treatment. solely providing liberty “trade- such a would not process of due tolerate concepts could analysis Appeals' the Court Because off.” not be it should results, those authorizing be read followed.