A model treatment refusal procedure for defendants found incompetent to stand trial in the ninth circuit

Pretrial detainees have a constitutionally protected right to refuse medical treatment in most circumstances; however, individuals found incompetent to stand trial (IST) due to a mental disorder can be treated involuntarily by clinicians who adhere to careful medical and legal procedures. The process of involuntary treatment of IST pretrial detainees begins with categorization into particular legal and medical groups. These different categories affect the individual's access to treatment. In this article, we review the relevant case law for the jurisdiction of the Ninth Circuit and place the medical-legal debate regarding these procedures in the context of recent cases. To address the medical-legal disjunction, we propose and discuss a model for managing treatment refusal in pretrial detainees found IST.