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Each year, U.S. courts send thousands of incompetent defendants to hospitals for treatment, where psychiatrists frequently administer psychotropic medication that can alleviate symptoms and allow the defendants to proceed with criminal adjudication. Although defendants and their attorneys usually do not object to such treatment, treatment refusals in two recent, nationally prominent cases-those of Russell Eugene Weston, Jr., the accused Capitol shooter, and Charles T. Sell, a dentist charged with filing false insurance claims-have focused legal and media attention on whether and under what conditions competence restoration can be forced on an unwilling defendant.

In its June 2003 decision in Sell v. United States, the Supreme Court issued guidelines for forcible administration of medication to restore competence to stand trial. Among those guidelines is a requirement that the proposed treatment be "medically appropriate." This requirement forces both testifying and treating physicians to consider some under-appreciated ethical issues: How can it be proper, or "medically appropriate," for a physician to treat a patient when "success" makes the patient eligible for prosecution, a guilty verdict, and punishment? Can any meaningful consideration of what is "medically appropriate" treatment for a patient ignore the consequences of treatment which, in the case of many incompetent criminal defendants, includes the likelihood that they will regain competence, be prosecuted, and be punished? Where defendants are charged with capital crimes, can it ever be "medically appropriate" for doctors to administer antipsychotic therapy, knowing that if convicted, their patient would face life in prison at the very least, and could possibly be sentenced to death?

This Article explains why medicating incompetent defendants is ethical, despite the practical consequences of such treatment. After summarizing the psychiatric backgrounds of Weston and Sell, the Article describes major legal developments in their cases. Next, the Article describes how the Sell ruling frames the question of medical appropriateness for courts and testifying physicians, and examines what occurrences of the phrase "medically appropriate" in case law and medical literature tell us about what doctors consider when they evaluate a proposed treatment.

The Article then returns to the Sell and Weston cases to review the arguments made by their attorneys in opposition to administering antipsychotic medication. The Article then lays out what the author believes is the strongest argument-grounded in medical ethics, as opposed to legal concerns-that one might advance for opposing the treatment of many incompetent defendants. Finally, the Article uses a Kantian conceptualization of punishment's justification to show that the same principles that permit fair, justly administered punishment also provide physicians with an ethical imperative to give defendants competence restoring medical therapy.