The decision by the Supreme Court in O’Connor v. Donaldson has been ridiculed since it was decided in 1975. This was the first case that presented the rights of people with mental illness and their access to treatment to the Supreme Court. The Court’s narrow decision failed to take advantage of an opportunity to address the critical issues raised in the case, such as what it means to be “dangerous” and if there is a constitutional right to treatment. Instead, the Court, deciding unanimously, centered its decision on the right to liberty found in the Due Process Clause of the Fourteenth Amendment. Since the Court chose not to address certain issues from this case and only addressed the problems that could be resolved by looking at precedent, the decision in O’Connor exemplifies what legal scholar Stephen Feldman terms a “legal purist” approach—where judicial decision-making is based solely on applying legal doctrine and precedent to facts rather than political or societal considerations.1
In its decision in O’Connor v. Donaldson, the Court held that “a state cannot constitutionally confine a nondangerous individual who is capable of surviving safely in freedom by himself or with the help of others.”2 The Court determined that an individual is “dangerous,” only if they have a foreseeability of “self-injury or suicide” and “for physical or other reasons, is helpless to avoid the hazards of freedom either through his own efforts or with the aid of willing family members or friends.”3 However, many activists for the rights of the mentally ill agree that this definition is inadequate and too vague, rendering it useless in practical matters as it can be interpreted in a variety of ways.4 The first part of the definition, concerning the foreseeability of suicide or self-harm, has long been criticized for its inconsistency. Psychiatrists typically determine whether someone is likely to commit suicide or self-harm. However, they often base this decision on their personal preferences and experiences.5 Since their decisions are based on personal influences, psychiatrists frequently overestimate an individual's dangerousness and request hospitalization, even if the individual showed virtually no signs of violence or harm.6 Likewise, the second part of the “dangerous” definition—that an individual, for some reason, is unable to avoid the hazards of freedom with or without help—has been historically interpreted to imply that all mentally ill people are incapable of taking care of themselves. This interpretation led to decisions such as Lynch v. Baxley (1984), which holds that even if mentally ill people do not threaten violence, they may still be considered dangerous if it can be proven that they have a mental illness and that their illness affects the standard by which they care for themselves.7 This interpretation assumes that all mentally ill people are incompetent simply because they live differently than people without mental illness. Due to these broad interpretations, people with mental illnesses were involuntarily confined at increasingly frequent rates in hospitals.
Others, such as Virginia lawmakers, have interpreted this definition strictly and made it nearly impossible to force people into hospitals unless they were exceedingly dangerous. The case of Mike Earley, documented by his father, Pete Earley, demonstrates the real-world consequences of such strict interpretations. Mike, diagnosed with bipolar and schizoaffective disorder, broke into a random house, took a bath, and smashed several pictures.8 However, his actions in this situation were insufficient for the courts to declare Mike as “dangerous” and to force him into confinement in a hospital.9 After this incident occurred, police officers and nurses recommended that Mike’s father lie and say that his son had threatened him so that Mike could be hospitalized, but not even that was enough for Mike to be involuntarily committed.10 Thus, as seen through both the strict and broad interpretations, there is no straightforward way to determine what qualifies someone to be “dangerous,” and the justices in O’Connor did nothing to rectify this issue, leaving the decision to lower court procedures, state laws, and wavering psychiatric testimony. The Supreme Court had the opportunity to establish a new, applicable definition of “dangerous” in O’Connor, but hesitated to do so since neither the Constitution nor precedent clearly defines what determines someone to be “dangerous.”
Similar to the definition of “dangerousness,” the justices did not make definitive judgments about patients’ right to mental health treatment if involuntarily confined. A previous Supreme Court case, Jackson v. Indiana (1972), held that involuntary confinement must cease when the original reason for confinement no longer exists. This decision was used as a precedent in the decision of O’Connor v. Donaldson.11 However, this precedent did not directly address a constitutional right to treatment. Several lower courts have ruled on this issue, finding that treatment must be given to any individual involuntarily confined based on needing treatment, but if not given, due process would be violated.12 The court, in Wyatt v. Stickney (1971), for instance, held that involuntarily committed individuals have a constitutional right to receive treatment to improve their mental condition. The Fifth Circuit Court of Appeals in O’Connor concurred with this decision, stating that Jackson also supports this decision because it holds that due process requires the duration of commitment to have some relation to the reason for which the person was committed originally.13 However, following the legal purist lens, the Supreme Court did not extend these lower court rulings into constitutional law matters; instead, they limited their decision to only what was clearly established in the Constitution and previous Supreme Court decisions. This adherence to legal purism left the right to treatment unresolved.
Despite Jackson v. Indiana and lower court rulings, state hospitals where mentally ill patients were confined at the time of the O’Connor decision were characterized by deplorable conditions. When Mike Early was admitted to psychiatric hospitals, his father, Pete Earley, noted that they were often overcrowded, with patients sleeping in hallways or sharing rooms meant for one person.14 The rooms were unsanitary and lacked basic supplies such as soap, towels, and clean sheets.15 Patients were left in their rooms for hours without treatment or interaction with others and were often heavily sedated.16 Many were forced into confinement for treatment purposes but never improved because they received no valuable treatment.17 Despite these glaring issues surrounding the treatment of those with mental illness, the Supreme Court omitted the right-to-treatment topic from its decision in O’Connor, even though they could have ruled on it, once more illustrating that this case was decided on law instead of politics.
The unanimous decision in O’Connor, despite the varying political ideologies of the justices at the time, is another reason to view the Court’s decision from a legal purist point of view. On this Court, Chief Justice Warren Burger, William Rehnquist, and Lewis Powell typically ruled in favor of conservative beliefs; Harry Blackmun, Byron White, and Potter Stewart typically ruled in favor of moderate beliefs; and Thurgood Marshall, William Brennan, and William Douglas typically ruled in favor of liberal beliefs. Despite their differing beliefs, all nine justices came to the same decision, demonstrating their adherence to legal doctrine over political preferences. When looking at the 159 cases decided by this same Court in 1975, forty-two percent were decided unanimously and only sixteen percent were largely divided by political views, resulting in narrow 5-4 decisions.18 Thus, in 1975, the Court had a pattern of basing more decisions on legal precedent than on politics. Had they used politics in their decision-making, more of their decisions would have had a closer 5-4 margins because their political beliefs varied so much. Given this pattern, it is even more likely that the decision in O’Connor was based on law rather than politics.
When looking at the decision in O’Connor v. Donaldson from a legal purist perspective, it is clear that the justices based their decision on the Constitution and judicial precedent. The justices exclusively decided on the right to liberty protected by the Due Process Clause of the Fourteenth Amendment because this was the only issue in the case that the Constitution and precedent clearly outlined. The other issues—what qualifies someone to be “dangerous” and if individuals involuntarily committed on the basis of treatment had the right to treatment—were not decided on by the Court because there is no clear decision based on the Constitution or precedent. Any decision on these issues would have been based on the justices’ personal beliefs and politics. Moreover, the fact that this case was one of many unanimously decided in 1975 by this Court highlights how these justices typically practiced judicial restraint, deciding on clearly outlined laws and precedent rather than their political preferences. The narrow decision from the Court, while establishing an important precedent for the right to liberty protected by due process in the Fourteenth Amendment, still leaves significant confusion today regarding the rights of the mentally ill—a consequence of the Court’s strict adherence to legal purist principles.
