O'CONNOR v. DONALDSON 422 U.S. 563 (1975)

Donaldson was initially billed as the case that would decide whether a mental patient held in custody had a constitutional "right to treatment." Ultimately the Court did not decide that issue, but it did make some important pronouncements on the relation between mental illness and the constitution.

Kenneth Donaldson was committed to a state hospital at the request of his father; the committing judge found that he suffered from "paranoid schizophrenia." Although the commitment order specified "care, maintenance, and treatment," for almost fifteen years Donaldson received nothing but "milieu therapy"—the hospital superintendent's imaginative name for involuntary confinement. Donaldson finally sued the superintendent and others for damages under section 1983, title 42, united states code, claiming they had intentionally denied his constitutional rights. The federal district judge instructed the jury that Donaldson's rights had been denied if the defendants had confined him against his will, knowing that he was neither dangerous nor receiving treatment. The jury awarded damages, and the court of appeals affirmed, specifically endorsing the district court's theory of a mental patient's constitutional right to treatment.

The Supreme Court unanimously held that Donaldson had stated a valid claim, but remanded the case for reconsideration of the hospital superintendent's assertion of executive immunity. Justice potter stewart, for the Court, said that a finding of mental illness alone could not justify a state's confining a person indefinitely "in simple custodial confinement." The Court did not reach the larger question of a "right to treatment"; it disclaimed any need to decide whether persons dangerous to themselves or others had a right to be treated during their involuntary confinement by the state, or whether a nondangerous person could be confined for purposes of treatment. But when the state lacked any of the usual grounds for confinement of the mentally ill—the safety of the person confined or others, or treatment for illness—involuntary confinement was a denial of liberty without due process of law. Confinement was not justified, for example, in order to provide the mentally ill with superior living standards, or to shield the public from unpleasantness. To support the latter point, the Court cited first amendment decisions including cohen v. california (1971). Chief Justice warren e. burger concurred in the Court's opinion, but wrote separately to express his opposition to any constitutional "right to treatment."

Kenneth L. Karst
(1986)