by Amanda Cort*

In Parham v. J.R., the Supreme Court infamously limited due process protections for children in the medical context. At the same time, the Supreme Court has acknowledged that children enjoy First Amendment protections—to the point where they have rights beyond the traditional parent-child relationship. Additionally, lower courts have articulated a strong connection between First Amendment protection from intrusions into mental processes and the right to refuse treatment. This Contribution argues that the First Amendment can be used as a new avenue to advocate for the rights of mature minors to refuse psychiatric drugs that alter their ability to think and express themselves.

A study published in 2022 identified a significant uptick in visits to pediatric emergency rooms for mental health emergencies, with a 43% increase from 2015 and 2020, averaging an annual rise of 8%.1 The patients most likely to reappear in emergency rooms often received antipsychotic medications, antihistamine medications, and benzodiazepines such as Xanax and Valium, with the purpose to restrain and subdue them.2

Further, the use of psychotropic polypharmacy—the practice of prescribing children more than one psychiatric medication—has risen drastically, “despite limited evidence of efficacy and mounting safety concerns.”3 One study found that antipsychotic prescriptions for children increased from 38.3% in 1999–2004 to 75% in 2011–2015.4 It is widely recognized that psychotropic drugs have side effects,5 and studies have indicated that children may be more sensitive to those adverse effects.6 With the growing use of pharmacologic restraints and psychotropic treatment for children, society must look at how mature minors7 want to be treated for their mental disabilities.

In Parham v. J.R.,8 the Supreme Court infamously limited Fourteenth Amendment due process protections for children in the medical context. At the same time, the Supreme Court has acknowledged that children can enjoy First Amendment protections that reach beyond the traditional parent-child relationship. Additionally, lower courts have articulated a strong connection between First Amendment protection from intrusions into mental processes and the right to refuse treatment. This Contribution argues that the First Amendment can be used as a new avenue to advocate for the rights of mature minors to refuse psychiatric drugs that alter their ability to think and express themselves.

* * * * *

The Supreme Court in Parham v. J.R. addressed for the first, and only, time children’s due process rights in mental health institutions.9 At issue was a Georgia statute that allowed for the “voluntary” admission of minors into a state regional hospital at the request of their parents.10 The statute provided that only a neutral factfinder—the superintendents or physicians of the hospitals—needed to certify that the minor should remain committed.11

In deciding whether the due process rights of institutionalized minors were violated under the statute, the Court used the Mathews v. Eldridge test, which balances “private interests . . . affected by the official action”; risks of the procedures erroneously depriving private interests; and the Government’s interest, “including the function involved and the fiscal and administrative burdens that the additional or substitute procedural requirement would entail.”12 For the first factor, the Court conflated the child’s interest in not being committed with the parents’ interest in the welfare and health of the child.13 The Court rejected J.R.’s argument that the constitutional rights of children in this context outweigh parents’ traditional interests in and responsibility for the upbringing of their child. Although the Court recognized that “[i]t is not disputed that a child, in common with adults, has a substantial liberty interest in not being confined unnecessarily for medical treatment,” it ultimately deferred to the parents’ decision to commit a minor to a mental institution, relying on “Western civilization concepts of the family as a unit with broad parental authority over minor children.”14 The Court found the statute’s procedural protections sufficient to satisfy the child’s due process rights.15

The Parham Court left many questions unanswered. It determined that a child’s Fourteenth Amendment Due Process protections are limited in the admissions decisions of minors at mental institutions, but it did not consider other constitutional rights of children and how they should be weighed against parents’ interests. It also did not address what happens when a child does have the capacity to make “life’s difficult decisions.”16 A five-year-old and a seventeen-year-old have different levels of capacity to decide what treatment they do or do not want, but the Court made no such distinction.

At both the federal and state levels, the general rule is that parents exercise the right to consent to or refuse medical treatment—in addition to many other rights—on behalf of their children. All states, however, have adopted exceptions to this rule.17 Exceptions for minors to consent to or refuse treatment include when the minor is emancipated, married, or enlisted.18 Some states have gone further and recognized a “mature minor” exception, either through common law or state statute, that affords consent and refusal rights to minors who have the capacity to decide for themselves what happens to their bodies.19 The child’s age plays a major role in determining whether they are “mature,” but other factors are also sometimes considered.20 The details around the mature minor exception may vary, but the theory behind it is consistent: minors with the capacity to understand informed consent should have the same rights as adults to consent to or refuse treatment.21

The Parham Court limited children’s due process rights in the context of admittance into mental institutions, but the Supreme Court has time and again acknowledged that children enjoy other constitutional rights.22 Indeed, children enjoy constitutional rights independent of their parents. In Tinker v. Des Moines Independent Community School District, the Supreme Court looked at a First Amendment challenge to a policy developed by local high schools that prohibited students from wearing an armband to school.23 Multiple high school students subsequently wore black armbands to school to protest the Vietnam War and were suspended from school.24 The Court held that the school violated the students’ First Amendment rights.25 In so holding, the Court acknowledged that “[s]tudents in school as well as out of school are ‘persons’ under our Constitution.”26 Absent from the Court’s analysis was a discussion about the children’s need to receive permission from their parents to engage in this fundamental right. In other words, Tinker did not condition a minor’s right to engage in free expression on their parents’ or school’s approval.27

Further, the Supreme Court has suggested that minors can exercise independent constitutional rights when obtaining an abortion, a major medical decision. For example, in Planned Parenthood v. Danforth, the Court held that states could not impose a blanket condition requiring that minors receive consent from their parents for an abortion during the first twelve weeks of pregnancy.28 In addressing the interest of “safeguarding” the “family unit and of parental authority,” the Court noted it unlikely that giving a parent the ultimate decision for their child’s abortion “will enhance parental authority or control where the minor and the nonconsenting parent are so fundamentally in conflict and the very existence of the pregnancy already has fractured the family structure.”29 Similarly, in Bellotti v. Baird, the Court found a state statute requiring that pregnant minors obtain parental consent for an abortion without a judicial bypass option unconstitutional.30 The Court noted that a minor is entitled to show “that she is mature enough . . . to make her abortion decision . . . independently of her parents’ wishes.”31

Jurisprudence on children’s constitutional rights is not linear. In some contexts, the Supreme Court has taken a more traditionalist approach to the family unit, granting parents broad authority over their children.32 Elsewhere, such as with regards to First Amendment rights, the Court has recognized children as autonomous individuals, free to make their own choices.33 Even in some cases that touch on traditionalist views of parent-child dynamics, they still “present[] a nontraditional message that children, though vulnerable and immature, do sometimes have the constitutional right to make crucial choices about their lives without parental interference.”34

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A mature minor’s right to refuse psychotropic medication is different from the issue of a minor’s due process rights in mental health institutions that Parham addressed. The Supreme Court has acknowledged an adult’s right to refuse psychotropic medication as a liberty interest under the Fourteenth Amendment.35 The Court has never explicitly held that this right also implicates a First Amendment interest. However, the Court has alluded that the First Amendment implicates a freedom from intrusions into mental processes, and therefore illustrates that the right to refuse psychotropic medication expands to freedom of speech protection. Lower courts have been more forthcoming in finding that freedom from intrusion of mental processes via psychotropic medication is a right that deserves First Amendment scrutiny.

The First Amendment prohibits the government from making laws that limit freedom of speech.36 The Supreme Court has long recognized that this is not limited to the “spoken or written word.”37 The Court has read the right to freedom of speech broadly to “protect the purposes underlying the first amendment.”38 For example, in Board of Education v. Pico, the Court recognized the “right to receive information and ideas” as “an inherent corollary of the rights of free speech and press that are explicitly guaranteed” by the First Amendment.39 The Court also noted that the Constitution “does not permit the official suppression of ideas.”40

The Supreme Court has also extended freedom of speech to include a negative speech right—in other words, a right to not speak. In West Virginia State Board of Education v. Barnette, the Court found that a state school board’s resolution could not require that teachers and students salute to the American flag.41 The resolution provided that failure to salute was an “act of insubordination.”42 In finding the school board’s policy unconstitutional, the Court emphasized that the compulsive nature of the resolution “invades the sphere of intellect and spirit which it is the purpose of the First Amendment to our Constitution to reserve from all official control.”43 The Court also weighed an adherence to the “strength to individual freedom of mind” over “officially disciplined uniformity for which history indicates a disappointing and disastrous end.”44

Most recently, the Court reiterated the concept of negative speech rights in Janus v. AFSCME, Council 31.45 In Janus, an Illinois law required public employees who were not members of a union to pay union dues.46 The Court struck the law down, emphasizing that because it compelled speech, the government required a greater justification for the law.47 In her dissent, Justice Kagan distinguished the Illinois law as not the government compelling speech, “but instead compelling a subsidy that others will use for expression.”48 Justice Kagan stressed that the law at issue in Janus was different from the resolution at issue in Barnette, which was the “most exceptional in our First Amendment annals” because there, “the state forc[ed] children to swear an oath contrary to their religious beliefs.”49

Both the majority and dissent in Janus then seemingly agree that compulsory speech that is the “most exceptional” requires a greater government justification, but they disagree that it should expand to circumstances beyond that. Regardless, the case of forcing someone to have their thoughts altered should rise to that “exceptional” level. Those with the capacity to invoke informed consent are at risk of having their First Amendment rights violated when they are exposed to psychiatric treatment that affects their personality, emotional responsiveness, and thought processes. Specifically, in the context of psychotropic medication, the purpose is to alter one’s mind as a treatment measure.50 Unlike behavioral modification therapy, or another less invasive treatment plan, psychotropic medications—especially antipsychotic medication and benzodiazepines—directly impact a patient’s mental processes and importantly, patients are unable to resist or mitigate the effects of those medications.51 The primary purpose of the medications is to alter a patient’s mind in a clinically beneficial way; however, the medications also frequently mentally incapacitate patients.52

And although the Supreme Court has not spoken directly on the issue, there is strong support from lower courts that the right to refuse psychotropic medical treatment is intertwined with First Amendment rights. One of the earliest acknowledgements of that right is from Kaimowitz v. Department of Mental Health for the State of Michigan.53 There, a Michigan state court held that an involuntarily committed mental patient did not have the capacity to consent to experimental psychosurgery.54 As part of its reasoning, the court determined that allowing the state to perform psychosurgery would violate the patient’s First Amendment rights.55 When describing the effects of the psychosurgery, the court emphasized that “[i]ts potential for injury to the creativity of the individual is great, and can impinge upon the right of the individual to be free from interference with his mental processes.”56 Because of this, the court held that the state failed to meet its burden in “demonstrating such a compelling State interest” in performing the surgery outweighed the protection of the patient’s “mental processes, the communication of ideas, and the generation of ideas.”57

In Scott v. Plante, the Third Circuit suggested that “the involuntary administration of drugs which affect mental processes . . . could amount . . . to an interference with [a patient’s] rights under the first amendment.”58 Similarly, in Lojuk v. Quandt, the Seventh Circuit relied on other courts that “found that compulsory treatment with mind-altering drugs may invade a patient’s First Amendment interests in being able to think and communicate freely” as part of its analysis to implicate those interests by compulsory electroshock therapy.59 The Tenth Circuit in Bee v. Greaves also identified that the First Amendment “protects the communication of ideas, which itself implies protection of the capacity to produce ideas.”60 The court in Bee analyzed whether the forced administration of an antipsychotic drug on a pretrial detainee violated his First Amendment rights. Looking to how antipsychotic drugs can drastically alter an individual’s ability to think and communicate, the court held that “a pretrial detainee retains a liberty interest derived from the Constitution in avoiding unwanted medication with such drugs.”61 The Sixth Circuit in United States v. Brandon held that a pretrial detainee was entitled to a judicial hearing to decide whether he may be forcibly medicated.62 In so holding, the court noted that the defendant had a “First Amendment interest in avoiding forced medication, which may interfere with his ability to communicate ideas.”63 State and federal courts have continued to echo this logic.64

First Amendment principles reflect the right to be free from coerced intrusion into one’s own thoughts, and therefore one’s mental processes.65 Protection of these inward mental processes is a prerequisite to being able to form fully protected speech and thoughts. Otherwise, any speech stemming from coercion would defeat the purpose of the First Amendment to protect against the “abridge[ment] [of] the freedom of speech.”66 The values underlying the First Amendment should therefore protect mental patients who seek to resist mind-altering medication.

* * * * *

Supreme Court doctrine regarding parent-child relationships has been consistent on two contradicting points: first, minors have First Amendment rights that are independent from their parents;67 and second, the traditional understandings of childhood should be preserved when dealing with issues within the family context.68 The right to refuse psychotropic medication touches on both issues—the medication’s purpose is to change a person’s thought processes, and children are brought in for mental health treatment often at the insistence of their parents. Assuming there is a First Amendment right to refuse mind-altering medication,69 a court would have to decide what is more important—a mature child’s right to determine what happens within their own mind or maintaining the traditional family dynamic of parents making choices on behalf of their children. As Professor Janet Dolgin suggests, “[o]nce children are recognized as autonomous individuals in one context, it is likely that that recognition will eventually be extended to the familial context as well.”70 The First Amendment right to refuse psychotropic drugs presents the opportunity to acknowledge that mature minors have more autonomy in the familial context. To accomplish this, a litigant could start an action against a state71 that does not have a “mature minor” exception and challenge the current law on First Amendment grounds.

Children are in a precarious position. The use of psychotropic medication is on the rise, and there are limited protections in most states for minors who do not want their thoughts and personalities altered by that medication. To find relief in court, mature minors can and should argue that their First Amendment interests are violated when states limit their refusal authority of psychotropic medications.

* Amanda Cort is a J.D. Candidate (2024) at New York University School of Law. This Contribution arose from a paper for the course Mental Disability Law Seminar taught by Professor Robert M. Levy examining current and developing legal theory around the rights of people with intellectual and psychosocial disabilities.

1. Ellen Barry, Parents Often Bring Children to Psychiatric E.R.s to Subdue Them, Study Finds, N.Y. Times (Dec. 27, 2022),

2. Id.; see also Ashley A. Foster et al., Pharmacologic Restraint Use During Mental Health Visits in Pediatric Emergency Departments, 236 J. of Pediatrics 276, 278 (2021) (finding that between 2009 and 2019, chemical restraint use increased by 370%).

3. Chengchen Zhang et al., Characteristics of Youths Treated with Psychotropic Polypharmacy in the United States, 1999 to 2015, 175 JAMA Pediatrics 196, 196 (2021).

4. Id. at 197.

5. Mental Health Medications, National Institute of Mental Health, (last visited Aug. 24, 2023); see also, e.g., Bruce J. Winick, The Right to Refuse Mental Health Treatment: A First Amendment Perspective, 44 U. Miami L. Rev. 1, 71–72 (1989) (listing physical, autonomic, and cognitive side effects).

6. See, e.g., Ajit Ninan et al., Adverse Effects of Psychotropic Medications in Children: Predictive Factors, 23 J. of the Canadian Acad. of Child and Adolescent Psychiatry 218, 219 (2014) (“Children can be more sensitive to [adverse effects] than adults.”); Robert J. Hilt et al., Side Effects from Use of One or More Psychiatric Medications in a Population-Based Sample of Children and Adolescents, 24 J. of Child and Adolescent Psychopharmacology 83, 87 (2014) (“[A]dverse reactions were very commonly reported for psychiatric medications as a whole, with fewer than one in five subjects taking medications without any parent-observed side effects.”).

7. “Mature minors” refers to people under the age of 18 who can “exercise the judgment of an adult and understand the relevant consequences, to give informed consent to or refuse medical treatment on his or her own.” Soo Jee Lee, Note, A Child’s Voice vs. A Parent’s Control: Resolving a Tension Between the Convention on the Rights of the Child and U.S. Law, 117 Colum. L. Rev. 687, 711–12 (2017). Recognizing that jurisdictions have different views of what defines a mature minor, see infra note 19, this Contribution does not take a normative stance on which standard should apply.

8. 442 U.S. 584 (1979).

9. 442 U.S. 584 (1979).

10. Id. at 590–91.

11. Id.

12. Parham, 442 U.S. at 599–600 (quoting Mathews v. Eldridge, 424 U.S. 319, 335 (1976)).

13. Id. at 600 (“[T]he private interest at stake is a combination of the child’s and parents’ concerns.”).

14. Id. at 600–02; see also id. at 602 (“The law’s concept of the family rests on a presumption that parents possess what a child lacks in maturity, experience, and capacity for judgment required for making life’s difficult decisions.”).

15. Id. at 607.

16. Id. at 602.

17. See generally Nat’l Dist. Attorneys Ass’n, Minor Consent to Med. Treatment Ls. (2013), (compiling statutes in each state regarding minor consent to medical treatment).

18. E.g., N.Y. Pub. Health Law § 2504; Me. Rev. Stat. Ann. tit. 22, § 1503; Mass. Ann. Laws ch. 112, § 12F.

19. See generally Doriane L. Coleman & Philip M. Rosoff, The Legal Authority of Mature Minors to Consent to General Medical Treatment, 131 Pediatrics 786, 789–91 (2013) (identifying trends in states that permit minors to consent to medical treatment); see, e.g., In re E.G., 549 N.E.2d 322, 326–27 (Ill. 1989) (recognizing a mature 17-year-old has a common law right to refuse medical treatment); Cardwell v. Bechtol, 724 S.W.2d 739, 745 (Tenn. 1987) (adopting a mature minor exception, “limited by the application of the Rule of Sevens and is an exception to the general rule that parental consent is required to treat minors”); In re Swan, 569 A.2d 1202, 1206 (Me. 1990) (holding it proper to respect the wishes of “a normally mature high school senior” to not remain in a permanent vegetative state); SC Code Ann. § 63-5-340 (2023) (“Any minor who has reached the age of sixteen years may consent to any health services from a person authorized by law to render the particular health service for himself.”); but see In re E.G., 549 N.E.2d at 328 (“If a parent or guardian opposes an unemancipated mature minor’s refusal to consent to treatment for a life-threatening health problem, this opposition would weigh heavily against the minor’s right to refuse.”).

20. See, e.g., Cardwell, 724 S.W.2d at 748 (listing factors to consider while also being “[g]uided by the presumptions in the Rule of Sevens”); Ala. Code § 22-8-4 (granting consent authority to minors who are over 14 years old).

21. See Kelli Schmidt, Notes and Comments, “Who Are You to Say What My Best Interest Is?” Minor’s Due Process Rights When Admitted by Parents for Inpatient Mental Health Treatment, 71 Wash. L. Rev. 1187, 1190 (1996) (“[Mature minor] policies are consistent with social science studies that show that the medical decision-making process employed by minors over the age of thirteen is generally indistinguishable from the process employed by adults.”).

22. See e.g., In re Gault, 387 U.S. 1, 13 (1967) (“[N]either the Fourteenth Amendment nor the Bill of Rights is for adults alone.”); Bellotti v. Baird, 443 U.S. 622, 633 (1979) (plurality) (“A child, merely on account of his minority, is not beyond the protection of the Constitution.”); Wisconsin v. Yoder, 406 U.S. 205, 243 (1972) (Douglas, J., dissenting) (“[C]hildren are ‘persons’ within the meaning of the Bill of Rights. We have so held over and over again.”).

23. 393 U.S. 503, 504 (1969).

24. Id.

25. Id. at 514 (“In the circumstances, our Constitution does not permit officials of the State to deny [the students’] form of expression.”).

26. Id. at 511 (emphasis added).

27. See also Frazier ex rel. v. Alexandre, 555 F.3d 1292, 1294 (11th Cir. 2009) (en banc rehearing denied) (Barkett, J., dissenting) (“[N]o court has ever required parents to consent to a minor’s exercise of his or her constitutional rights of conscience.”); W. Va. State Bd. of Educ. v. Barnette, 319 U.S. 624, 637, 642 (1943) (holding that the compulsive nature of a school resolution requiring saluting the American flag “invades the sphere of intellect and spirit which it is the purpose of the First Amendment to our Constitution to reserve from all official control” and emphasizing “strength to individual freedom of mind” over “officially disciplined uniformity for which history indicates a disappointing and disastrous end”).

28. 428 U.S. 52, 74 (1976) (“Constitutional rights do not mature and come into being magically only when one attains the state-defined age of majority.”).

29. Id. at 75; see also Parham, 442 U.S. at 631 (Brennan, J., dissenting) (arguing that the case should be governed by Danforth in that “a child who has been ousted from his family has even greater need for an independent advocate”).

30. 443 U.S. at 651.

31. Id. at 643 (emphasis added).

32. Janet L. Dolgin, The Fate of Childhood: Legal Models of Childhood and of the Parent-Child Relationship, 61 Alb. L. Rev. 345, 374–75 (1997) (“[I]n cases involving disputes between parents and children, the Court has preserved much of the Traditional Model.”).

33. Id. at 376 (defining the Individualist Model, which “does not define children through their status within families,” but rather it “allows for the autonomy of children and defines them, at least in theory, as complete human beings under the Constitution”); id. (noting that the Supreme Court has applied the Individualist Model in First Amendment cases) (citing Tinker, 393 U.S. at 511).

34. Id. at 399 (citing Bellotti, 443 U.S. at 643–44); see also id. at 382–84 (identifying Yoder, Parham, and Bellotti as “reaffirm[ing], though far from completely and with significant hesitation, the traditional model of the parent-child relationship.”).

35. Washington v. Harper, 494 U.S. 210, 221 (1990) (holding that the right of prisoners to refuse psychotropic medication is a constitutionally protected liberty interest).

36. U.S. Const. amend. I.

37. Texas v. Johnson, 491 U.S. 397, 404 (1989).

38. Bruce J. Winick, The Right to Refuse Mental Health Treatment: A First Amendment Perspective, 44 U. Miami L. Rev. 1, 17 (1989).

39. 457 U.S. 853, 867 (1982) (plurality opinion) (holding that removal of books by a local school board from high school and junior high school libraries violates the First Amendment).

40. Id. at 871.

41. 319 U.S. 624, 642 (1943).

42. Id. at 626.

43. Id. at 642; see also id. (“If there is any fixed star in our constitutional constellation, it is that no official, high or petty, can prescribe what shall be orthodox in politics, nationalism, religion, or other matters of opinion or force citizens to confess by word or act their faith therein.”).

44. Id. at 637; see also Pacific Gas & Elec. Co. v. Pub. Utils. Comm’n, 475 U.S. 1, 16 (1986) (plurality opinion) (“[T]he choice to speak includes within it the choice of what not to say.”).

45. 138 S. Ct. 2448, 2463 (2018) (“We have held time and again that freedom of speech ‘includes both the right to speak freely and the right to refrain from speaking at all.’”) (quoting Wooley v. Maynard, 430 U.S. 705, 714 (1977)).

46. Id. at 2459–60.

47. See id. at 2464 (“[O]ne of our landmark free speech cases said that a law commanding ‘involuntary affirmation’ of objected-to beliefs would require ‘even more immediate and urgent grounds’ than a law demanding silence.) (quoting Barnette, 319 U.S. at 633); id. (“When speech is compelled . . . additional damage is done. In that situation, individuals are coerced into betraying their convictions.”).

48. Id. at 2494 (Kagan, J., dissenting).

49. Id.

50. See Mills v. Rogers, 457 U.S. 291, 293 n.1 (1982) (noting that psychotropic drugs are “‘mind-altering.’ Their effectiveness resides in their capacity to achieve such effects.”).

51. See Winick, supra note 38, at 26 (“[I]ntrusive mental health treatment techniques . . . that effect massive changes in the individual’s personality, mental processes, and emotional responsiveness which the individual is unable to resist, clearly constitute a direct and serious invasion of ‘individual freedom of mind.’”) (quoting Wooley, 430 U.S. at 714); see also Joanna Moncrieff, David Cohen & Sally Porter, The Psychoactive Effects of Psychiatric Medication: The Elephant in the Room, 45 J. Psychoactive Drugs 409, 412 (2013) (“The mental effects of antipsychotics . . . can be experienced as more unpleasant and impairing than their physical effects, and can interfere with people’s ability to carry out daily tasks.”).

52. See Moncrieff, Cohen & Porter, supra note 51, at 412; supra note 5.

53. No. 73-19434-AW (Mich. Cir. Ct. July 10, 1973), 1 Mental Disability L. Rep. 147 (1976).

54. Id. at 153.

55. Id. at 152.

56. Id.

57. Id. at 151–52.

58. 532 F.2d 939, 946 (3d Cir. 1976), vacated, 458 U.S. 1101 (1982).

59. 706 F.2d 1456, 1465 (7th Cir. 1983) (citing Scott, 532 F.2d at 946).

60. Bee v. Greaves, 744 F.2d 1387, 1393–94 (10th Cir. 1984) (citing Rogers v. Okin, 478 F. Supp. 1342, 1366–67 (D. Mass. 1979), aff’d in part and rev’d in part, Rogers v. Okin, 634 F.2d 650 (1st Cir. 1980), vacated and remanded on other grounds sub nom; Mills v. Rogers, 457 U.S. 291 (1982)). In Rogers v. Okin, the Massachusetts District Court issued a class-wide injunction restricting the involuntary administration of psychotropic medication in the Boston State Hospital. The court relied in part on the First Amendment to reason that “the power to produce ideas is fundamental to our cherished right to communicate and is entitled to comparable constitutional protection.” 478 F. Supp. at 1367. The First Circuit did not address whether the decision to refuse medication implicates a First Amendment right because it found a sufficient justification in the Due Process Clause of the Fourteenth Amendment. 634 F.2d at 654 n.2. The Supreme Court ultimately avoided resolving which liberty interests are implicated in the right to refuse medication and instead remanded it to the lower court to consider the effect of a different Massachusetts state court decision. 457 U.S. at 306.

61. Bee, 744 F.2d at 1394.

62. 158 F.3d 947, 949 (6th Cir. 1998).

63. Id. at 953 (citing Bee, 744 F.2d at 1393).

64. See, e.g., United States v. Santonio, Case No. 2:00-CR-90C, 2001 U.S. Dist. LEXIS 5892, at *3–4 (D. Utah May 4, 2001) (“[T]here is the First Amendment interest in free expression: the drugs may interfere with [the defendant’s] ability to communicate ideas.”); In re Det. of B.M., 432 P.3d 459, 464 (Wash. 2019) (“The involuntary administration of antipsychotic drugs implicates the First Amendment because ‘of their potential impact on an individual’s ability to think and communicate.’”) (citation omitted); Joshua v. Foreman, No. H-18-2283, 2018 U.S. Dist. LEXIS 235426, at *22 n.20 (S.D. Tex. Nov. 29, 2018) (noting that “some courts have held that the involuntary administration of drugs which affects mental processes could be a violation of the first amendment”) (citing Scott, 532 F.2d at 946; Mackey v. Procunier, 477 F.2d 877, 878 (9th Cir. 1973); Rennie v. Klein, 462 F. Supp. 1131, 1144 (D.N.J. 1978)).

65. Winick, supra note 38, at 30 (“The principles of ‘freedom of the mind,’ ‘freedom of belief,’ and ‘freedom of thought,’ apply in the context of coerced mental health treatment.”).

66. U.S. Const. amend. I; see also Benjamin N. Cardozo, The Paradoxes of Legal Science, Columbia University Lectures (1928), reprinted in Selected Writings of Benjamin Nathan Cardozo 317 (Margaret E. Hall, ed., Fallon Publications 1947) (“We are free only if we know, and so in proportion to our knowledge. There is no freedom without choice, and there is no choice without knowledge . . . Implicit, therefore, in the very notion of liberty is the liberty of the mind to absorb and to beget.”).

67. Janet L. Dolgin, The Fate of Childhood: Legal Models of Childhood and of the Parent-Child Relationship, 61 Alb. L. Rev. 345, 376 (1997).

68. Id. at 376–77.

69. See supra notes 35–66.

70. Dolgin, supra note 67, at 377.

71. See Doriane L. Coleman & Philip M. Rosoff, The Legal Authority of Mature Minors to Consent to General Medical Treatment, 131 Pediatrics 786, 791 (2013) (“Thirty-four jurisdictions have no mature minor exception applicable in the general medical setting.”).