Dr. Charles Sell sees imaginary leopards, believes the FBI is trying to kill him and wants to go into combat. He is locked up in a psychiatric unit while the Supreme Court decides if the 53-year-old can be forced to take anti-psychotic drugs.
Justices seemed conflicted with the question before them: How to balance the government's interest in punishing nonviolent crime with a person's constitutional right to control his or her body?
Despite his delusions, Sell can behave normally and knows that he does not want to be put on powerful drugs, justices were told by attorney Barry Short.
"Then he should be able to stand trial," Justice Antonin Scalia interrupted.
Justice Anthony Kennedy asked if prosecutors should be allowed to medicate defendants, and witnesses, all in the name of justice.
"Could you send your guy out there with a needle the day before the trial ... so that he behaves the way the government wants him to at trial?" Kennedy asked the government lawyer.
Later, Kennedy told the attorney, "I do not understand your basic authority to do this at all."
The justices were hearing arguments in a follow-up to a 1992 court ruling that defendants can be forced to take drugs only if it is medically appropriate.
Sell's case raises questions that could apply more broadly to, for example, government programs requiring vaccinations against anthrax or school mandates that children with hyperactivity or attention deficit disorder take drugs to remain in class.
No one disputes that Sell, of suburban St. Louis, is mentally ill and too unstable to stand trial. There is disagreement over whether medicines will help him, and whether he is dangerous.
The Bush administration argues that hundreds of federal defendants a year are medicated, and that most become competent to stand trial. Most take the drugs willingly. In a recent 12-month period, 59 people were medicated against their wishes and about three-fourths were restored to competency, the administration told the court.
Sell and his wife are accused of submitting bogus claims to Medicaid and private insurance companies for dental services. Sell was later charged with conspiring and attempting to kill a witness - a former worker in his office - and the FBI agent who arrested him.
He has spent more than four years in a prison hospital as his lawyers fought over his drugging, more jail time than he would receive if convicted of the fraud crimes. He has been diagnosed with a delusional disorder.
Some were surprised when the Supreme Court announced last fall it would hear Sell's case. The justices refused to take up the subject in 2001 in the appeal of Russell Eugene Weston, a schizophrenic charged with killing two U.S. Capitol police officers in 1998.
The court signaled Friday that there may be problems with the Sell case. It asked both sides to prepare arguments about whether the case was properly appealed.
The case has attracted the attention of medical organizations and civil rights groups.
Peter Joy, a professor at Washington University School of Law who filed a brief on behalf of the American Civil Liberties Union, said the powerful drugs Sell would be given can cause serious side effects and potentially death.
"It shocks my conscience to think we might risk putting someone to death prior to trying them on nonviolent charges," he said.
Kent Scheidegger, legal director of the Criminal Justice Legal Foundation, said there's an interest to victims and society in putting defendants on trial. "The criminal justice system makes all kinds of intrusion on people's privacy. It locks people up, searches their houses, searches their bodies," he said.