Can a government in the US enforce administration of a drug onto a US citizen during a public health crisis?

Question

Is there a law or a judgment from a Court in the United States wherein it is established that a government (at any level) in the US, during an officially declared public health crisis, can enforce administration of a drug/medical treatment onto a US citizen who has been declared by a public health authority (PHA) to be medically ill/sick?

I've come to know that a State government can make vaccination mandatory¹. That said, I've also learned that in cases concerning mandatory vaccination⁴ of persons of certain age groups, some state governments provide exemptions on certain grounds, such as medical, religious and philosophical².

However, in my proposed example case, the drug in question, let us call it DRUG, is not a vaccine at all. Instead, DRUG is a drug which has induced swift recovery in some of the sick patients. Assume that information is not available in public domain as to whether the aforesaid recovered patients were able to give informed consent with regard to the treatment they received or not. Neither can a Jack or Joe contact those patients for the lack of their contact details available on account of protecting their privacy.

Points to be noted:

1. The available data from hospitals and PHA suggests that no known medical treatment or DRUG is so far universally effective on patients -- varied age-groups (some having co-morbidity too).

   Varying amount of information on other treatments/drugs already tested on patients or been researched/explored is available in the public domain, therefore, a citizen can attempt to make an opinion based on the available data.

2. There may be a dearth of data released from PHA (whether deliberately done or not is not proven yet) on the number of patients administered with the DRUG who either fell more sick or died, but PHA is providing the statistics on those who did recover.

   Some probable reasons behind the data release could be:

   • PHA might be biased in the favor of DRUG (for whatsoever reason - genuine or otherwise).

   • Another reason could be: PHA's accountability is sought by political leaders, and the latter - under public pressure - might be pushing PHA to push forward with the DRUG. Like many political issues, this is subjective and open to speculation.

     Suggestion: consider historical data and analyses of earlier epidemics with similar medical treatment related issues, so as to make a reasonable assumption on why PHA is doing what it is doing.

     Note: to be clear here, I'm not trying to establish that PHA is a bad actor. But during crises, a lot of folks, whether acting as or for the authorities, want the crises to end as quickly as possible, sometimes by sidelining or deliberately encroaching the fundamental rights of the citizens. Hence, skepticism towards PHA's actions is justified from a citizen's point of view.

3. There is emerging evidence, in the form of patient/medical staff testimonies and/or medical literature, that DRUG cause some serious side effects. Whether this happens with every patient or not is not clear yet.

4. Armed with the information (as given in points 1,2,and 3), some veteran medical professionals using medical literature and statistical data available from PHA and hospitals have called into question the efficacy of DRUG.

5. Despite the evidences (from points 3 and 4) already at the disposal of PHA, it has argued to their respective government that further delay in administering the DRUG upon the sick patients can severely harm the community's health and prosperity, and that the whole of the community should not be held as a hostage by those who are resisting the administration of DRUG, irrespective of them being patients.

6. Information tsunami from hundreds of print media and electronic media outlets, and from dozens of social media sites has made it near impossible for a lot of citizens to accept as well as discard information, especially when "sponsored content as news" has become the norm for many such outlets and sites.

   The citizens concerned are capable of informed decision making. I'm not concerned with the process and information a citizen would use to reach a decision.

Intertwined questions I'm looking to be answered:

1. What hard legal facts (such as a law or the effects of its application discussed in a judgment) are available to a US citizen so as to make a reasonable assumption on whether their own elected government can forcefully (against their will) administer a drug/medical treatment onto them if they are declared sick and are deemed a threat to public health?
2. If step1 is positive, it would mean informed consent to medical treatment³ is no longer sought. However, does the law/judgment allows information about the treatment be made available to the patient, whether voluntarily or mandatory?

Please note:

• I'm only interested in a law (Act, Rules, Regulations, etc.) or a judgment from a Court of the US. Everything else, no matter how obvious it is, is a personal opinion which I'm not looking for.

• the question is not specifically about the ongoing health crisis in the US as of May 2020.

---

Sources:

1. Is Mandatory Vaccination Legal in Time of Epidemic?

2. Vaccination Law 101: A Guide for Children’s Lawyers

3. Informed Consent: An Ethical Obligation or Legal Compulsion?

4. State Law & Vaccine Requirements

Answer 1

The government cannot force people to get vaccinated, without passing a law to that effect. When they do, they can. This was sorted out in Jacobson v. Massachusetts, 197 U.S. 11, when the Supreme Court, in 1905, ruled:

The liberty secured by the Constitution of the United States does not import an absolute right in each person to be at all times, and in all circumstances, wholly freed from restraint, nor is it an element in such liberty that one person, or a minority of persons residing in any community and enjoying the benefits of its local government, should have power to dominate the majority when supported in their action by the authority of the State.

It is within the police power of a State to enact a compulsory vaccination law, and it is for the legislature, and not for the courts, to determine in the first instance whether vaccination is or is not the best mode for the prevention of smallpox and the protection of the public health.

Nothing in that ruling is specific to vaccinations as opposed to other medical treatments. If a law mandating a certain vaccination exists in a state, the citizen's beliefs about the efficacy of the vaccination are irrelevant to the legal issue -- get the vaccination, or the punishment.

If a state were to pass a law mandating snake-oil innoculations to prevent smallpox infections, the law could be challenged in court. In general, people have the right to go about their business without the government interfering in their fundamental rights, but fundamental rights are not absolute, they are attenuated in case of a "compelling government interest": which leads to a particular kind of judicial review, strict scrutiny. While preventing a virulent deadly disease is arguably a compelling government interest, snake-oil is not necessary to reach that end (it does not reach that end, so it is certainly not necessary to reach that end).

Answer 2

Where DRUG exists, a law can be passed to that effect.

It's worth noting as a corollary that where DRUG does not yet exist, the government is allowed to quarantine people indefinitely where they present a risk. This was perfectly demonstrated in the case of Typhoid Mary - she was initially quarantined for several years, then allowed out on the condition that she did not work as a cook, and when she did start work as a cook again she was quarantined for the rest of her life.

The laws relating to this will be specific to each jurisdiction. Mary Mallon was held in quarantine under laws in New York State, but each US state can set up their own laws, or the federal government can set a law across the states to harmonise this.

Relating to refusal of certain groups to vaccinate, then, it would be completely legal under the older laws to control typhoid for states or the federal government to give them a choice of either accepting vaccination or accepting living in permanent quarantine until they die.

Answer 3

The state can, and does force people to undergo medical treatment without their consent, and indeed against their wills, in cases other than vaccination or contagious disease. In particular, various laws compel treatment of mental illness in some cases without the consent of the patients.

in O’Connor v. Donaldson, 422 U.S. 563 (1975) It was held that a state could confine a mentally ill person, if and only if that person was "a danger to himself or others". in Washington v . Harper, 494 U.S. 210 (1990) it was held that the required due process for a forced medication order was provided by a hospital committee consisting of a psychiatrist, psychologist and n hospital official not currently involved inthe inmate’s diagnosis and treatment. In Jurasek v. Utah State Hospital it was held that A state hospital can forcibly medicate a mentally ill patient who has been found incompetent to make medical decisions if the patient is dangerous to himself or others and the treatment is in the patient’s medical interests.

Answer 4

To supplement the points made in other answers, which are good, it is important to note that while physically holding someone down and giving them a shot or pill is one way to enforce a requirement to receive a drug, it is not the only, or the most common way to enforce a violation of this requirement.

It is far more common to, for example, pass laws that state that if you fail to take the drug or get the shot that you can't, drive a car in public, go to a public place, go to school, go to a business providing services to the general public, gather with a neighbor, go to a government office, show up to a workplace with other workers present, spend time in the presence of your children, etc., or that if you fail to do so, you face a fine.

The situation can be made unlivable for a person failing to comply, or penalizing someone monetarily for failure to comply, and this is a far more common means of enforcement than it is to specifically enforce the requirement to take the drug or receive the shot.

While the constitution may not require it, it is very rare to require a mentally competent adult who is not incarcerated to take a drug or a shot by actually giving them the drug or shot, as opposed to imposing consequences on that person for failing to do so.

Answer 5

Generally speaking, US courts have come down on the side of patients' rights to self-determination, in this case, acceptance or refusal of medical treatment, provided that patient is of sufficient mental competence.

These judgments often come when a hospital or physician, for their own reasons, deem a patient's survival to be of such importance that it overrides that patient's right to choose between their mores or survival.

There is a good downloadable .pdf here, which outlines some history in US courts on this topic: http://www.rbs2.com/rrmt.pdf

Legal Right to Refuse Medical Treatment in the USA
^{Copyright 2012 by Ronald B. Standler}