O'Connor v. Donaldson

Summary

In January 1957 Kenneth Donaldson was committed to the Florida State Hospital at Chattahoochee after his father sought a hearing before a Pinellas County judge, who found him mentally ill. He remained there against his will for nearly fifteen years. Dr. J. B. O'Connor was the hospital's superintendent for most of that time. Donaldson repeatedly asked for release, insisting that he was dangerous to no one, that he was not ill, and that in any case the hospital gave him no treatment. Offers to take him in, from a halfway house supported by a Minneapolis psychiatric clinic and four times from John Lembcke, a college classmate, were refused; O'Connor would release him only to his elderly parents. In February 1971 Donaldson sued O'Connor and other staff members for damages under the federal civil rights statute, 42 U.S.C. § 1983. He was released later that year, shortly after O'Connor retired. At trial the evidence showed that Donaldson had never been dangerous to himself or others, had supported himself for years before his commitment, and received only custodial care, which staff called milieu therapy. O'Connor's defense was that he had acted in good faith under a state law he believed authorized custodial confinement. The jury awarded $38,500, including punitive damages, and the Court of Appeals for the Fifth Circuit affirmed in a broad opinion recognizing a constitutional right to treatment for persons civilly committed. The question before the Supreme Court, as Justice Stewart framed it, was narrower: whether a State may confine a nondangerous person who is capable of surviving safely in freedom. Donaldson's side relied on the jury's findings and the right to liberty; O'Connor's side argued that he had followed state law in good faith and that the right to treatment announced by the appeals court had no basis in the Constitution. On 26 June 1975 a unanimous Court held that a finding of mental illness alone cannot justify indefinite custodial confinement. The State may not confine the harmless merely to give them a better standard of living than they would have outside, nor to spare the public from people whose ways are different. A State cannot constitutionally confine, without more, a nondangerous individual able to live safely in freedom alone or with the help of willing family or friends. The Court declined to decide whether a right to treatment exists, and it vacated the judgment and remanded so the appeals court could reconsider O'Connor's immunity defense under Wood v. Strickland (1975). Chief Justice Burger, concurring, emphasized that Donaldson had refused treatment offered to him and that state courts had repeatedly denied his petitions, and argued at length that history gives no support for limiting state confinement to cases where treatment is provided. The library text contains Stewart's full opinion and the first part of Burger's concurrence, without notes. Donaldson described his experience in Insanity Inside Out (1976). The decision contributed to tighter state commitment standards and was followed by Addington v. Texas (1979) and Youngberg v. Romeo (1982).

Plot or Argument

• Fifteen years at Chattahoochee

  Stewart recounts Donaldson's commitment, his repeated demands for release, the offers of responsible persons to care for him, O'Connor's refusals and the evidence that he received only custodial care.

• The trial and the appeals court

  The jury was instructed that involuntary hospitalization of a nondangerous person is justified only by treatment, and it awarded damages; the Fifth Circuit affirmed, holding that a civilly committed patient has a constitutional right to treatment.

• A narrower question

  The Court declines to decide whether there is a right to treatment and instead asks what justification remained for confining a man the jury found harmless and untreated.

• Three rejected justifications

  Mental illness alone, a wish to raise the patient's living standard, and the public's discomfort with people who are different all fail to justify confining a person who is dangerous to no one and can live safely in freedom.

• Immunity and remand

  On O'Connor's good-faith defense, the Court vacates and remands for reconsideration under Wood v. Strickland, decided earlier that year.

• Burger's concurrence (excerpt)

  Burger notes Donaldson's refusals of treatment and his unsuccessful state-court petitions, and argues that history and the State's police and parens patriae powers do not support a rule that the mentally ill may be confined only if treated; the excerpt stops partway through his analysis.

Characters

• Kenneth Donaldson, respondent

  Man who had supported himself for years before his commitment, was confined nearly fifteen years, and found a job in hotel administration soon after release.

• Dr. J. B. O'Connor, petitioner

  Superintendent of the Florida State Hospital who refused Donaldson's release except to his parents.

• Justice Potter Stewart, author of the opinion of the Court

  Held that a State may not confine a harmless person capable of living safely in freedom.

• Chief Justice Warren E. Burger, concurring

  Joined the opinion but wrote to reject any broad constitutional right to treatment.

• Morton Birnbaum, advocate of the right to treatment

  Physician and lawyer who first proposed a legal right to treatment and helped bring Donaldson's case.

Lessons

• Liberty and the harmless

  The Court's holding rests on a simple principle: liberty is the rule, and confinement requires a justification. Illness alone, the State's benevolent wish to care for someone, or the public's discomfort does not suffice when a person is dangerous to no one and can live safely in freedom.

  • What three possible justifications for Donaldson's confinement does Stewart consider and reject?
  • Why does Stewart say a mentally ill person may still prefer his home to the comforts of an institution?
  • When, if ever, should the State confine a person for his own good?

• Deciding no more than necessary

  The Fifth Circuit had announced a broad right to treatment. The Supreme Court deliberately decided a narrower question, leaving the larger issues for another day, and Burger wrote separately to stress that the broader holding had no approval. The case shows how courts control the reach of their own rulings.

  • What questions does the Court expressly decline to decide?
  • Why might a court choose a narrow ground even when a broad one is available?

• Custody and care

  The evidence described a large ward of sixty patients, no occupational training and treatment that staff admitted was a euphemism for confinement. Burger's history recalls that custodial care, in poorhouses, almshouses and later state hospitals, was long the main function of institutions. The case asks what an institution owes those it holds.

  • How did hospital staff describe the milieu therapy Donaldson received?
  • According to Burger, what role did custodial care play in the history of state institutions?
  • What responsibilities does a person with authority over another's liberty bear?

• Good faith and responsibility

  O'Connor argued that he had relied in good faith on state law. The Court did not excuse him but sent the question back to be decided under the standard that an official is liable if he knew or reasonably should have known that his actions violated constitutional rights. Students can weigh how personal responsibility applies to officials acting under law.

  • What was O'Connor's principal defense at trial?
  • Should an official be personally liable for following a law later found unconstitutional?
  • How does Burger's point about Donaldson's state-court petitions bear on the immunity question?

Context

Through the first half of the twentieth century American state hospitals grew to hold more than half a million patients, many confined for years with little active treatment. From the mid-1950s, new medications, the community mental health movement and critiques of institutional care began to reduce hospital populations. Lawyers and physicians such as Morton Birnbaum argued for a legal right to treatment, and Wyatt v. Stickney (1971) in Alabama set treatment standards for state institutions.

Composition

Donaldson's suit was filed in the Northern District of Florida in 1971 and tried in 1972. The Fifth Circuit's 1974 opinion, written by Judge John Minor Wisdom, broadly endorsed a right to treatment. The Supreme Court heard argument on 15 January 1975, with Bruce Ennis of the American Civil Liberties Union arguing for Donaldson.

Reception

Advocates welcomed the decision as recognizing that confinement of the harmless violates liberty, while the Court's refusal to reach the right-to-treatment question disappointed some reformers. States revised their commitment laws to require findings of dangerousness, and the decision is commonly cited in the history of deinstitutionalization. Some psychiatrists and historians later questioned whether stricter commitment standards, combined with reduced hospital capacity, left some seriously ill persons without care.

Comparisons

• addington-v-texas

  Four years later the Court, citing Donaldson, set the standard of proof that a State must meet before committing a person to a mental hospital.

• youngberg-v-romeo

  In 1982 the Court took up the question Donaldson left open, defining the rights of a person lawfully committed to safety, freedom from undue restraint and minimally adequate training.

• olmstead-v-lc

  Under a federal statute rather than the Constitution, the Court in 1999 held that unjustified institutional isolation of persons able to live in the community is a form of discrimination.

• description-of-the-retreat

  Samuel Tuke's 1813 account of the York Retreat describes the moral-treatment ideal of humane asylum care, a standard against which the custodial regime at Chattahoochee can be measured.

• robinson-v-california

  Both opinions by Justice Stewart insist that illness alone, without dangerous conduct, cannot justify punishment or confinement.

Quotes

For Students

A reading companion for classical Christian high school students. See the student guide.

Reading Guide

Watch for

• The facts about offers from a halfway house and a friend to care for Donaldson.
• The trial evidence about custodial care and milieu therapy.
• The questions the Court expressly declines to decide in Part II.
• The three justifications Stewart considers and rejects.
• Burger's account of poorhouses, almshouses and state institutions.

Key terms and names

Civil commitment

Confinement of a person in a hospital by court order on grounds of mental illness, rather than as punishment for a crime.

Custodial care

Keeping a person in safe confinement and meeting basic needs without treatment aimed at improvement.

Parens patriae

Latin for parent of the country; the State's authority to protect persons unable to care for themselves.

Section 1983

The federal statute allowing suits for damages against persons who, under color of state law, deprive others of constitutional rights.

Qualified immunity

A defense shielding officials from personal liability unless they knew or reasonably should have known they were violating constitutional rights.

Seminar Questions

1. Comprehension How long was Donaldson confined, and what did the jury find about his dangerousness and treatment?
2. Comprehension What broad right had the Court of Appeals recognized, and did the Supreme Court adopt it?
3. Comprehension Why did the Court send the case back to the Court of Appeals?
4. Interpretation Why does Stewart compare confining the harmless mentally ill to incarcerating the physically unattractive or socially eccentric?
5. Interpretation How does Burger's history of custodial care affect his view of a right to treatment?
6. Big Question How should a society balance care for the vulnerable with respect for their freedom to refuse that care?

Faith Connections

• Luke 4:18 (Scripture)

  Jesus reads from Isaiah that he has come to preach deliverance to the captives and to set at liberty them that are bruised, words often applied to those confined without cause.

• Mark 5:1-20 (Scripture)

  The man among the tombs, bound with chains and set apart by his community, is restored and sent home to his friends, a picture of return from isolation.

Logic and Rhetoric

Central argument: Stewart reasons that once the jury found Donaldson harmless and untreated, the State needed some justification for continued confinement; mental illness alone, a wish to improve his circumstances and public discomfort each fail, so confining a nondangerous person able to live safely in freedom violates the right to liberty.

Rhetorical device: rhetorical question. Stewart structures Part II around questions such as whether the State may fence in the harmless mentally ill to spare citizens from those whose ways are different, then answers each in turn (quote 3).

Debate: Resolved: that persons with mental illness who are not dangerous should never be confined against their will.

Memory Work

In short, a State cannot constitutionally confine without more a nondangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends.

But the mere presence of mental illness does not disqualify a person from preferring his home to the comforts of an institution.

Writing Prompts

Essay: Explain why the Court chose to decide a narrow question about liberty rather than the broad question of a right to treatment, and evaluate Burger's reasons for rejecting that broader right.

Comparison with Addington v. Texas: Compare the protections Donaldson and Addington give persons facing civil commitment, and explain how a standard of proof complements a substantive limit on confinement.

Medical Lens

O'Connor v. Donaldson is a landmark in the law and history of psychiatry: it established that mental illness alone does not justify involuntary confinement of a nondangerous person able to live safely in freedom, and it sits at the center of the debates over the right to treatment and deinstitutionalization. Stewart's opinion acknowledges the uncertainty of psychiatric diagnosis, and Burger's concurrence offers a short history of custodial care from almshouses to state hospitals. The record avoids clinical detail.

• Opinion of the Court, Part I, paragraph beginning: The evidence showed that Donaldson's confinement was a simple regime of enforced custodial care

  The trial evidence on custodial care, the term milieu therapy as staff used it, and a ward of sixty patients, a record of state-hospital conditions in the 1950s and 1960s.

  Asylum Institution
• Opinion of the Court, Part II, paragraph beginning: A finding of "mental illness" alone cannot justify a State's locking a person up against his will

  The Court's holding that a diagnosis by itself does not justify confinement of the harmless, with a caution about whether the term mentally ill can be given reasonably precise content.

  Madness Psychosis Asylum Institution
• Concurrence of Chief Justice Burger, Part II-A, paragraph beginning: That proposition is surely not descriptive of the power traditionally exercised by the States

  Burger's history of the care of the mentally ill from poorhouses and jails through the rise of state institutions, citing Albert Deutsch's The Mentally Ill in America.

  Asylum Institution

Creative Prompts

• Classroom

  Hold a moot court in January 1975: one team argues for Donaldson from the jury's findings, the other for O'Connor on good faith and the absence of a constitutional right to treatment.

• Essay

  Write a letter Kenneth Donaldson might have sent to the hospital superintendent in 1963 after the Helping Hands offer was refused, using only facts given in the opinion.

• Essay

  Using Burger's history of custodial care, explain how the purposes of state institutions for the mentally ill changed from the nineteenth to the twentieth century.

• Dialogue

  Write a conversation between a state hospital physician and a civil liberties lawyer in 1975 about what the decision requires of hospitals.

Further Reading

• Insanity Inside Out, Kenneth Donaldson

  Donaldson's own account of his confinement and his long legal struggle, published in 1976.

• The Mentally Ill in America: A History of Their Care and Treatment from Colonial Times, Albert Deutsch

  The classic history cited in Burger's concurrence.

• Madness in the Streets: How Psychiatry and the Law Abandoned the Mentally Ill, Rael Jean Isaac and Virginia C. Armat

  A critical history of deinstitutionalization and the legal reforms that followed decisions such as Donaldson.