Compulsory Drug Therapy and Supervised Freedom: Cassation Ruling 10777/2025

The Court of Cassation, with Ruling No. 10777 of December 3, 2024 (filed on March 18, 2025), has issued a crucial decision. Rejecting an appeal by the Supervisory Court of Cagliari, the ruling addresses the legitimacy of imposing drug therapy and its administration methods on mentally ill individuals under supervised freedom. This is a topic that balances public health, rehabilitative purposes, and fundamental rights.

Security Measures, Magistrate's Powers, and the Specific Case

Supervised freedom (Articles 228 et seq. of the Criminal Code) is a non-custodial personal security measure for socially dangerous individuals, even if not imputable due to mental illness (Article 202 of the Criminal Code). Its purpose is to prevent new crimes and facilitate reintegration. The supervisory magistrate oversees the prescriptions, including behavioral obligations. The ruling, referencing Articles 199 and 232 of the Criminal Code, extends these prescriptions to health treatments. The case concerned D. P.M. S. D'A. P., who was under supervised freedom, for whom the Supervisory Court of Cagliari had imposed not only therapy but also its administration via injection, given his resistance to oral intake. The Cassation Court confirmed the legitimacy of the measure.

In the context of supervised freedom, the measure by which the supervisory magistrate, in addition to imposing a specific therapy on an individual incapable of understanding and willing, establishes the practical methods of its administration is legitimate. (Case concerning a measure that, due to the individual's resistance to taking drug therapy orally, imposed its administration via injection).

This maxim establishes that the supervisory magistrate's power extends to defining the concrete methods of therapy administration, not merely imposing it. This is crucial when the effectiveness of treatment and the management of social dangerousness depend on the administration method, especially for individuals incapable of understanding and willing who refuse oral intake. The Court recognized that specifying the methods (e.g., injection) is essential to ensure the health of the supervised individual and social safety, preventing the worsening of their condition and the re-emergence of dangerousness.

Constitutional Balancing and Conclusions

The decision raises issues of balancing the right to health (Article 32 of the Constitution) and personal liberty (Article 13 of the Constitution). Although the Constitution protects the freedom of choice regarding health treatment, jurisprudence allows for mandatory treatments in the context of security measures and proven dangerousness linked to psychiatric pathologies. The ruling aligns with previous trends, framing the specification of methods as a necessary concretization of a legally imposed obligation.

• Established incapacity to understand and will.
• Correlation between pathology, lack of therapy, and dangerousness.
• Proportionality and adequacy of the treatment.
• Judicial oversight by the supervisory magistrate.

In summary, Ruling 10777/2025 consolidates the incisive role of the supervisory magistrate in managing security measures for individuals with psychiatric pathologies. The power to impose therapy and its methods is an indispensable tool for the effectiveness of the measure, balancing treatment, reintegration, and the protection of the community. It underscores the importance of a multidisciplinary approach, integrating medical-scientific and legal aspects, to address social dangerousness linked to mental health, always respecting constitutional principles.