heller doe argued march decided june kentucky permits involuntary commitment mentally retarded mentally ill individuals present threat danger family others reasonably benefit available treatment least restrictive alternative placement relevant facility however statutory procedures commitment two groups differ two respects issue first applicable burden proof mental retardation commitment proceedings clear convincing evidence standard mental illness proceedings beyond reasonable doubt second guardians immediate family members subject mental retardation proceeding may participate parties proceedings attendant rights action respondents class involuntarily committed mentally retarded persons claimed distinctions irrational therefore violate fourteenth amendment equal protection clause granting close family members guardians status parties violates due process clause district granted summary judgment appeals affirmed held respondents claim statutes reviewed heightened scrutiny standard properly presented since raised lower courts ruled ground rational basis review pp distinctions two proceedings consistent equal protection clause pp classifications neither involving fundamental rights proceeding along suspect lines run afoul equal protection clause rational relationship disparity treatment legitimate governmental purpose legislature need articulate rationale state need produce evidence sustain classification rationality moreover courts compelled accept legislature generalization even imperfect fit means ends pp kentucky proffered adequate justifications burden proof scheme mental retardation developmental disability usually well documented throughout childhood easier diagnose mental illness may sudden onset adulthood thus assigned higher burden proof mental illness equalize risk erroneous determination subject commitment proceeding condition question ease diagnosis also result accurate dangerousness determination mentally retarded relatively static condition record previous behavior contrast since manifestations mental illness may sudden past behavior may adequate predictor future actions higher standard mentally ill also justified ground general treatment much intrusive received mentally retarded pp also rational basis kentucky allow immediate family members guardians participate parties proceedings commit mentally retarded mentally kentucky rationally conclude close relatives guardians may intimate knowledge subject abilities experiences provides valuable insights considered involuntary commitment process contrast mental illness may arise minority afflicted person immediate family members ceased provide care support proper course treatment may depend matters related observations made household setting addition adults previously sound mental health diagnosed mentally ill may need privacy justifies confining commitment proceeding smallest group possible whether kentucky chosen means party status achieving legislative end irrelevant rational basis review pp allowing close relatives legal guardians participate parties violate due process consideration factors set mathews eldridge private interest affected risk erroneous deprivation interest government interest compels conclusion rather increasing risk erroneous deprivation allowing close relatives guardians participate parties actually increases proceeding accuracy putting valuable information also implements state interest providing family members voice proceedings even favor commitment participation undermine interest individual facing commitment individual interest protected due process clause accurate decision favorable one pp kennedy delivered opinion rehnquist white scalia thomas joined filed opinion concurring judgment part dissenting part post blackmun filed dissenting opinion post souter filed dissenting opinion blackmun stevens joined part ii joined post william moore argued cause petitioner briefs edward klatte charles lawrence kelly miller argued cause respondents brief brian wolfman briefs amici curiae urging reversal filed state new jersey et al robert del tufo attorney general joseph yannotti assistant attorney general mary jacobson senior deputy attorney general sharon hallanan deputy attorney general joined attorneys general respective follows linley pearson indiana frank kelley michigan hubert humphrey iii minnesota stenberg nebraska mark barnett south dakota mary sue terry virginia concerned families hazelwood center et al frank coryell voice retarded et al william sherman briefs amici curiae urging affirmance filed american association mental retardation et al james ellis maureen sanders focus community understanding services et al ronald smith michael kirkman john townsend rich christopher palmer leonard rubenstein filed brief mental health law project amicus curiae justice kennedy delivered opinion commonwealth kentucky involuntary civil commitments alleged mentally retarded alleged mentally ill governed separate statutory procedures two differences commitment proceedings issue case first final commitment hearing applicable burden proof involuntary commitment based mental retardation clear convincing evidence michie standard involuntary commitment based mental illness beyond reasonable doubt second commitment proceedings mental retardation unlike mental illness uardians immediate family members subject proceedings may participate party proceedings attendant rights including right present evidence appeal respondents class mentally retarded persons committed involuntarily kentucky institutions argue distinctions irrational violate equal protection clause fourteenth amendment claim also granting close family members guardians status parties violates due process clause reject contentions hold kentucky statutes constitutional case long complicated history began respondents filed suit petitioner kentucky secretary cabinet human resources claiming kentucky failure provide certain procedural protections institutionalizing people basis mental retardation violated constitution kentucky amended civil commitment statutes several times since new statute attacked respondents previous incarnations lawsuit little effect issues currently limit discussion current round litigation see doe cowherd wd recounting procedural history issue elements kentucky statutory procedures enacted involuntary commitment mentally retarded many respects procedures governing commitment mentally retarded mentally ill parallel statutes recognize large class persons petition individual involuntary commitment whether grounds mental retardation mental illness michie mental retardation mental illness upon filing petition trial must appoint counsel represent individual question unless retains private counsel mental retardation mental illness trial also must examine person filed petition probable cause believe individual subject petition involuntarily committed must order examination two qualified professionals mental retardation mental illness subject proceeding right retain professional choosing may witness participate examination mental retardation mental illness cases commitment mental retardation professional retained subject parent guardian also must permitted witness participate examination qualified professionals certify individual meets criteria involuntary commitment trial must conduct preliminary hearing mental retardation mental illness hearing must receive evidence reports two professionals professional retained statute mental retardation mental illness individual whose commitment sought may testify may call witnesses mental retardation mental illness cases mental retardation preliminary hearing one final hearing kentucky law provides particular rights guardians immediate family members guardians immediate family members respondent shall allowed attend hearings conferences similar proceedings may represented private counsel desired may participate hearings conferences party proceedings may witnesses desired shall standing appeal adverse decision final hearing state county attorney county person subject proceeding lives prosecutes petition mental retardation mental illness tr oral arg counsel person defends institutionalization hearing manner proceeding rules evidence shall criminal proceeding mental retardation mental illness preliminary hearing subject proceedings may testify call witnesses mental retardation mental illness proceedings commitment based mental retardation standard proof clear convincing evidence mental illness standard proof beyond reasonable doubt commitment mentally retarded four propositions must proved clear convincing evidence person mentally retarded person person presents danger threat danger self family others least restrictive alternative mode treatment presently available requires placement residential treatment center treatment reasonably benefit person available residential treatment center criteria commitment mentally ill substance identical requiring proof beyond reasonable doubt individual mentally ill person presents danger threat danger self family others result mental illness reasonably benefit treatment hospitalization least restrictive alternative mode treatment presently available appeals involuntary commitment proceedings taken manner appeals trial mental retardation mental illness enactment modifications respondents moved summary judgment pending lawsuit petitioner argued among things differences treatment mentally retarded mentally ill different standards proof right immediate family members guardians participate parties commitment proceedings mentally retarded mentally ill violated equal protection clause prohibition distinctions lack rational basis participation family members guardians violated due process clause district western district kentucky accepted arguments granted summary judgment respondents grounds issue appeals sixth circuit affirmed doe cowherd granted kentucky petition certiorari reverse ii respondents contend evaluating constitutionality distinctions drawn kentucky statutes apply rational basis review form heightened scrutiny brief respondents claim properly presented respondents argued district appeals kentucky statutory scheme subject review courts ruled ground indeed respondents conceded pressed heightened scrutiny argument first time merits brief espondents argue particular issue even respondents correct heightened scrutiny applies inappropriate us apply standard parties litigating case years theory rational basis review noted see infra require state place evidence record let alone extensive evidentiary showing required statutes survive heightened scrutiny imprudent unfair inject new standard stage litigation see tennessee dunlap ernst ernst hochfelder therefore decide case presented courts whose judgments reviewed iii many times said weeks ago repeated rational basis review equal protection analysis license courts judge wisdom fairness logic legislative choices fcc beach communications see also dandridge williams authorize judiciary sit superlegislature judge wisdom desirability legislative policy determinations made areas neither affect fundamental rights proceed along suspect lines new orleans dukes per curiam reasons classification neither involving fundamental rights proceeding along suspect lines accorded strong presumption validity see beach communications supra kadrmas dickinson public schools hodel indiana massachusetts bd retirement murgia per curiam classification run afoul equal protection clause rational relationship disparity treatment legitimate governmental purpose see nordlinger hahn dukes supra legislature creates categories need actually articulate time purpose rationale supporting classification nordlinger supra see also railroad retirement bd fritz allied stores ohio bowers instead classification must upheld equal protection challenge reasonably conceivable state facts provide rational basis classification beach communications supra see also nordlinger supra sullivan stroop fritz supra vance bradley dandridge williams supra state moreover obligation produce evidence sustain rationality statutory classification legislative choice subject courtroom factfinding may based rational speculation unsupported evidence empirical data beach communications supra see also vance bradley supra hughes alexandria scrap locomotive firemen chicago statute presumed constitutional see supra burden one attacking legislative arrangement negative every conceivable basis might support lehnhausen lake shore auto parts internal quotation marks omitted whether basis foundation record finally courts compelled rational basis review accept legislature generalizations even imperfect fit means ends classification fail rational basis review made mathematical nicety practice results inequality dandridge williams supra quoting lindsley natural carbonic gas problems government practical ones may justify require rough accommodations illogical may unscientific metropolis theatre chicago see also burlington northern ford vance bradley supra new orleans dukes supra schweiker wilson applied rational basis review previous cases involving mentally retarded mentally see cleburne cleburne living center schweiker wilson supra neither case purport apply different standard rational basis review described true even standard rationality often defined must find footing realities subject addressed legislation requirement satisfied kentucky proffered adequate justifications differences treatment mentally retarded mentally kentucky argues lower standard proof commitments mental retardation follows fact mental retardation easier diagnose mental illness general proposition cause little surprise mental retardation developmental disability becomes apparent adulthood see american psychiatric diagnostic statistical manual mental disorders rev ed hereinafter manual mental disorders american assn mental retardation mental retardation definition classification systems support ed hereinafter mental retardation brakel parry weiner mentally disabled law ed hereinafter mentally disabled michie time person reaches years age documentation evidence condition accumulated years mental illness hand may sudden may occur least manifest adulthood see manual mental disorders onset schizophrenia may occur time adulthood onset depression usually adulthood furthermore recognized earlier case diagnosis mental illness difficult see addington texas see also mentally disabled kentucky basic premise mental retardation easier diagnose mental illness sufficient basis fact see ellis luckasson mentally retarded criminal defendants difference two conditions justifies kentucky decision assign lower standard proof commitment proceedings involving mentally retarded assigning burden proof kentucky determining risk error faced subject proceedings addington texas supra diagnosis difficult cases mental illness instances mental retardation higher burden proof former tends equalize risks erroneous determination subject commitment proceeding condition question see keppel design analysis diagnostic standpoint alone kentucky differential burdens proof well statutory distinction issue see infra rational moreover reasonably conceivable state facts beach communications kentucky conclude second prerequisite commitment person presents danger threat danger self family others michie established easily general rule case mentally retarded previous instances violent behavior important indicator future violent tendencies see monahan clinical prediction violent behavior hereinafter monahan kozol boucher garofalo diagnosis treatment dangerousness crime delinquency mental retardation permanent relatively static condition see mentally disabled determination dangerousness may made accuracy based previous behavior deal adults almost definition case retarded record upon rely mentally manifestations mental illness may sudden past behavior may adequate predictor future actions prediction future behavior complicated well difficulties inherent diagnosis mental illness developments law civil commitment mentally ill harv rev thus surprise many psychiatric predictions future violent behavior mentally ill inaccurate see steadman employing psychiatric predictions dangerous behavior policy vs fact dangerous behavior problem law mental health frederick ed monahan reasons plausible kentucky conclude dangerousness determination accurate mentally retarded mentally statutory classification fails rational basis review rests grounds wholly irrelevant achievement state objective holt civic club tuscaloosa quoting mcgowan maryland see also mcdonald board election chicago kotch board river port pilot port new orleans ease diagnosis relevant two four inquiries wholly irrelevant achievement kentucky objective thus statutory difference applicable burden proof survives rational basis review event plausible kentucky found purposes determining acceptable risk error diagnosis dangerousness critical factors commitment decision appropriate burden proof tied rationale justifying different burdens proof prevailing methods treatment mentally retarded general rule much less invasive given mentally mentally ill subjected medical psychiatric treatment may involve intrusive inquiries patient innermost thoughts see meissner nicholi psychotherapies individual family group harvard guide modern psychiatry nicholi ed hereinafter harvard guide use psychotropic drugs see baldessarini chemotherapy harvard guide berger medical treatment mental illness science mentally disabled brief american psychological association amicus curiae washington harper pp contrast mentally retarded general subjected medical treatments rather mental retardation learning disability training impairment rather illness youngberg romeo quoting brief american psychiatric association amicus curiae youngberg romeo mentally retarded provided habilitation consists education training aimed improving skills see youngberg supra rosen clark kivitz habilitation handicapped mentally disabled true loss liberty following commitment mental illness mental retardation may similar many respects different treatment committed individual subjected provides rational basis kentucky decide greater burden proof needed person may committed mental illness procedures required government acts often depend nature extent burden deprivation imposed see addington texas example confinement prison punitive hence onerous confinement mental hospital due process clause subjects former proof beyond reasonable doubt winship whereas requires latter case clear convincing evidence addington texas supra may also true persons committed mental retardation subjected intrusive treatments confined see post souter dissenting nonetheless plausible kentucky legislature believe mentally retarded individuals committed receive treatment different less invasive mentally ill subjected required convince courts correctness legislative judgments minnesota clover leaf creamery thus since question least debatable western southern life ins state bd equalization quoting carolene products rational basis review permits legislature use sort generalization distinctions may explain differences treatment mentally retarded mentally ill long existed law english common law marked distinction treatment accorded idiots mentally retarded lunatics mentally ill pollock maitland history english law ed hereinafter pollack maitland blackstone explained retarded person became ward king duty preserve individual estate provide necessaries king profit wardship contrast king required provide custody sustentation mentally ill preserve lands profits king prohibited profiting thereby blackstone commentaries see pollack maitland herr rights advocacy retarded people ancient lineage legal concept give immunity attack lacking rational basis law long treated classes distinct however suggests distinction mentally retarded mentally ill differentiation continues present day large majority separate involuntary commitment laws two groups many well separate agencies addressing needs kentucky burden proof scheme explained differences ease diagnosis accuracy prediction future dangerousness nature treatment received commitment rationales standing suffice establish rational basis distinction question rational basis also distinction challenged respondents kentucky allows close relatives guardians participate parties proceedings commit mentally retarded mentally noted see supra definition mental retardation onset person developmental period mental retardation furthermore results deficits impairments adaptive functioning say person effectiveness areas social skills communication daily living skills well person meets standards personal independence social responsibility expected age cultural group manual mental disorders see also mental retardation based facts kentucky may concluded close relatives guardians likely intimate knowledge mentally retarded person abilities experiences valuable insights considered involuntary commitment process mental illness contrast may arise manifest suddenness minority see supra afflicted person immediate family members knowledge medical condition long ceased provide care support determining proper course treatment may far less dependent upon observations made household setting indeed noted severe difficulties inherent psychiatric diagnosis conducted experts field addington texas see also mentally disabled addition adults previously sound mental health diagnosed mentally ill may need privacy justifies state confining commitment proceeding smallest group compatible due process based facts kentucky may concluded participation parties relatives guardians mentally ill cases sufficient help trier fact justify additional burden complications granting party status sure kentucky provided relatives guardians mentally retarded participation commitment proceedings methods short providing status parties however irrelevant rational basis review require kentucky chosen least restrictive means achieving legislative end san antonio independent school dist rodriguez long kentucky rationally advances reasonable identifiable governmental objective must disregard existence alternative methods furthering objective individuals perhaps preferred schweiker wilson iv turn respondents claim one aspect involuntary commitment procedures violates procedural due process note outset respondents challenge violative due process provisions kentucky comprehensive involuntary commitment procedures allow participation proceedings guardians immediate family members see michie respondents claim allowing participation persons whose interests may adverse individual facing possible involuntary commitment statute skews balance retarded individual therefore imposes burden brief respondents courts apparently accepted argument almost without explanation see view claim without merit evaluate sufficiency procedural rule mathews eldridge held determining dictates due process requires consideration three factors first private interest affected official action second risk erroneous deprivation interest procedures used probable value additional substitute procedural safeguards finally government interest including function involved fiscal administrative burdens additional substitute procedural requirement entail sure additional parties involved proceedings favor commitment participation may increase chances result proceeding decision commit fact however beside point due process clause require state adopt one procedure another basis may produce results favorable party challenging existing procedures medina california function legal process concept embodied constitution realm factfinding minimize risk erroneous decisions broad spectrum concerns term must apply flexibility necessary gear process particular need quantum quality process due particular situation depend upon need serve purpose minimizing risk error greenholtz inmates neb penal correctional complex allowing guardians immediate family members participate parties commitment proceedings increases accuracy proceedings implements state interest providing family members voice proceedings without undermining interests individual protected due process clause kentucky statutes run afoul due process deal issues unusual delicacy area professional judgments regarding desirable procedures constantly rapidly changing context restraint appropriate part courts called upon adjudicate whether particular procedural scheme adequate constitution smith organization foster families equality reform sum plausible rationales statutory distinctions challenged respondents case assumptions underlying rationales erroneous fact arguable sufficient rational basis review immunize legislative choice constitutional challenge beach communications quoting vance bradley judgment appeals sixth circuit reversed footnotes et seq mental retardation et seq supp mental illness alaska et seq mental illness et seq supp mental illness ann mental retardation mental illness welf ann et seq west supp mental retardation et seq mental illness stat et seq supp mental illness et seq mental retardation et seq mental illness del code tit mental retardation et seq supp mental illness code ann et seq mentally retarded et seq mental illness et seq supp mental retardation supp mental illness code ann et seq supp mental retardation et seq supp mental illness et seq supp mental illness idaho code mental retardation supp mental illness ch et seq mental retardation et seq mental illness et seq burns mental illness iowa code et seq mental retardation et seq mental illness et seq supp mental illness et seq michie mental retardation et seq mental illness west mental retardation et seq west supp mental illness tit et seq mental retardation mental illness md health code ann et seq mental retardation et seq mental illness laws ch et seq mental illness laws et seq mental retardation et seq mental illness et seq mental illness ann et seq mental retardation et seq mental illness et seq supp mental illness et seq mental retardation et seq mental illness ii mental retardation et seq mental illness west supp mental illness mental retardation et seq mental illness mental et seq mckinney mental retardation et seq mental illness et seq mental illness ohio ann et seq supp mental retardation et seq mental illness tit supp mental illness et seq mental retardation et seq mental illness tit purdon supp mental retardation et seq mental illness et seq mental retardation mental illness ann supp mental retardation et seq mental illness codified laws et seq mental retardation et seq mental illness ann et seq supp mental illness tex health safety code ann et seq mental retardation et seq mental illness utah code ann supp mental retardation mental illness tit et seq mental retardation et seq mental illness ann et seq supp mental illness supp mental retardation mental illness see et seq mental retardation mental illness ann et seq supp mental retardation mental illness et seq supp mental retardation mental illness et seq supp mental retardation mental illness et seq mental retardation mental illness mental retardation mental illness see brief new jersey et al amici curiae previous version kentucky laws relating commitment mentally retarded application parents guardian mentally retarded person placement mental retardation treatment center treated voluntary commitment procedural requirements involuntary commitments inapplicable see michie supp previous decision appeals held persons committed upon application parents guardians must considered admitted involuntarily doe austin denied kentucky petition certiorari decision kentucky subsequently amended statutes remove provision brief however kentucky attacks prior holding appeals see brief petitioner even issue mooted repeal provision issue see department treasury galioto kremens bartley fairly included within questions granted certiorari rule see pet cert justice concurring judgment part dissenting part agree justice souter kentucky differential standard proof committing mentally ill mentally retarded irrational therefore join part ii opinion conclude however rational basis permitting close relatives guardians participate parties proceedings commit mentally retarded mentally points sufficiently plausible legitimate reasons legislative determination area also agree allowing guardians immediate family members participate parties commitment proceedings violate procedural due process like colleagues reach question whether heightened equal protection scrutiny applied kentucky scheme justice blackmun dissenting join justice souter dissenting opinion agree statute even rational write separately note continuing adherence view laws discriminate individuals mental retardation cleburne cleburne living center opinion marshall joined brennan blackmun jj infringe upon fundamental rights foucha louisiana plurality opinion white joined blackmun stevens souter jj subject heightened review justice souter justice blackmun justice stevens join justice joins part ii dissenting conclude kentucky provision different procedures institutionalization mentally retarded mentally ill supported rational justification respectfully dissent begin declines address doe argument employ strict heightened scrutiny assessing disparity treatment challenged may disagree basis conclusion argument properly presented ante decline address contention strict heightened scrutiny applies conclude distinctions wrought kentucky scheme survive even rational basis scrutiny requiring rational relationship disparity treatment legitimate governmental purpose previously applied classification basis mental disability see cleburne cleburne living center therefore need reach question whether scrutiny searching cleburne applied cleburne recent instance addressed classification basis mental disability enquiring record support state proffered justifications examining distinction treatment light purposes put forward support see cites cleburne purport overrule neither apply end day cleburne status left uncertain follow cleburne ii obviously differences mental retardation mental illness distinct conditions different manifestations require different forms care treatment course differs without doubt permissible state treat mentally retarded differently respects mentally ill question however whether difference two conditions rationally justify particular disparate treatment accorded kentucky statute first distinction wrought statute imposition lesser standard proof involuntary institutionalization alleged basis need confinement mental retardation rather mental illness observes four specific propositions must proven person may involuntarily institutionalized basis mental retardation person mentally retarded person person presents danger threat danger self family others least restrictive alternative mode treatment presently available requires placement institution reatment reasonably benefit person available institution michie issue case application provision adults shown mentally retarded simply alleged subject proceeding retains full interest liberty anyone else state kentucky deemed liberty interest precious one may institutionalized basis mental illness statutory prerequisites must shown beyond reasonable doubt however allegation individual one mental retardation deprived protection high burden proof first question whether light state decision provide high burden proof involuntary commitment proceedings illness alleged something mental retardation rationally justify provision less protection upholding disparate treatment relies first state assertion mental retardation easier diagnose mental illness concludes discrimination burdens proof rational lessened risk error resulting higher burden proof see ante quoting addington texas understood offset greater ris erroneous determination subject commitment proceeding condition question allegation one mental illness rather mental retardation ante reaches essentially conclusion respect second prerequisite individual present danger threat danger others see ante determination dangerousness may made accura cy respect mentally retarded mentally ill concluding however demands minimal rationality satisfied burdens proof rise simply difficulties proof misunderstands principal object setting burdens coincidence difficult issues civil cases subject proof beyond reasonable doubt even garden variety elements criminal cases satisfied preponderance evidence reason burdens proof assigned risks error allocated reflect mere difficulty avoiding error importance avoiding judged thorough consideration respective interests parties affected allocation see addington civil commitment proceeding state side balance interests protecting society posing dangers protecting ill helpless individual incapacities side clear cases involving individual rights whether criminal civil standard proof minimum reflects value society places individual liberty brackets original citation omitted encompasses freedom restraint freedom stigma restraint justifications impose institutionalized person question whether lower burden proof rationally justified turns whether ease diagnosis proof dangerousness differ cases illness retardation also whether differences respective interests public subjects commitment proceedings two groups subject commitment rationally treated differently imposing lower standard proof commitment retarded answer clearly difficulty proof interpretation evidence legitimately counsel setting standard high state may unable satisfy thereby effectively thwarting efforts satisfy legitimate interests protection care treatment see justify lower standard allegedly difficult cases illness easier cases retardation lower burdens proof merely easy prove proposition issue raise merely difficult reasonably conceivable facts cut favor distinction treatment drawn kentucky statute ill retarded may dangerous may require care state interest seemingly equal strength category cases one argue value liberty varies somehow depending whether one alleged ill retarded mentally retarded person much lose civil commitment institution mentally ill counterpart including loss liberty choos friends companions selec daily activities decid eat retai level personal privacy among things brief american association mental retardation aamr et al amici curiae aamr presume curtailment liberty disabled disability less severe loss ill even individuals subject involuntary commitment proceedings previously shown mentally retarded thus still retain strong legally cognizable interest liberty cf foucha concurring part concurring judgment even assuming assertion different degrees difficulty proof mental illness mental retardation dangerousness inherent condition true assertion support record lends shred rational support decision discriminate retarded allocating risk erroneous curtailment liberty also rests conclusion view plausible kentucky legislature believe mentally retarded individuals committed receive treatment less invasive tha mentally ill subjected ante nothing cited however demonstrates belief plausible kentucky legislature discussion render plausible cf railroad retirement bd fritz rational basis scrutiny disparate treatment must justified plausible reasons one example invasiveness refers use results administration psychotropic drugs take exception proposition extensively used treating mental illness see ante citing authorities proposition drugs used treating mental illness except proposition appropriate perhaps characteristic response mental retardation mental illness kind training necessities known habilitation see ibid citing authorities describing training neither propositions tells us however invasive medication prescribed mental illness also used responding mental retardation fact apparent plausibility suggestion mentally retarded general subjected th medical treatmen dissipates moment examine readily available material subject including studies institutional practices affecting retarded comparable studies concerning treatment mental illness cited one recent examination institutions mentally retarded kentucky neighboring state missouri example found institutionalized retarded receive type psychoactive drug fully receive psychotropic drugs see intagliata rinck psychoactive drug use public community residential facilities mentally retarded persons psychopharmacology bull another study one national scope found residents institutions mentally retarded receive psychotropic drugs see hill balow bruininks national study prescribed drugs institutions community residential facilities mentally retarded people psychopharmacology bull surveys conducted within institutions mentally retarded generally shown prevalences range residents receiving psychotropic drugs given time aman singh pharmacological intervention handbook mental retardation matson mulick ed hereinafter handbook mental retardation psychotropic drugs according available material used treat institutionalized retarded often misused indeed findings fact district north carolina another state nearby kentucky show three hospitals persons committed mentally retarded receiving antipsychotic drugs less half individuals diagnosed mentally ill well mentally retarded following commitment latter ground see thomas flaherty wdnc aff cert denied district found institutionalized retarded plaintiffs seriously endangered injured inappropriate use antipsychotic drugs flaherty supra see also halderman pennhurst state school hospital ed aff rev grounds discussing evidence residents state institution mentally retarded received psychotropic drugs though less received drugs monitored determine effectiveness treatment bates smeltzer arnoczky appropriate inappropriate use psychotherapeutic medications institutionalized mentally retarded persons mental deficiency finding medications prescribed mentally retarded persons inappropriate conditions diagnosed facts consistent law review study drugs employed treating retardation observed reduction need institutional staff resulting use sedating drugs promoted drug use responding retardation despite frightening adverse effects including suppression learning intellectual development plotkin gill invisible manacles drugging mentally retarded people nothing record suggest kentucky institutions free practices reason whatever assume simply plausible basis assumption institutional response mental retardation main less intrusive way treatment mental illness also suggests medical treatment mentally retarded less invasive case mentally ill mentally ill subjected psychiatric treatment may involve intrusive enquiries patient innermost thoughts see ante disagree mentally ill often subject intrusive psychiatric therapy mentally retarded subject intrusive therapy available material medical treatment mentally retarded demonstrates mentally retarded often subjected behavior modification therapy correct among things anxiety disorders phobias hyperactivity antisocial behavior therapy may include aversive conditioning well forced exposure objects trigger severe anxiety reactions see mcnally anxiety phobias handbook mental retardation mulick hammer dura assessment management antisocial hyperactive behavior handbook mental retardation gardner use behavior therapy mentally retarded psychiatric approaches mental retardation menolascino ed like drug therapy psychiatric therapy mentally retarded misused one recent case federal district found aversive procedures including seclusion physical restraints inappropriately used evidence effectiveness relationship choice procedure analysis cause problem plac ing clients extreme risk maltreatment lelsz kavanagh nd tex internal quotation marks citation omitted rev unrelated grounds invasive behavior therapy mentally retarded finally often employed together drug therapy see mcnally supra mulick hammer dura supra sorts published authorities relies sum refute contention prevailing methods treatment mentally retarded general rule much less invasive given mentally ante available literature indicates psychotropic drugs invasive therapy routinely administered retarded well mentally ill apparent differences therapeutic regimes plausibly explain less rigorous commitment standards alleged mentally retarded alleged mentally iii respect involvement family members guardians commitment proceeding holds justified fact mental retardation onset person developmental period mental illness may arise manifest suddenness minority ante suggests mentally ill person parents may ceased provide care support well onset illness whereas parents likely retained connection retarded son daughter whose proper course treatment may depend matters related observations made household setting ibid suggested distinctions true apparently apply guardians whose legal obligations protect persons estates wards seem require much connection one class people event although differences might justify scheme immediate relatives guardians automatically called witnesses cases seeking institutionalization basis mental retardation completely unrelated aspects statute doe objects permitting immediate relatives guardians involved parties give among things right appeal adverse decision institutionalize individual subject proceedings third party supports commitment someone alleged retarded faced second advocate institutionalization second prosecutor capacity call witnesses obtain expert testimony raise appeal might otherwise taken whereas person said require commitment basis mental illness mere theoretical difference suggestion relatives guardians may support curtailment liberty finds support record case indicates commitments kentucky institutions mentally retarded period middle one achieved application consent family members guardians see record state answers plaintiff first set interrogatories simply points characteristic mental retardation rationally justify imposing burden second prosecutor alleged mentally retarded state decided impose upon alleged mentally ill even assumed generally regular connection relatives guardians alleged retarded said mentally ill explain former subject second prosecutor latter may said second suggested justification mentally ill may need privacy shown retarded even assuming ill need additional privacy participation others commitment proceeding therefore limited smallest group compatible due process ante retarded subject second prosecutor provides answer without plausible justification kentucky allowed draw distinction difficult see resting anything stereotypical assumption retarded perpetual children assumption historically taken justify disrespect grotesque mistreatment retarded subjected see cleburne stevens concurring internal quotation marks citation omitted said cleburne mentally retarded cut pattern range whose disability immediately evident must constantly cared recent times least imposing responsibilities citizenship jurisprudence seemed reject analogy mentally retarded adults nondisabled children see penry lynaugh controlling opinion mentally retarded people virtue mental retardation alone apart individualized consideration personal responsibility inevitably lack cognitive volitional moral capacity act degree culpability associated death penalty see also reliance mental age measure capabilities retarded person purposes eighth amendment disempowering effect applied areas law cf ante citing parham case parents rights minor children state kentucky sets respective schemes institutionalization basis mental illness mental retardation obliged reject analogy rest difference standards involuntary commitment ill retarded plausible reason iv absence rational justification disparate treatment either respect burdens proof participation third parties institutionalization proceedings affirm judgment appeals conclusion statute violates equal protection reach question validity due process clause doe relies first nature right stake citing decision last term foucha louisiana faced equal protection challenge louisiana statute authorizing continued commitment currently sane insanity acquitees standards applied criminal convicts completed prison terms insanity acquitee kept incarcerated mental institution unless prove dangerous see art west supp whereas louisiana law justice white wrote provide similar confinement classes persons committed criminal acts later prove dangerous criminals completed prison terms obvious large category persons however state law allow th continuing confinement criminals may unable prove dangerous based merely dangerousness freedom physical restraint fundamental right state must particularly convincing reason put forward discrimination insanity acquitees longer mentally foucha plurality opinion white joined blackmun stevens souter jj see also concurring part concurring judgment although think unnecessary reach equal protection issues facts us permissibility holding acquitee mentally ill longer person convicted crimes imprisoned open serious question curtailment liberty undoubtedly involved involuntary civil commitment institutionalization see vitek jones quoting humphrey cady doe argues heightened scrutiny applies foucha alleged mentally retarded denied protection afforded another obvious large category potential civil committees said mentally doe also argues discrimination second aspect justifies application strict heightened scrutiny classification basis mental retardation although recognizes held retarded individuals class see cleburne cleburne living center argues subsequently enacted americans disabilities act ada amounts exercise congress power fourteenth amendment secure guarantees equal protection clause disabled see katzenbach morgan ada includes findings people disabilities among included mental impairments doe argues include mental retardation see supp iii discrete insular minority faced restrictions limitations subjected history purposeful unequal treatment relegated position political powerlessness society doe argues findings together expressions purpose contained ada amount clear indication congress individuals disabilities including individuals mental retardation treated suspect class brief respondent approach complies two cardinal rules governing federal courts one never anticipate question constitutional law advance necessity deciding never formulate rule constitutional law broader required precise facts applied brockett spokane arcades citations internal quotation marks brackets omitted consistent past practice see hooper bernalillo county assessor declining decide whether apply heightened scrutiny classification failed rational basis test cf mississippi univ women hogan declining decide whether apply strict scrutiny classification survive heightened scrutiny notes statutory prerequisites substantially identical commitment basis illness retardation commitment ground mental illness requires proof beyond reasonable doubt individual mentally ill person ho presents danger threat danger self family others result mental illness ho reasonably benefit treatment hospitalization least restrictive alternative mode treatment presently available michie addition two prerequisites mentioned text state must also prove commitment beneficial least restrictive alternative method treatment contend rational justification imposition lowered burden proof respect prerequisites institutionalization cases allegation one retardation illness see ante indeed extent addington texas discuss difficulty diagnosing mental illness see supports use lesser standard proof practical problems created supposed serious question whether state ever prove beyond reasonable doubt individual mentally ill likely dangerous course case kentucky determined liberty alleged mentally ill sufficiently precious state assume risk inherent use higher standard also see little point excursion historical difference treatment idiots lunatics see ante surely intend suggest irrational scientifically unsupported beliefs england support distinction treatment mentally ill mentally retarded today time lunatics een demonically possessed products parental sin often punished left perish see herr rights advocacy retarded people primary purpose adjudication idiocy appears depriv individual property profits without wealth dealt like destitute vagrant persons workhouses houses correction petitioner also argues mental retardation different cases mental illness permanent condition may require lifetime care see brief petitioner petitioner completely fails explain permanence condition likely need lifetime care rationally justify regime alleged require institutionalization based mental retardation face greater risk erroneous curtailment liberty alleged require based mental illness distinction proffered state accepting factually accurate based merely stereotype cuts quite way possibility condition thought justify commitment last lifetime suggests person committed institution basis mental retardation less likely regain liberty one institutionalized basis rationally justify disparity commitment standards requiring stricter protection mental retardation cases based mental illness way around course guardians relatives already act witnesses kind proceeding subject limitations relevance interest also note provides support speculation adult develops mental illness greater need desire privacy involuntary commitment proceeding adult mentally retarded