donaldson argued january decided june respondent confined almost years care maintenance treatment mental patient florida state hospital brought action damages petitioner hospital superintendent staff members alleging intentionally maliciously deprived constitutional right liberty evidence showed respondent whose frequent requests release rejected petitioner notwithstanding undertakings responsible persons care necessary dangerous neither others mentally ill received treatment petitioner principal defense acted good faith since state law believed valid authorized indefinite custodial confinement sick even treated release harmful petitioner therefore immune liability monetary damages jury found respondent awarded compensatory punitive damages petitioner codefendant appeals broad fourteenth amendment grounds affirmed district ensuing judgment entered verdict held state constitutionally confine without individual capable surviving safely freedom help willing responsible family members friends since jury found upon ample evidence petitioner confine respondent properly concluded petitioner violated respondent right liberty pp since appeals consider whether trial judge erred refusing give instruction requested petitioner concerning claimed reliance state law authorization respondent continued confinement since neither benefit decision wood strickland scope state official qualified immunity case vacated remanded consideration petitioner liability vel non monetary damages violating respondent constitutional right pp stewart delivered opinion unanimous burger filed concurring opinion post raymond gearey assistant attorney general florida argued cause petitioner pro hac vice briefs robert shevin attorney general daniel dearing special assistant attorney general bruce ennis argued cause respondent brief morton birnbaum william hyland attorney general stephen skillman assistant attorney general joseph maloney deputy attorney general filed brief state new jersey amicus curiae urging reversal briefs amici curiae urging affirmance filed barrett prettyman american psychiatric assn francis shea ralph moore john townsend rich james fitzpatrick kurt melchior harry rubin sheridan neimark zwerdling american association mental deficiency june resnick german alfred berman committee mental hygiene new york state bar assn william brown attorney general andrew ruzicho barbara rouse assistant attorneys general filed brief state ohio amicus curiae justice stewart delivered opinion respondent kenneth donaldson civilly committed confinement mental patient florida state hospital chattahoochee january kept custody nearly years petitioner hospital superintendent period throughout confinement donaldson repeatedly unsuccessfully demanded release claiming dangerous one mentally ill rate hospital providing treatment supposed illness finally february donaldson brought lawsuit district northern district florida alleging members hospital staff named defendants intentionally maliciously deprived constitutional right liberty trial jury returned verdict assessing compensatory punitive damages codefendant appeals fifth circuit affirmed judgment granted petition certiorari important constitutional questions seemingly presented donaldson commitment initiated father thought son suffering delusions hearings county judge pinellas county donaldson found suffering paranoid schizophrenia committed care maintenance treatment pursuant florida statutory provisions since repealed state law less clear specifying grounds necessary commitment record scanty donaldson condition time judicial hearing matters however irrelevant case involves challenge initial commitment focused instead upon nearly years confinement followed evidence trial showed hospital staff power release patient dangerous others even remained mentally ill lawfully committed despite many requests refused allow power exercised donaldson case trial indicated believed donaldson unable make successful adjustment outside institution recall basis conclusion retired superintendent shortly suit filed months thereafter trial donaldson secured release judicial restoration competency support hospital staff testimony trial demonstrated without contradiction donaldson posed danger others long confinement indeed point life conceded personal secondhand knowledge donaldson ever committed dangerous act evidence donaldson ever suicidal thought likely inflict injury upon one codefendants acknowledged donaldson earned living outside hospital done years commitment immediately upon release secured responsible job hotel administration furthermore donaldson frequent requests release supported responsible persons willing provide care might need release example representative helping hands halfway house mental patients wrote asking release donaldson care request accompanied supporting letter minneapolis clinic psychiatry neurology codefendant conceded good clinic rejected offer replying donaldson released parents rule apparently making time donaldson years old knew donaldson parents elderly infirm take responsibility moreover continuing correspondence donaldson parents never informed helping hands offer addition four separate occasions john lembcke college classmate donaldson longtime family friend asked release donaldson care occasion refused record shows lembcke serious responsible person willing able assume responsibility donaldson welfare evidence showed donaldson confinement simple regime enforced custodial care program designed alleviate cure supposed illness numerous witnesses including one codefendants testified donaldson received nothing custodial care hospital described donaldson treatment milieu therapy witnesses hospital staff conceded context case milieu therapy euphemism confinement milieu mental hospital substantial periods donaldson simply kept large room housed patients many criminal commitment donaldson requests ground privileges occupational training opportunity discuss case staff members repeatedly denied trial principal defense acted good faith therefore immune liability monetary damages position short state law believed valid authorized indefinite custodial confinement sick even given treatment release harm one trial judge instructed members jury find violated donaldson constitutional right liberty found confined donaldson knowing mentally ill dangerous knowing mentally ill receiving treatment alleged mental illness purpose involuntary hospitalization treatment mere custodial care punishment patient danger others without treatment justification constitutional continued confinement unless also find donaldson dangerous either others reasonably believed good faith detention donaldson proper length time confined however mere good intentions give rise reasonable belief detention lawfully required justify donaldson confinement florida state hospital appeals affirmed judgment district broad opinion dealing question whether fourteenth amendment guarantees right treatment persons involuntarily civilly committed state mental hospitals appellate held donaldson case rationale confinement patient need treatment constitution requires minimally adequate treatment fact provided expressed view regardless grounds involuntary civil commitment person confined state mental institution constitutional right receive individual treatment give reasonable opportunity cured improve mental condition conversely opinion implied constitutionally permissible state confine mentally ill person order treat illness regardless whether illness renders dangerous others see ii concluded difficult issues constitutional law dealt appeals presented case present posture specifically reason decide whether mentally ill persons dangerous others right treatment upon compulsory confinement state whether state may compulsorily confine nondangerous mentally ill individual purpose treatment view case raises single relatively simple nonetheless important question concerning every man constitutional right liberty jury found donaldson neither dangerous dangerous others also found mentally ill donaldson received treatment verdict based abundant evidence makes issue narrow one need decide whether procedures mentally ill person may confined state grounds contemporary statutes generally advanced justify involuntary confinement person prevent injury public ensure survival safety alleviate cure illness see jackson indiana humphrey cady jury found none grounds continued confinement present donaldson case given jury findings left justification keeping donaldson continued confinement fact state law may authorized confinement harmless mentally ill establish constitutionally adequate purpose confinement see jackson indiana supra mcneil director patuxent institution enough donaldson original confinement founded upon constitutionally adequate basis fact even involuntary confinement initially permissible constitutionally continue basis longer existed jackson indiana supra mcneil director patuxent institution supra finding mental illness alone justify state locking person keeping indefinitely simple custodial confinement assuming term given reasonably precise content mentally ill identified reasonable accuracy still constitutional basis confining persons involuntarily dangerous one live safely freedom may state confine mentally ill merely ensure living standard superior enjoy private community state proper interest providing care assistance unfortunate goes without saying mere presence mental illness disqualify person preferring home comforts institution moreover state may arguably confine person save harm incarceration rarely ever necessary condition raising living standards capable surviving safely freedom help family friends see shelton tucker may state fence harmless mentally ill solely save citizens exposure whose ways different one might well ask state avoid public unease incarcerate physically unattractive socially eccentric mere public intolerance animosity constitutionally justify deprivation person physical liberty see cohen california coates city cincinnati street new york cf dept agriculture moreno short state constitutionally confine without nondangerous individual capable surviving safely freedom help willing responsible family members friends since jury found upon ample evidence agent state knowingly confine donaldson properly concluded violated donaldson constitutional right freedom iii contends event held personally liable monetary damages decisions made good faith specifically argues acting pursuant state law believed authorized confinement mentally ill even release compromise safety constitute danger others reasonably expected know state law understood constitutionally invalid proposed instruction effect rejected district district instruct jury without objection monetary damages assessed believed reasonably good faith donaldson continued confinement proper punitive damages awarded acted maliciously wantonly oppressively appeals approved instructions consider whether error trial judge refuse additional instruction concerning claimed reliance state law authorization donaldson continued confinement neither district appeals acted benefit recent decision scope qualified immunity possessed state officials wood strickland decision relevant question jury whether knew reasonably known action took within sphere official responsibility violate constitutional rights donaldson took action malicious intention cause deprivation constitutional rights injury donaldson see also scheuer rhodes wood strickland supra opinion powell purposes question official course duty anticipate unforeseeable constitutional developments wood strickland supra accordingly vacate judgment appeals remand case enable consider light wood strickland whether district judge failure instruct regard effect claimed reliance state law rendered inadequate instructions liability compensatory punitive damages ordered footnotes donaldson release district dismissed action class suit donaldson filed amended complaint repeating claim compensatory punitive damages although amended complaint retained prayer declaratory injunctive relief request eliminated case prior trial see judicial commitment proceedings pursuant state public health code provided whenever person adjudged mentally incompetent requires confinement restraint prevent violence others said judge shall direct person forthwith delivered superintendent florida state hospital mentally ill admission authorized regulations approved board commissioners state institutions care maintenance treatment provided sections make disposition may permitted law laws extra incompetent reason mental illness sickness drunkenness excessive use drugs insanity mental physical condition incapable caring managing property likely dissipate lose property become victim designing persons inflict harm others laws whether florida statute provided right treatment involuntarily committed patients also open dispute commitment prevent violence others care maintenance treatment recently florida totally revamped civil commitment law provides statutory right receive individual medical treatment stat ann sole statutory procedure release required judicial reinstatement patient mental competency public health code laws pp procedure initiated hospital staff indeed staff initiative donaldson finally restored competency liberty almost immediately retired superintendency addition witnesses testified hospital always procedure releasing patients trial visits home visits furloughs state discharges even though patients judicially restored competency conditional releases often became permanent hospital merely closed books patient deny trial power release patients conceded duty superintendent hospital determine whether patient reached hospital condition request considered release hospital evidence donaldson christian scientist occasion refused take medication trial judge instructed jury award damages period confinement donaldson declined treatment close donaldson case chief moved directed verdict ground state law time donaldson confinement authorized institutionalization mentally ill even posed danger others motion denied close evidence asked jury instructed defendants acted pursuant statute declared unconstitutional time held accountable action district declined give requested instruction district defined treatment follows instructed person involuntarily civilly committed mental hospital constitutional right receive treatment give realistic opportunity cured improve mental condition emphasis added pertinent part instructions read follows plaintiff claims brief throughout period hospitalization mentally ill dangerous others claims mentally ill defendants believed mentally ill defendants withheld treatment necessary improve mental condition defendants claim brief plaintiff detention legal proper detention legal proper result mistake without malicious intent order prove claim civil rights act burden upon plaintiff case establish preponderance evidence case following facts defendants confined plaintiff knowing mentally ill dangerous knowing mentally ill receiving treatment alleged mental illness hat defendants acts conduct deprived plaintiff federal constitutional right denied deprived liberty without due process law phrase defined explained instructions instructed person involuntarily civilly committed mental hospital constitutional right receive treatment give realistic opportunity cured improve mental condition purpose involuntary hospitalization treatment mere custodial care punishment patient danger others without treatment justification constitutional continued confinement unless also find plaintiff dangerous either others trial judge instructed punitive damages awarded act omission defendant defendants proximately caused injury plaintiff maliciously wantonly oppressively done given jury instructions see supra possible jury went far find knew donaldson harmless others also mentally ill found jury permitted instructions rule regardless nature treatment provided construe jury verdict fashion remain substantial issue case wholly sane innocent person constitutional right physically confined state freedom pose danger neither others seriously doubted judge instructions used phrase dangerous course even foreseeable risk suicide person literally dangerous physical reasons helpless avoid hazards freedom either efforts aid willing family members friends might argued judge instructions detailed point raised objection presumably evidence clearly showed donaldson dangerous however broadly phrase might defined argues despite jury verdict must assume donaldson receiving treatment sufficient justify confinement adequacy treatment nonjusticiable question must left discretion psychiatric profession argument unpersuasive treatment sole asserted ground depriving person liberty plainly unacceptable suggest courts powerless determine whether asserted ground present see jackson indiana neither party objected jury instruction defining treatment accordingly occasion case decide whether provision treatment standing alone ever constitutionally justify involuntary confinement much kind treatment suffice purpose present posture case involves involuntary treatment simply involuntary custodial confinement see supra years confinement donaldson unsuccessfully petitioned state federal courts release florida state hospital number occasions none claims ever resolved merits evidentiary hearings ever held contended relied unsuccessful actions independent intervening reason continuing donaldson confinement instructions score requested upon remand appeals consider question whether held liable monetary damages violating donaldson constitutional right liberty jury found substantial evidence adequate instructions deprived donaldson dangerous neither others provided treatment constitutional right liberty cf supra finding needs consideration appeals holds remand district necessary issue determined whether immune liability monetary damages necessity decision vacating judgment appeals deprives opinion precedential effect leaving opinion judgment sole law case see munsingwear chief justice burger concurring although join opinion judgment case seems several factors merit emphasis gives therefore add following remarks respect remand appeals issue official immunity liability monetary damages seems entirely irrelevant substantial evidence donaldson consistently refused treatment offered claiming mentally ill needed treatment appropriately takes notice uncertainties psychiatric diagnosis therapy reported cases replete evidence divergence medical opinion vexing area greenwood see also drope missouri nonetheless one areas agreement among behavioral specialists uncooperative patient benefit therapy first step effective treatment acknowledgment patient suffering abnormal condition see katz right treatment enchanting legal fiction chi rev donaldson adamant refusal taken account considering petitioner defense perhaps important issue immunity factor referred obliquely opinion numerous occasions period confinement donaldson unsuccessfully sought release florida courts indeed last proceedings terminated months prior bringing action see cert denied whatever reasons state repeated denials relief regardless whether correctly resolved issue tendered petitioner members medical staff florida state hospital surely justified considering judicial decision approval continued confinement independent intervening reason continuing donaldson custody thus fact inescapably related issue immunity must considered appeals remand new trial issue ordered district ii points ante district instructed jury part person involuntarily civilly committed mental hospital constitutional right receive treatment give realistic opportunity cured emphasis added appeals unequivocally approved phrase standing alone correct statement law opinion plainly gives approval holding makes clear binds neither parties case courts fifth circuit see ante moreover light importance future litigation area emphasized appeals analysis basis decisions doubt involuntary commitment mental hospital like involuntary confinement individual reason deprivation liberty state accomplish without due process law specht patterson cf gault commitment must justified basis legitimate state interest reasons committing particular individual must established appropriate proceeding equally important confinement must cease reasons longer exist see mcneil director patuxent institution jackson indiana appeals purported applying principles developing first theories supporting constitutional right treatment first identified perceived traditional bases civil commitment physical dangerousness oneself others need treatment stated donaldson case rationale confinement parens patriae rationale patient need treatment due process clause requires minimally adequate treatment fact provided deprive citizen liberty upon altruistic theory confinement humane therapeutic reasons fail provide adequate treatment violates fundamentals due process proposition surely descriptive power traditionally exercised area historically considerable period time subsidized custodial care private foster homes boarding houses benign form care provided incompetent mentally ill persons assumed responsibility well century vast majority persons simply restrained poorhouses almshouses jails see deutsch mentally ill america ed established institutions mentally ill early period concerned primarily providing humane place confinement secondarily curing persons sent see trend toward state care mentally ill expanded eventually leading present statutory schemes protecting persons dual functions institutionalization continued recognized one goals movement provide medical treatment benefit acknowledged done cases large range mental illness known cure existed time providing places custodial confinement dependent insane emerged major goal programs area remained well century see rothman discovery asylum short idea may confine mentally ill except purpose providing treatment recent origin historical basis imposing limitation state power analysis sources civil commitment power likewise lends support notion little doubt exercise police power state may confine individuals solely protect society dangers significant antisocial acts communicable disease cf minnesota ex rel pearson probate jacobson massachusetts additionally vested historic parens patriae power including duty protect persons legal disabilities act hawaii standard oil see also mormon church classic example role state undertakes act general guardian infants idiots lunatics hawaii standard oil supra quoting blackstone commentaries course inevitable consequence exercising parens patriae power ward personal freedom substantially restrained whether guardian appointed control property placed custody private third party committed institution thus however power implemented due process requires invoked indiscriminately minimum particular scheme protection mentally ill must rest upon legislative determination compatible best interests affected class members unable act cf mormon church supra moreover use alternative forms protection may motivated different considerations justifications one may invoked rationalize another cf jackson indiana see also american bar foundation mentally disabled law brakel rock ed however existence due process limitations parens patriae power justify conclusion may exercised confine mentally ill person purpose confinement treatment despite many recent advances medical knowledge remains stubborn fact many forms mental illness understood untreatable sense effective therapy yet discovered rates cure generally low see schwitzgebel right effective mental treatment rev little responsible debate regarding uncertainty diagnosis field tentativeness professional judgment greenwood see also ennis litwack psychiatry presumption expertise flipping coins courtroom rev similarly previously observed universally recognized fundamental effective therapy patient acknowledge illness cooperate attempting give treatment yet failure large proportion mentally ill persons common phenomenon see katz supra chi may persons either categories may others unable function society suffer real harm unless provided care sheltered environment see lake cameron app dissenting opinion least able say state legislature powerless make kind judgment see greenwood supra alternatively argued fourteenth amendment right treatment involuntarily confined mental patients derives fact many safeguards criminal process present civil commitment appeals described theory follows due process right treatment based principle three central limitations government power detain detention retribution specific offense limited fixed term permitted proceeding fundamental procedural safeguards observed absent must quid pro quo extended government justify confinement quid pro quo commonly recognized provision rehabilitative treatment well established require extended discussion due process inflexible concept rather requirements determined particular instances identifying accommodating interests individual society see morrissey brewer mcneil director patuxent institution mckeiver pennsylvania plurality opinion claims state acting best interests individual said justify reduced procedural substantive safeguards decisions require candidly appraised gault however judges free read private notions public policy public health constitution olsen nebraska quid pro quo theory sharp departure coexist due process principles initial matter theory presupposes essentially interests involved every situation state seeks confine individual assumption however incorrect elementary justification criminal process unique deprivation liberty impose requires invoked commission specific offense prohibited legislative enactment see powell texas opinion black incongruous example apply limitation quarantine imposed state protect public highly communicable disease see jacobson massachusetts troublesome feature quid pro quo theory elevate concern essentially procedural safeguards new substantive constitutional right rather inquiring whether strict standards proof periodic redetermination patient condition required civil confinement theory accepts absence safeguards insists state provide benefits view adequate compensation confinement light wide divergence medical opinion regarding diagnosis proper therapy mental abnormalities prospect especially troubling area squared principle courts may substitute judgments legislators understanding public welfare must instead concern validity constitution methods legislature selected gault harlan concurring dissenting course questions regarding adequacy procedure power state continue particular confinements ultimately courts aided expert opinion extent found helpful persuaded abandon traditional limitations scope judicial review sum accept reasoning appeals discern basis equating involuntarily committed mental patient unquestioned constitutional right confined without due process law constitutional right treatment given present state medical knowledge regarding abnormal human behavior treatment things fraught peril irrevocably condition state power protect mentally ill upon providing treatment give realistic opportunity cured accept theory state may lawfully confine individual thought need treatment justify deprivation liberty solely providing treatment concepts due process tolerate appeals analysis read authorizing results followed difficulty understanding issue immunity resolved record hence likely new trial issue may required case hope sensitive important issues benefit effective presentation articulation behalf petitioner reference milieu therapy ante may construed disparaging concept true capable used simply cloak official indifference reality mental abnormalities respond known treatment also mental patients respond persons suffering variety physiological ailments loosely called milieu treatment keeping comfortable well nourished protected environment us say baffling field psychiatry milieu therapy always pretense petitioner counsel failed raise issue reason considered respect immunity light holding defense preserved appellate review see editorial new right indeed considerable debate concerning threshold questions constitutes mental disease treatment see szasz right health geo indeed respondent may shared characteristics illness paranoid schizophrenia notoriously unsusceptible treatment see livermore malmquist meehl justifications civil commitment rev reports florida state hospital staff introduced evidence expressed view unwilling acknowledge illness generally uncooperative imply accept appeals conclusions regarding limitations upon power detain persons commit crimes example notion confinement must fixed term difficult square widespread practice indeterminate sentencing least upper limit life sentence even advocates right treatment criticized quid pro quo theory ground developments law civil commitment mentally ill harv rev pointed several issues touched upon contexts involved opinion makes plain case person seeking release confined without ever obtaining judicial determination confinement warranted mcneil director patuxent institution although respondent amended complaint alleged hearing pinellas county procedurally defective ignored various factors relating necessity commitment persons allegations applied either served process dismissed district prior trial respondent sought review latter rulings case involve rights person initial competency commitment proceeding cf jackson indiana specht patterson minnesota ex rel pearson probate alleged respondent singled discriminatory treatment staff florida state hospital patients institution denied privileges generally available persons commitment florida thus question whether different bases commitment justify differences conditions confinement involved litigation cf jackson indiana supra baxstrom herold finally evidence whatever respondent abused mistreated florida state hospital failure provide treatment aggravated condition testimony regarding general quality life hospital jury asked consider whether respondent confinement effect punishment mentally ill record provides basis concluding therefore respondent denied rights secured eighth fourteenth amendments cf robinson california