An Analysis of United States v. Randall
Here’s a breakdown of that brilliant and complex legal note on United States v. Randall and the doctrine of medical necessity as a defense to criminal charges—made digestible, point-by-point:
🧾 Background: United States v. Randall (1976)
Robert C. Randall was arrested for possessing marijuana in D.C. in 1975.
He admitted to the facts of the crime but claimed medical necessity as a defense.
He had glaucoma, a degenerative eye disease that can lead to blindness.
Marijuana was the only effective treatment left; other meds failed, and surgery was risky.
The court agreed: if use was medically necessary, he was not criminally liable.
⚖️ Medical Necessity as a Legal Defense
A. Definition & Origin
Derived from the broader common law doctrine of necessity.
Traditional necessity: unlawful act justified if it prevents greater harm.
Medical necessity: use of illegal medicine (e.g. cannabis) to preserve health or life.
B. Difference from Duress:
Duress: external coercion by a person (e.g. someone threatens you).
Necessity: response to natural or circumstantial danger (e.g. disease).
📚 Legal Frameworks Compared
Common Law:
Necessity was narrowly applied, especially not allowed in homicide (e.g. Regina v. Dudley & Stephens).
U.S. courts were more flexible in non-homicide cases like mutiny or embargo violations.
Model Penal Code (MPC):
Codifies necessity more broadly.
Allows the defense even in non-immediate threats.
Puts burden on prosecution to disprove necessity beyond reasonable doubt.
Rejects the blanket rule against using necessity to justify homicide.
🏥 Medical Necessity vs. General Necessity
Medical necessity is distinct: based not on immediate danger but on ongoing threats to health.
Centers the existence of a real medical condition, not just subjective belief.
Requires expert medical testimony: diagnosis, severity, lack of alternatives.
⚖️ The Burden of Proof Debate
Courts split on who must prove necessity:
Prosecution? (like with insanity under Winship and Wilbur)
Defendant? (like James v. U.S.)
Randall court placed the burden on Randall to prove necessity by a preponderance of evidence.
Critics argue this contradicts due process protections, especially when justification negates criminality (like self-defense).
📈 Implications of Randall
Set a precedent for recognizing medical necessity as a defense in cannabis cases.
Did not negate criminal law, but carved out a narrow, fact-specific exception.
Future implications:
Euthanasia: if suffering is unbearable and irreversible, medical necessity could justify mercy killing.
Experimental drugs: like laetrile in Rutherford v. U.S., where courts overrode FDA regulation for terminally ill cancer patients.
🧪 Evidentiary Standards for Medical Necessity
Prove the condition exists (diagnosis).
Show that legal treatments failed or are unavailable.
Demonstrate that the illegal act alleviates the condition.
Establish no safer legal alternatives existed at the time.
Defendant’s belief must be reasonable and genuine.
Emergency situations may allow self-diagnosis.
If time permits, reliance on medical advice is expected.
🧠 Court’s Reasoning in Randall
Recognized the right to preserve one’s sight as fundamental.
Balanced:
Individual’s health rights
vs. Government’s interest in banning marijuana
Found the “social harm” of Randall’s marijuana use speculative.
Therefore, necessity justified his act.
⚠️ Weaknesses in the Decision
Unclear classification of necessity as excuse vs. justification.
Placed burden of proof on defendant without clear justification.
Did not assess Randall’s intent or belief at the time of the initial act (pre-study self-treatment).
📌 Key Takeaways
United States v. Randall was the first modern case to recognize medical necessity as a valid defense to marijuana charges.
It created a narrow exception to drug laws based on health preservation.
Opened the door to broader concepts:
Affirmative right to health
Judicial challenges to rigid drug laws
Potential support for regulated euthanasia under tight medical scrutiny
🧭 Legacy
Randall helped frame the argument that when law and medicine conflict, courts may side with health.
It set the stage for the Compassionate IND program, and decades later, debates around medical cannabis access for veterans, the terminally ill, and those with chronic conditions.
