He is locked up in a psychiatric unit while the Supreme Court considers if the 53-year-old can be forced to take anti-psychotic drugs to make him well enough to stand trial on insurance fraud charges.
His case asks the high court to balance the government's interest in punishing nonviolent crime with a person's constitutional right to control his or her body.
The justices were hearing arguments Monday in a follow-up to a 1992 court ruling that defendants can be forced to take drugs only if it is medically appropriate.
Sell's case raises questions that could apply more broadly to, for example, government programs requiring vaccinations against anthrax or school mandates that children with hyperactivity or attention deficit disorder take drugs to remain in class.
No one disputes that Sell, of suburban St. Louis, is mentally ill and too unstable to stand trial. There is disagreement over whether medicines will help him, and whether he is dangerous.
The Bush administration argues that hundreds of federal defendants a year are medicated, and that most become competent to stand trial. Most take the drugs willingly. In a recent 12-month period, 59 people were medicated against their wishes and about three-fourths were restored to competency, the administration told the court.
Sell and his wife are accused of submitting bogus claims to Medicaid and private insurance companies for dental services. Sell was later charged with conspiring and attempting to kill a witness — a former worker in his office — and the FBI agent who arrested him.
He has spent more than four years in a prison hospital as his lawyers fought over his drugging, more jail time than he would receive if convicted of the fraud crimes. He has been diagnosed with a delusional disorder.
Some were surprised when the Supreme Court announced last fall it would hear Sell's case. The justices refused to take up the subject in 2001 in the appeal of Russell Eugene Weston, a schizophrenic charged with killing two U.S. Capitol police officers in 1998.
The court signaled Friday that there may be problems with the Sell case. It asked both sides to prepare arguments about whether the case was properly appealed.
The case has attracted the attention of medical organizations and civil rights groups.
Peter Joy, a professor at Washington University School of Law who filed a brief on behalf of the American Civil Liberties Union, said the powerful drugs Sell would be given can cause serious side effects and potentially death.
"It shocks my conscience to think we might risk putting someone to death prior to trying them on nonviolent charges," he said.
Kent Scheidegger, legal director of the Criminal Justice Legal Foundation, said there's an interest to victims and society in putting defendants on trial. "The criminal justice system makes all kinds of intrusion on people's privacy. It locks people up, searches their houses, searches their bodies," he said.
Mark N. Light, one of Sell's lawyers, said the case will resolve "whether American citizens have a fundamental right to avoid being drugged against their will simply because they've been charged with a crime."
The case is Sell v. U.S., 02-5664.
The high court is also expected to hear arguments in the case Madigan v. Telemarketing Associates, a lawsuit filed by Illinois Attorney General Lisa Madigan against a firm that solicited donations but spent little of the money on any charitable cause.
Madigan claims the firm committed fraud; at issues is whether telemarketers have a first amendment protection against such charges.