Heller v. Doe, 509 U.S. 312, 14 (1993)

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Cite as: 509 U. S. 312 (1993)

Opinion of the Court

chotherapies: Individual, Family, and Group, in The Harvard Guide to Modern Psychiatry 357-385 (A. Nicholi ed. 1978) (hereinafter Harvard Guide), and use of psychotropic drugs, see Baldessarini, Chemotherapy, in Harvard Guide 387-431; Berger, Medical Treatment of Mental Illness, 200 Science 974 (1978); Mentally Disabled 327-330; Brief for American Psychological Association as Amicus Curiae in Washington v. Harper, O. T. 1988, No. 88-599, pp. 10-11. By contrast, the mentally retarded in general are not subjected to these medical treatments. Rather, " 'because mental retardation is . . . a learning disability and training impairment rather than an illness,' " Youngberg v. Romeo, 457 U. S. 307, 309, n. 1 (1982), quoting Brief for American Psychiatric Association as Amicus Curiae in Youngberg v. Romeo, O. T. 1981, No. 80-1429, p. 4, n. 1, the mentally retarded are provided "habilitation," which consists of education and training aimed at improving self-care and self-sufficiency skills. See Youngberg, supra, at 309, n. 1; M. Rosen, G. Clark, & M. Kivitz, Habilitation of the Handicapped 47-59 (1977); Mentally Disabled 332.

It is true that the loss of liberty following commitment for mental illness and mental retardation may be similar in many respects; but the different treatment to which a committed individual is subjected provides a rational basis for Kentucky to decide that a greater burden of proof is needed before a person may be committed for mental illness. The procedures required before the government acts often depend on the nature and extent of the burden or deprivation to be imposed. See Addington v. Texas, 441 U. S., at 423- 424. For example, because confinement in prison is punitive and hence more onerous than confinement in a mental hospital, id., at 428, the Due Process Clause subjects the former to proof beyond a reasonable doubt, In re Winship, 397 U. S. 358 (1970), whereas it requires in the latter case only clear and convincing evidence, Addington v. Texas, supra. It may also be true that some persons committed for mental retardation are subjected to more intrusive treatments while

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