US District Judge Robert Blackburn ruled that involuntary medication was the only realistic approach with a substantial chance of making Dear competent to stand trial, and was also in the best interest of his overall health, both mental and physical.
"Under the proposed treatment plan, and again based on clear and convincing evidence, involuntary medication of Mr Dear is not substantially likely to engender dangerous and unmanageable side effects," he said.
Dear is represented by federal public defenders who do not comment on cases.
Dear, who has called himself a "warrior for the babies", intended to wage "war" against the clinic because it offered abortion services, arming himself with four semi-automatic rifles, five handguns, two other rifles, a shotgun, propane tanks, and 500 rounds of ammunition, prosecutors have alleged. He began shooting outside the clinic before getting inside by shooting his way through a door, according to his federal indictment.
According to experts who testified and Dear's lawyers, Dear has persecutory delusions which cause him to believe that the FBI is following him because he called a radio show in 1993 to criticise the agency over the law enforcement siege against the Branch Davidian compound in Waco, Texas. He also believes his lawyers are working for the FBI and that the judge is also in on the arrangement.
Dear mentioned the radio call in one of many outbursts during the recent hearing, where he also claimed the shooting was a "success" and told the judge to 'go to hell' because he did not get to testify. He largely remained quiet after Blackburn warned him that he would not tolerate any more disturbances. The judge said he concluded the outbursts were not the result of Dear's mental illness, but of "selfish, childish and disaffected arrogance".
After Dear's prosecution bogged down in state court over the competency issue, Dear was charged in federal court in 2019 under the 1994 Freedom of Access to Clinic Entrances Act. Federal prosecutors have said they would not seek the death penalty against him if he is convicted, but life in prison instead.
Two of the people killed in the attack were accompanying friends to the clinic — Ke'Arre Stewart, 29, an Army veteran who served in Iraq and was a father-of-two, and Jennifer Markovsky, 36, a mother-of-two who grew up in Oahu, Hawaii. The third person killed was a campus police officer at a nearby college, Garrett Swasey, who responded to the clinic after hearing there was an active shooter.