COLLOTON, Circuit Judge.
Shawn Mackey was indicted for failing to register as a sex offender, in violation of 18 U.S.C. § 2250(a). After the parties stipulated that Mackey was incompetent to understand the proceedings against him or to assist in his own defense, see 18 U.S.C. § 4241, the government moved to medicate Mackey involuntarily to restore his competency to stand trial. Applying the criteria set forth in Sell v. United States,
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