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The Eighth Amendment to the U.S. Constitution prohibits cruel and unusual punishment, which, according to the U.S. Supreme Court decision in Ford v. Wainwright (1986), includes the execution of the insane. Thus, it is unconstitutional to execute condemned inmates who become incompetent while on death row while they remain in an incompetent state. Statutes set forth by those states that permit the death penalty often do not include specific guidelines for evaluating competency for execution, and when guidelines do exist, they vary widely. When the issue of an inmate's competency for execution arises, mental health professionals are called on to assist the court in the evaluation of competency for execution and for restoring competency in those found incompetent. Given the nature of the consequences involved, these practices often present ethical challenges and are controversial in nature.

Competency for execution, called by some commentators the “last competency” for its temporal proximity to the final resolution of an inmate's legal proceedings, is raised as an issue far less often than competency to stand trial but is no less important. The legal system in the United States and many other countries has as one of its bases the presumption of competence. That is, all defendants are presumed competent unless this issue is called into question by one of the parties to a legal proceeding. The competence of a criminal defendant may arise as an issue at any point in the legal proceedings, from as early as initial arrest and interrogation, throughout the entire legal process, and finally to the time of sentencing or, for those who have been sentenced to the ultimate penalty of death, the time of execution. Just as an incompetent defendant is not allowed to proceed to trial, so too an incompetent defendant/inmate is prohibited from being sentenced or executed. The rationale against executing incompetent individuals is that, among other things, it is inhumane, neither deterrence nor retribution is accomplished, and incompetent individuals are unable to assist in appealing their sentence.

Legal Standards

The issue of the constitutionality of executing incompetent individuals was heard by the U.S. Supreme Court in 1986 in Ford v. Wainwright. The Court in Ford held that the Eighth Amendment, which bans cruel and unusual punishment, prohibits the execution of an “insane” (mentally incompetent) person. The Court reasoned that (a) execution of the insane would offend humanity, (b) executing the insane would not serve to set an example and would not reaffirm the deterrence value believed to exist in capital punishment, (c) any individual who is believed to be insane is also believed unable to prepare “spiritually” for death, (d) madness itself is punishment and, therefore, negates the punishment value of execution, and (e) no retributive value is believed to be served by executing the mentally incompetent.

The Court in Ford also ruled that when questions of competency for execution were raised, due process entitled a defendant to an evidentiary hearing. Furthermore, the Court stated that this evidentiary hearing is required only when defendants make a “high threshold showing” that their competency to be executed is in question. The justices, however, did not define the precise nature of the “high threshold.” Moreover, the justices could not agree on the specific fact-finding procedures to be used in case such a threshold is met: Some agreed that a full “panoply” of trial-type procedures was required, others argued that a more relaxed hearing was acceptable if due process was ensured, and still others argued that the most minimal “pro forma” procedures were acceptable.

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