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As death row prisoners age, a new set of issues arises regarding their competence to be executed. Can a prisoner with dementia who no longer remembers the crime be put to death? What if the dementia has progressed to the point that the prisoner no longer understands that he or she faces execution, or why? These issues were considered by the U.S. Supreme Court in its recent decision in Madison v. Alabama . Implicitly rejecting the cruelty of executing a highly impaired prisoner, the court clarified the conditions that could preclude execution and the degree of impairment that must be present.

The change is based on ethical concerns, including racial bias.

This response refutes the claim made in a recent article that organs for transplantation in China will no longer be sourced from executed prisoners. We identify ongoing ethical problems due to the lack of transparent data on current numbers of transplants in China; implausible and conflicting claims about voluntary donations; and obfuscation about who counts as a voluntary donor. The big unanswered question in Chinese transplant ethics is the source of organs, and until there is an open and independently audited system in China, legitimate concerns remain about organ harvesting from prisoners of conscience., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

The rate of erroneous conviction of innocent criminal defendants is often described as not merely unknown but unknowable. There is no systematic method to determine the accuracy of a criminal conviction; if there were, these errors would not occur in the first place. As a result, very few false convictions are ever discovered, and those that are discovered are not representative of the group as a whole. In the United States, however, a high proportion of false convictions that do come to light and produce exonerations are concentrated among the tiny minority of cases in which defendants are sentenced to death. This makes it possible to use data on death row exonerations to estimate the overall rate of false conviction among death sentences. The high rate of exoneration among death-sentenced defendants appears to be driven by the threat of execution, but most death-sentenced defendants are removed from death row and resentenced to life imprisonment, after which the likelihood of exoneration drops sharply. We use survival analysis to model this effect, and estimate that if all death-sentenced defendants remained under sentence of death indefinitely, at least 4.1% would be exonerated. We conclude that this is a conservative estimate of the proportion of false conviction among death sentences in the United States.

Publication is one of the primary rewards in the academic research community and is the first step in the dissemination of a new discovery that could lead to recognition and opportunity. Because of this, the publication of research can serve as a tacit endorsement of the methodology behind the science. This becomes a problem when vulnerable populations that are incapable of giving legitimate informed consent, such as prisoners, are used in research. The problem is especially critical in the field of transplant research, in which unverified consent can enable research that exploits the vulnerabilities of prisoners, especially those awaiting execution. Because the doctrine of informed consent is central to the protection of vulnerable populations, we have performed a historical analysis of the standards of informed consent in codes of international human subject protections to form the foundation for our limit and ban recommendations: (1) limit the publication of transplant research involving prisoners in general and (2) ban the publication of transplant research involving executed prisoners in particular., (Copyright © 2013 American Association for the Study of Liver Diseases.)

The current study is a partial replication of previous studies designed to estimate the level of risk posed by capital murder defendants. The study draws on data describing the behavior of nearly 2,000 incarcerated capital murderers to forecast violence propensity among defendants sentenced to life imprisonment. Logistic regression is used to model various violence outcomes, relying on the following predictors: age, educational attainment, prior imprisonment, and gang affiliation. This exercise is designed to illustrate how actuarial data may be used to anchor individualized clinical assessments of risk in capital murder trials.

The study by Corwin et al. adds to the emerging but limited data on the impact of defendant remorse on sentencing decisions. The authors studied verbal and nonverbal expressions of defendant remorse and whether they were perceived as remorseful by mock jurors. They found that incongruent verbal and nonverbal behavior, as well as mock jurors' willingness to approach emotional situations, resulted in more lenient sentences for defendants. An overarching and as yet unanswered validity concern regarding this line of research in general is whether the use of undergraduate mock jurors reliably models real jurors in actual courtroom settings.

The capital trial, by its nature, is fraught with emotionally disturbing elements that jurors must face when deciding the ultimate fate of a guilty defendant. A confluence of mitigating and aggravating factors influences a capital jury's decision to impose a sentence of death. The presence or absence of defendant remorse in these cases may make all the difference in whether a capital defendant's life is spared. This commentary examines the onerous emotional toll encountered by capital jurors in light of the findings of Corwin and colleagues regarding defendant remorse and juror's need for affect. The commentary also presents practical and ethics-related considerations that should be kept in mind when reflecting on their study.

Defendant remorse is generally accepted as a mitigating factor in capital murder sentencing in the legal system. The current study addressed whether verbal and nonverbal expressions of defendant remorse are perceived as remorseful by mock jurors. Moreover, this study investigated the associations of defendant behaviors and mock juror need for affect on sentencing decisions. Participants watched a video of a defendant depicting either high or low levels of verbal and nonverbal remorseful behavior. Results indicated that nonverbal behaviors were more important than verbal cues for perception of remorse. Incongruent verbal and nonverbal behavior, as well as mock juror willingness to approach emotional situations (i.e., high need for affect (NFA)) resulted in more lenient sentences for defendants. Implications for the remorse construct, for witness preparation, and for jury selection are discussed.

Forensic psychiatric evaluators of adolescent defendants are often asked to address open-ended questions that affect what court an adolescent will be tried in and what sentence he might receive. Such questions often involve the extent to which the adolescent should be considered less culpable than an adult who has committed a similar offense. Assessing partial or diminished culpability in an adolescent is difficult because the concept of partial culpability is complex, assessment methods are inexact, and the implications for legal disposition are often not clear. This article suggests 10 factors a forensic evaluator may wish to consider in reaching opinions about an adolescent's culpability: appreciation of wrongfulness, ability to conform to law, developmental course of aggression and impulsivity, psychosocial immaturity (including time sense, susceptibility to peer pressure, risk-taking, and ability to empathize), environmental circumstances, peer group norms, out-of-character action, incomplete personality development, mental illness, and reactive attitudes toward the offense.

A substantial body of research has explored the extent to which the race of offenders and victims influences who receives a death sentence for capital crimes. Little is known about how race and ethnicity might pattern death-row outcomes. Drawing upon evidence from male offenders sentenced to death in Texas during the years 1974 through 2009, we extend recent research by examining whether the race and ethnicity of offenders and victims and a number of offender, victim, and crime attributes influence the likelihood of executions and sentence relief (whereby prisoners leave death row). Cox regression analyses are used in conjunction with a multiple-imputation method for handling a modest amount of missing data. The results show that cases involving minorities—with black or Latino offenders or victims—have lower hazards of execution than cases in which both offenders and victims are white. Victim and offender race and ethnicity have little to no independent effect upon the hazard of sentence relief.

The postconviction prison disciplinary records of capital defendants (n = 73) who had been the subject of defense-sponsored violence risk assessments or risk-related testimony (1995-2007) that asserted an improbability of future serious prison violence were analyzed. During postconviction prison tenures averaging 4.4 years, none of the capital defendants was cited for accomplished serious assaults. The prevalence of misconduct was inversely related to severity: 54.8 percent were cited for some disciplinary misconduct, 27.4 percent for potentially violent disciplinary violations, 12.3 percent for assaultive misconduct, and 1.4 percent for attempted serious assault. Rates of misconduct among the capital offenders were equivalent to those among all inmates (n = 18,561, annual average) in high-security federal prisons (2001-2005). The accuracy rate of forecasts of improbability stands in sharp contrast to that of prosecution-sponsored expert testimony at capital sentencing that had asserted high rates of future violence.

In Panetti v. Quarterman, three professional associations advocated commutation of capital sentences for offenders who are incompetent to face execution. Some judicial opinions deny that convicted offenders have any protected interest in avoiding a legally imposed sentence, and other opinions have found that the Eighth Amendment requires treatment for prisoners with serious mental health needs. This article examines some circumstances in which health care providers in the context of criminal punishment encounter apparent conflicts among the treatment interests of the individuals, the comprehensive interests of these individuals, legally protected interests, and the public interest. This analysis pursues clarification of these interests and of potential tensions among legal and professional obligations of health care providers. This article does not provide comprehensive resolution of this tension. Rather, it is intended to promote rigorous ongoing inquiry by clarifying the relevant interests at stake and the responsibilities of various participants in the complex interaction of health care and corrections., ((c) 2009 John Wiley & Sons, Ltd.)

Objective: This study aimed to compare the dilemmas of using organs from prisoners with death penalties (PDP) from the perspectives of organ transplant health professionals (OTHP) from Taiwan (TW) and Mainland China (MC)., Materials and Methods: A purposive sample including TW's OTHP (including transplant surgeons, nurses, researchers, social workers, and medical religious and legal experts), and MC's OTHP (including surgeons and nurses) was obtained in this qualitative research. TW's subjects received face-to-face interviews, and MC's subjects received telephone interviews due to limited communication opportunities. Data were analyzed by content analysis., Results: A total of 105 subjects participated in this project (TW n = 99, MC n = 6). They were surgeons (n = 18: TW n = 14, MC n = 4), registered nurses (n = 42: TW n = 40, MC n = 2), OT coordinating nurses (n = 10 TW), OT researchers (n = 5 TW), social workers (n = 10 TW), medical religious experts (n = 15 TW), and medical legal experts (n = 5 TW). The following 8 ethical dilemmas were reported: (1) questionable legitimacy of PDP motivation (TW 100%, MC 100%); (2) recipients' worries about public discrimination (TW 89%, MC 50%); (3) difficulties in approaching PDP (TW 100%); (4) hesitation of HP and volunteers in helping PDP (TW 37%); (5) questionable social contribution of PDP as donor sources (TW 32%); (6) complex legal details of PDP issues (TW 26%); (7) potential threat from PDP families (TW 23%); and (8) difficulties in helping PDP families cope with post-organ donation syndrome (TW 11%)., Conclusions: Five suggestions were developed in managing these challenges: (1) TW OTHP may empower their basic social science knowledge and empirical competence; (2) TW government may form a task force wherein OTHP leaders are encouraged to foster interdisciplinary collaborations with the public within short-, mid-, and long-term time frames; (3) TW and MC may establish evidence-based center(s) to provide systematic literature reviews for clinical guidance, policy making, and educational resources; (4) TW and MC may try to improve the quality of PDP organ harvesting and donation practice in jails/health institutes; and (5) TW and MC may develop reliable communication systems to share experiences of quality care for PDP, and to evaluate the appraisals both pro and con from multidisciplinary societies and the public, if available.

On February 20, 2006, Michael Morales was hours away from execution in California when two anesthesiologists declined to participate in his lethal injection procedure, thereby halting all state executions. The events brought to the surface the long-running schism between law and medicine, raising the question of whether any beneficial connection between the professions ever existed in the execution context. History shows it seldom did. Decades of botched executions prove it. This Article examines how states ended up with such constitutionally vulnerable lethal injection procedures, suggesting that physician participation in executions, though looked upon with disdain, is more prevalent--and perhaps more necessary--than many would like to believe. The Article also reports the results of this author's unique nationwide study of lethal injection protocols and medical participation. The study demonstrates that states have continued to produce grossly inadequate protocols that severely restrict sufficient understanding of how executions are performed and heighten the likelihood of unconstitutionality. The analysis emphasizes in particular the utter lack of medical or scientific testing of lethal injection despite the early and continuous involvement of doctors but ongoing detachment of medical societies. Lastly, the Article discusses the legal developments that led up to the current rush of lethal injection lawsuits as well as the strong and rapid reverberations that followed, particularly with respect to medical involvement. This Article concludes with two recommendations. First, much like what occurred in this country when the first state switched to electrocution, there should be a nationwide study of proper lethal injection protocols. An independent commission consisting of a diverse group of qualified individuals, including medical personnel, should conduct a thorough assessment of lethal injection, especially the extent of physician participation. Second, this Article recommends that states take their execution procedures out of hiding. Such visibility would increase public scrutiny, thereby enhancing the likelihood of constitutional executions. By clarifying the standards used for determining what is constitutional in Baze v. Rees, the U.S. Supreme Court can then provide the kind of Eighth Amendment guidance states need to conduct humane lethal injections.

An explosion of Eighth Amendment challenges to lethal injection protocols has struck the federal courts. The Supreme Court's recent decision in Hill v. McDonough,1 which empowered prisoners to bring challenges to lethal injection procedures under 42 U.S.C. para. 1983, has facilitated a flood of new lethal injection cases. In response, several courts have ordered states to alter their protocols, spurring other capital inmates to litigate such challenges. Distressingly, the courts evaluating these claims have almost no law to guide them. The last Supreme Court decision applying the Eighth Amendment to a method of execution was written in 1947; that case, Louisiana ex rel. Francis v. Resweber,2 occurred before the Eighth Amendment was applied to the states and resulted in a 4-1-4 split. Although lower courts have heard numerous challenges to execution methods, few have analyzed the constitutional validity of a method of execution in detail. Making matters worse, courts that find Eighth Amendment violations must craft equitable remedies that often amount to entirely new execution protocols. No clear precedent exists to guide courts in formulating such remedies. This Note proposes a legal standard for the administration of Eighth Amendment method-of-execution claims, focusing on lethal injection cases. Part I describes lethal injection procedures and summarizes recent litigation. Part II discusses the difficulty of evaluating lethal injection claims, analyzing both general difficulties in interpreting the Eighth Amendment and specific difficulties associated with lethal injection cases. Part III proposes a standard for addressing method-of-execution claims that attempts to balance a prisoner's interest in a painless execution with a state's interest in conducting executions efficiently. Part IV discusses remedies for unconstitutional procedures. Part V concludes.

Psychiatrists conducting forensic evaluations of defendants facing a potential death penalty must understand the legal and ethical parameters governing these assessments in addition to the important clinical issues. Important areas to review with each defendant include the role of the evaluator, the party requesting the evaluation, circumstances in which the evaluation is not confidential, the nature, scope, and purpose of the evaluation, and the parties to whom the results of the evaluation are to be forwarded. In those circumstances in which the defense attorney has not retained the psychiatrist, the defendant's attorney must be aware that an evaluation has been ordered by the court or requested by the prosecution. The psychiatrist also must be prepared for passionate challenges to their findings from the defense or prosecution and in some instances for vigorous attacks on their own personal ethics. To weather such storms, the mental health evaluator must base their opinion on objective evidence rather than letting any personal bias guide their assessment.

Purpose of Review: To summarize recent ethical analyses of psychiatrists' participation in the evaluation and treatment of death row inmates., Recent Findings: Psychiatric participation in death penalty cases remains highly controversial in the United States, whereas there appears to be a more worldwide consensus that it is ethically inappropriate., Summary: Psychiatrists working in death penalty settings are functioning in a complex ethical arena, and must consider the implications of their decisions to participate and/or abstain from various activities with great care and attention to the circumstances of the individual cases at hand.

This article notes that, because understandings of what life imprisonment means are often ambiguous, the life sentence is sometimes perceived to be relatively uncontroversial. Life imprisonment without the prospect of parole for children under the age of 18 years is the most extreme form of this sentence that can be imposed. However, in the United States of America even such sentences have only recently become the subject of public debate. In contrast, in a small but growing number of jurisdictions all life sentences are regarded as constitutionally suspect and contrary to human rights, whilst in the majority of jurisdictions the imposition of life imprisonment is strictly limited. The article traces recent developments in the imposition and implementation of life imprisonment that have evoked some controversy. It pays particular attention to attempts that have been made in practice to ensure that life imprisonment produces punishment that is proportionate to the crime. It points out, however, that a renewed focus on combating dangerous offenders through indeterminate preventive sentences has blunted even this modest safeguard. It warns that this tendency increases the risk of life imprisonment being an unfairly harsh penalty.

Singleton v. Norris is a decision by the Eighth Circuit Court of Appeals stating that forced psychotropic medication can be continued after the date of execution is set if the medication had been given previously to prevent the inmate from being dangerous in the prison setting under a Harper-type review. The defendant had argued that after the date of execution was set, it was no longer in his medical interests to continue the medication. In the decision, the majority held that the fact that an execution is in the offing does not alter the medical interests for which the medication had been prescribed, and physicians should just continue to treat the medical condition. This decision may raise ethics problems for physicians in such settings, because they may be in violation of the American Medical Association (AMA) Code of Ethics if the original override is dubious.

Most scholars of religion who approach the phenomena associated with religious conversion in order to theorize religion tend to ignore the legal and political implications of the actual context in which conversion occurs for theorizing religion itself. Meanwhile, political and legal theorists who attend to the implications of executing convicted murderers who undergo religious conversion on death row err in a different direction. They virtually ignore the significance of the claims made by the converts and their associates about the conversion themselves for theorizing the state. Scholars across disciplines increasingly address issues of race, class, gender, and sexual orientation in respect to theorizing religion and theorizing the state independently of one another. At the same time, they do not seize the opportunity to incorporate their analyses into a wider study of the sociocultural production of religion and state in relation to each other. I examine the religious conversion of Karla Faye Tucker and Wanda Jean Allen on death row, as well as the scholarship that their convictions, conversions, and executions have generated across academic disciplines and fields. Close examination illustrates well the necessity for theorizing religion and the state in relation to one another in order to understand either adequately.

This study compares three groups of murderers: those who have received a death sentence (n = 18), those who were eligible to receive a death sentence but did not have it sought against them (n = 18), and those who were not eligible for the death penalty (n = 18). A retrospective record review of these 54 pretrial detainees in South Carolina who underwent court-ordered competency and criminal responsibility evaluations was completed comparing the following variables: age, race, marital status, educational level, prior legal history, relationship to the victim, race of the victim, existence of a codefendant, prior psychiatric history, psychiatric diagnoses, substance abuse history, use of substances at the time of the crime, Wechsler Adult Intelligence Scale (WAIS) or WAIS-Revised Full Scale IQ, and evidence of organic impairment. Statistically significant findings included race of the murderer, race of the victim, relationship to the victim, and existence of a codefendant. Death row inmates were more likely to be Caucasian and much more likely to have murdered a Caucasian than a non-Caucasian victim. Death row inmates were less likely to know their victims and more likely to have a codefendant. Psychiatric and organic findings did not differ among the groups, but the rate of organic findings and substance abuse was high in all three groups.

The following note considers the complex case of Perry v. Louisiana, in which the Louisiana Supreme Court ordered an insane defendant on death row to be medicated against his will in order to render him sane, and therefore capable of being executed. In so doing the court pit judicial interests in effecting punishment of certain murderers against the physician's Hippocratic Oath, "first do no harm." In considering this conflict, the note identifies "first do no harm" as a guiding principle, explores the societal values underlying this basic principle, and concludes the judiciary must provide legal support for this medical ethical imperative. Similarly the legal profession must identify its organizing principles, its "first do no harm" proscriptions, and consider the application of those principles in the context of representing the insane. Some of the conflicts confronting the physician in the Perry situation have parallels for the attorney representing an insane client. Should the client be medicated in order to proceed to trial? Is it in the best interests of the client to remain a prisoner of her mental illness rather than to risk the possibility of conviction? How should the attorney address the paradoxical reality that a heavily medicated client may indeed become more lucid without becoming more competent? By publishing this note, the Journal hopes to engender discussion and clarification of the vague and sometimes incoherent guidance offered by the Medical Rules of Professional Responsibility, the Model Code of Professional Conduct, and the Criminal Justice Mental Health Standards for legal work with mentally disturbed clients.