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In 1954, the Canadian government established the Royal Commission on the Law of Insanity as a Defence in Criminal Cases. While its final report had little impact at the time, the creation of the commission points to the emergence of insanity as a newly complex problem within the context of postwar Canada. Spurred on by the growing psychiatric profession and the destabilization of capital punishment as a viable sentence, the commission quickly realized that the building blocks of its solution - legal and psychiatric expertise - were largely incompatible. This article explores the commission's problematization of insanity, which, far from providing solutions, highlighted the difficulties surrounding the integration of both psychiatric and legal knowledges of the day. The commission played an important role in upholding the status quo, and it provides an early example of the stasis that would characterize this area of the law until the early 1990s.

It is absolutely essential to consider the abject ineffectiveness of counsel in a significant number of death penalty cases involving defendants with serious mental disabilities and how such ineffectiveness is often (scandalously) accepted by reviewing courts. We must also assess all of the concerns raised in this excellent paper by Hiromoto and colleagues through the filter of therapeutic jurisprudence as a way to guide counsel to thoroughly investigate all aspects of such cases (especially those involving defendants with PTSD) and to present substantial mitigating evidence to the fact finders in the sorts of cases the authors are discussing., (© 2022 American Academy of Psychiatry and the Law.)

This article summarizes the evolution of the U.S. Supreme Court's standard for assessing defendants' competency for execution. In Ford v. Wainwright (1986), the Court categorically exempted insane defendants from execution but failed to agree on how to define insanity. In Panetti v. Quarterman (2007), the Court ruled that defendants may be executed only if they rationally understand why they are being punished. In its most recent decision, the Supreme Court ruled in Madison v. Alabama (2019) that defendants who cannot remember committing the original crime may be executed, but dementia may prevent defendants from rationally understanding why they are being punished. The Court remanded the case to Alabama's trial court with instructions to re-determine Mr. Madison's competency. This article concludes by recommending best practices for those who evaluate defendants for competency to be executed., (© 2020 American Academy of Psychiatry and the Law.)

Sarah Jane Whiteling was accused of fatally poisoning her husband and two children in Philadelphia in 1888. The case prompted public outrage over the appearance that Ms. Whiteling's motive was to collect life insurance. It was evident, however, that she was disturbed, raising a question of culpability. Dr. Alice Bennett, the first female physician in charge of an asylum, provided the defense with expert testimony on the defendant's mental state. Dr. Bennett, who had little forensic but much clinical experience, proposed a physiological theory of insanity among women with reproduction-related derangements. At that time, cultural ideas about "female poisoners" colored popular and journalistic perceptions of Ms. Whiteling. Familicide was considered unconscionable because a mother's duty was to nurture and protect her family. When Ms. Whiteling was convicted and sentenced to death, Dr. Bennett undertook a campaign for commutation. Her unsuccessful efforts to reduce culpability were followed by Ms. Whiteling's hanging in 1889, the first execution of a woman in Philadelphia since colonial times. This article recounts the Whiteling case, Dr. Bennett's involvement in it, and how it relates to what is known about familicide. It is argued here that Dr. Bennett was a pioneer in applying medical expert testimony to effect individualized mitigation., (© 2020 American Academy of Psychiatry and the Law.)

The Eighth Amendment to the US Constitution prohibits the infliction of cruel and unusual punishments. However, no method of executing prisoners has ever been deemed by the Supreme Court to constitute Cruel and Unusual Punishment. Constitutional challenges to the dominant mode of executing prisoners today - lethal injection - are hobbled by a lack of clinical data that would reveal the likelihood this method might inflict gratuitous pain. Here, we assess the contemporary Eighth Amendment jurisprudence, including its legal and scientific limitations, and suggest modifications., (Copyright ©2019, Yale Journal of Biology and Medicine.)

This article reviews the history of the U.S. Supreme Court's rulings on intellectual disability in capital cases, highlighting the difficulty states have had in devising a workable definition that meets constitutional standards. The Court's decisions in Penry v. Lynaugh (1989), Atkins v. Virginia (2002), and Hall v. Florida (2014) are briefly summarized. Next, the Texas Court of Criminal Appeals' ruling in Ex parte Briseno (2004) is discussed as a prelude to the Supreme Court's decision in Moore v. Texas I (2017). On remand, the Texas Court of Criminal Appeals interpreted the Supreme Court's Moore I ruling in a manner that resulted in finding Mr. Moore intellectually able, and therefore eligible for the death penalty, in Ex parte Moore II (2018). Finally, the importance of the Supreme Court's most recent ruling on intellectual disability in capital cases, Moore v. Texas II (2019), is explored in depth. The article concludes with recommendations for best practices among forensic evaluators who assess capital defendants for intellectual disability., (© 2019 American Academy of Psychiatry and the Law.)

During its 2018-2019 term, the United States Supreme Court considered the constitutionality of executing a prisoner with dementia. In Madison v. Alabama, the Court ruled that, in certain circumstances, executing a prisoner with dementia violates the Eighth Amendment's ban on cruel and unusual punishment. Vernon Madison was sentenced to death for killing a police officer in 1985. After many years on Alabama's death row, he had a series of strokes and was diagnosed with vascular dementia. In 2016, Madison's lawyers unsuccessfully sought a stay of execution, arguing that, in light of his cognitive impairments, imposing the death penalty would violate the Constitution. After Alabama set a 2018 execution date, lawyers returned to the state court, arguing that the finding of competence should be reversed because Madison's cognitive impairments had worsened. When the trial court refused to grant the stay of execution, Madison's lawyers asked the Supreme Court to review the constitutionality of the state court decision., (© 2019 The Hastings Center.)

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.

A paper was published in 2003 discussing the ethics of nurses participating in executions by inserting the intravenous line for lethal injections and providing care until death. This paper was circulated on an international email list of senior nurses and academics to engender discussion. From that discussion, several people agreed to contribute to a paper expressing their own thoughts and feelings about the ethics of nurses participating in executions in countries where capital punishment is legal. While a range of opinions were presented, these opinions fell into two main themes. The first of these included reflections on the philosophical obligations of nurses as caregivers who support those in times of great need, including condemned prisoners at the end of life. The second theme encompassed the notion that no nurse ever should participate in the active taking of life, in line with the codes of ethics of various nursing organisations. This range of opinions suggests the complexity of this issue and the need for further public discussion.

In theory, sentencing decisions should be driven by legal factors, not extra-legal factors. However, some empirical research on the death penalty in the United States shows significant relationships between offender and victim characteristics and death sentence decisions. Despite the fact that China frequently imposes death sentences, few studies have examined these sanctions to see if similar correlations occur in China's capital cases. Using data from published court cases in China involving three violent crimes-homicide, robbery, and intentional assault-this study examines the net impact of offender's gender, race, and victim-offender relationship on death sentence decisions in China. Our overall multiple regression results indicate that, after controlling for other legal and extra-legal variables, an offender's gender, race, and victim-offender relationship did not produce similar results in China when compared with those in the United States. In contrast, it is the legal factors that played the most significant role in influencing the death penalty decisions. The article concludes with explanations and speculations on the unique social, cultural, and legal conditions in China that may have contributed to these correlations.

The U.S. state of Michigan abolished the death penalty in 1846. Since then, several abortive efforts have been made by state legislators to re-establish the death sentence to deal with convicted murderers. Concurrently, some support exists among Michigan residents for the restoration of capital punishment in the state. This article presents the results of the analysis of an attitudinal survey of 116 college students enrolled in three criminal justice courses in a Michigan public university concerning the reinstatement of the death sentence in the state. The data from this exploratory study show that a slight majority (52.6%) of respondents favored reinstatement whereas 45.7% opposed restoration. Advocates and opponents of re-establishment of the death penalty in Michigan provided similar religious, moral and economic arguments proffered by others in previous surveys on capital punishment available in the death penalty literature. The current study makes a contribution to the scant extant literature on attitudes toward the death penalty in abolitionist jurisdictions. As this body of literature grows, it can provide baseline data or information with which to compare attitudes in retentionist states.

The history of capital punishment in the United States is long and controversial. In many cases, lethal injection has brought medical personnel, ethically and professionally charged with preserving life, into the arena of assisting the state in taking life. U.S. Supreme Court decisions, including Baze v. Rees (2008) and Glossip v. Gross (2015), have evaluated and condoned lethal injection protocols. Despite the judicial validation of some midazolam-containing protocols, controversy exists about the level of unconsciousness provided due to the ceiling effects of the drug. Drug shortages, induced in part by manufacturers under pressure by death penalty opponents and governments opposed to capital punishment, have forced states to sometimes use creative means to obtain medications for use in lethal injection, even proposing to allow inmates to supply their own drugs for use in execution. Others have resorted to using compounding pharmacies and enacting tougher execution secrecy laws to protect the identities of those involved in the process. Professional organizations representing health care team members, including nursing, medicine, and pharmacy, among others, have roundly denounced the medicalization of capital punishment. Legal challenges continue to mount at all levels, leading to an uncertain future for lethal injection., (© 2017 Pharmacotherapy Publications, Inc.)

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

The United States Supreme Court has considered the question of whether a judge or a jury must make the findings necessary to support imposition of the death penalty in several notable cases, including Spaziano v. Florida (1984), Hildwin v. Florida (1989), and Ring v. Arizona (2002). In 2016, the U.S. Supreme Court revisited the subject in Hurst v. Florida Florida Statute § 921.141 allows the judge, after weighing aggravating and mitigating circumstances, to enter a sentence of life imprisonment or death. Before Hurst, Florida's bifurcated sentencing proceedings included an advisory sentence from jurors and a separate judicial hearing without juror involvement. In Hurst, the Court revisited the question of whether Florida's capital sentencing scheme violates the Sixth Amendment, which requires a jury, not a judge, to find each fact necessary to impose a sentence of death in light of Ring In an eight-to-one decision, the Court reversed the judgment of the Florida Supreme Court, holding that the Sixth Amendment requires a jury to find the aggravating factors necessary for imposing the death penalty. The role of Florida juries in capital sentencing proceedings was thereby elevated from advisory to determinative. We examine the Court's decision and offer commentary regarding this shift from judge to jury in the final imposition of the death penalty and the overall effect of this landmark case., (© 2016 American Academy of Psychiatry and the Law.)

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/)

Historically, the link between sexual deviance and criminality has been described and documented, asserted by psychiatry, and manifested in law. Laws that have regulated sexual behaviour have referred to terms such as 'sexual deviation', 'sexual perversion' or even archaic moral terms such as 'unnatural acts and unspeakable crimes against nature'. A possible link between sexual perversion, psychopathy, and criminality, specifically manifesting in sexual homicide, has been the subject of remarkable research in forensic psychiatry. This contribution examines the phenomenon of paraphilia with specific reference to its definition, diagnostic classification and characteristics, as well as a few selections of incidences of paraphilia in South African criminal case law. A brief assessment is made of how South African criminal courts have dealt with paraphilia. In this regard, an analysis is made of the criminal liability of the paraphiliac. The South African response to sexual deviation as addressed in the Criminal Law (Sexual Offences and Related Matters) Amendment Act 32 of 2007 will also be addressed with reference to its efficacy in addressing paraphilia within South African criminal law. The interface between criminal law and medical ethics within the context of this theme will also be canvassed. In conclusion, recommendations for possible reform are canvassed., (Copyright © 2016. Published by Elsevier Ltd.)

DSM-5 and Hall v. Florida (2014) have dramatically refocused attention on the assessment of adaptive functioning in death penalty cases. In this article, we address strategies for assessing the adaptive functioning of defendants who seek exemption from capital punishment pursuant to Atkins v. Virginia (2002). In particular, we assert that evaluations of adaptive functioning should address assets as well as deficits; seek to identify credible and reliable evidence concerning the developmental period and across the lifespan; distinguish incapacity from the mere absence of adaptive behavior; adhere faithfully to test manual instructions for using standardized measures of adaptive functioning; and account for potential bias on the part of informants. We conclude with brief caveats regarding the standard error of measurement (SEM) in light of Hall, with reference to examples of ordinary life activities that directly illuminate adaptive functioning relevant to capital cases., (© 2016 American Academy of Psychiatry and the Law.)

When anticipating the imposition of the death penalty, jurors may be less inclined to convict defendants. On the other hand, minority defendants have been shown to be treated more punitively, particularly in capital cases. Given that the influence of anticipated sentence severity on verdicts may vary as a function of defendant race, the goal of this study was to test the independent and interactive effects of these factors. We conducted a survey-embedded experiment with a nationally representative sample to examine the effect on verdicts of sentence severity as a function of defendant race, presenting respondents with a triple murder trial summary that manipulated the maximum penalty (death vs. life without parole) and the race of the defendant. Respondents who were told life-without-parole was the maximum sentence were not significantly more likely to convict Black (67.7%) than White (66.7%) defendants. However, when death was the maximum sentence, respondents presented with Black defendants were significantly more likely to convict (80.0%) than were those with White defendants (55.1%). The results indicate that the death penalty may be a cause of racial disparities in criminal justice, and implicate threats to civil rights and to effective criminal justice., ((c) 2015 APA, all rights reserved).)

In Dusky v. United States, the United States Supreme Court established "rational understanding" as a necessary component of a defendant's competency to stand trial. Yet, rational understanding has engendered misunderstanding, stemming from inconsistent court rulings and lack of systematic attention given to definitions of rationality. The purpose of this article is to assist with the conceptualization of rational understanding as it relates to competency to proceed to trial. This will be accomplished through a review of legal decisions and scholarly papers that provide various definitions of rationality. We discuss the suitability of standardized instruments of competency and how they may assist in providing a valid metric for evaluating rational abilities. We also provide discussion of how case law, in conjunction with psycholegal research, can be used to gain nuanced insight into operationalizations of rational understanding. By gaining a thorough understanding of rationality in competency to proceed to trial evaluations, clinicians may improve on the quality and foundation of their evaluations., (© The Author(s) 2014.)

Prior research suggests that homicide cases involving familial offenders and victims are subject to a "domestic discount" that reduces sentencing severity. However, the operation of a domestic discount in regard to death penalty sentencing has been rarely examined. The current research uses a near-population of jury decisions in capital murder trials conducted in North Carolina from 1991 to 2009 (n = 800), and a series of logistic regression analyses to determine whether there is (a) a direct effect between offender-victim relationship (e.g., domestic, friend/acquaintance, and stranger) and jury decision making, and/or (b) whether domestic offender-victim relationship (as well as other offender-victim relationships) moderates the effect of legal and extralegal case characteristics on jury assessment of the death penalty. Our findings revealed no empirical support for a "domestic discount" whereby juries are less likely to impose death sentences in cases involving domestic homicides. However, substantial differences in predictors of death sentencing were found across offender-victim dyads; most notably, domestic homicide cases demonstrated the most legalistic model of jury decisions to impose death sentences., ((c) 2015 APA, all rights reserved).)

The United States Supreme Court has ruled on the question of persons with intellectual disability and capital punishment in several notable cases, including Penry v. Lynaugh (1989) and Atkins v. Virginia (2002). In 2014, the U.S. Supreme Court revisited the subject in Hall v. Florida. Although Florida Statute § 921.137 prohibits imposing a sentence of death on a defendant convicted of a capital felony if it is determined that the defendant is intellectually disabled, the Florida Supreme Court strictly interpreted the law so that, because Mr. Hall's IQ was not below the cutoff of 70, further evidence could not be presented to show that he had an intellectual disability. In Hall v. Florida, the Court analyzed the relevance of the standard error of measurement of IQ testing, whether there is a consensus among the states regarding capital punishment, and whether there is a consensus among professional associations regarding these questions. The Court also adopted the term "intellectual disability" as opposed to "mental retardation," following changes in both the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the U.S. Code and Code of Federal Regulations. We examine the Court's decision and offer commentary regarding the overall effect of this landmark case., (© 2015 American Academy of Psychiatry and the Law.)

The purpose of the research was to determine whether European American and Latino mock jurors would demonstrate bias in death penalty decision making when mitigation evidence and defendant ethnicity and socioeconomic status (SES) were varied. A total of 561 actual venire persons acted as mock jurors and read a trial transcript that varied a defendant's case information (mitigating circumstances: strong/weak, defendant ethnicity: European American/Latino, and defendant SES: low/high). European American jurors recommended the death penalty significantly more often for the low SES Latino defendant when strength of mitigation evidence was weak. In addition, they also assigned this defendant higher culpability ratings and lower ratings on positive personality trait measures compared with all other conditions. Strong mitigation evidence contributed to lower guilt ratings by European American jurors for the high SES European American defendant. Latino jurors did not differ in their death penalty sentencing across defendant mitigation, ethnicity, or SES conditions. Discussion of in-group favoritism and out-group derogation, as well as suggestions for procedures to diminish juror bias in death penalty cases, is provided., ((c) 2015 APA, all rights reserved).)

The knowledge of experts presumably affects their credibility and the degree to which the trier of fact agrees with them. However, specific effects of demonstrated knowledge are largely unknown. In this experiment, we manipulated a forensic expert's level of knowledge in a mock-trial paradigm. We tested the influence of low versus high expert knowledge on mock juror perceptions of expert credibility, on agreement with the expert, and on sentencing. We also tested expert gender as a potential moderator. Knowledge effects were statistically significant; however, these differences carried little practical utility in predicting mock jurors' ultimate decisions. Contrary to the hypotheses that high knowledge would yield increased credibility and agreement, knowledge manipulations influenced only perceived expert likeability. The low-knowledge expert was perceived as more likeable than the high-knowledge counterpart, a paradoxical finding. No significant differences across expert gender were found. Implications for conceptualizing expert witness knowledge and credibility and their potential effects on juror decision-making are discussed., (© 2015 American Academy of Psychiatry and the Law.)

Most forensic psychiatrists occasionally face complex situations in forensic work in which ethics dilemmas cause discomfort. They want to determine the most ethical action, but the best choice is unclear. Fostering justice is primary in forensic roles, but secondary duties such as traditional biomedical ethics and personal values like helping society, combating racism, and being sensitive to cultural issues can impinge on or even outweigh the presumptive primary duty in extreme cases. Similarly, in treatment the psychiatrists' primary duty is to patients, but that can be outweighed by secondary duties such as protecting children and the elderly or maintaining security. The implications of one's actions matter. In forensic work, if the psychiatrist determines that he should not assist the party who wants to hire him, despite evidence clearly supporting its side, the only ethical option becomes not to accept the case at all, because the evidence does not support the better side. Sometimes it can be ethical to accept cases only for one side. In ethics-related dilemmas, I call the method of prioritizing and balancing all types of conflicting principles, duties, and personal and societal values in a dialectic to resolve conflicts among them dialectical principlism. This approach is designed to help determine the most ethical action. It is aspirational and is not intended to get the psychiatrist into trouble., (© 2015 American Academy of Psychiatry and the Law.)

When the U.S. Supreme Court held that persons with mental retardation (now called intellectual disability) could not be sentenced to death, it left the question of how to define the condition to the states. That issue was raised in Hall v. Florida, which challenged one state's "bright-line rule" barring consideration of defendants with IQs over 70. In an endorsement of the professional consensus, the justices ruled that a more flexible approach that takes into account both intellectual and adaptive functioning is required. The Court's posture may bode well for its acceptance of mental health expertise in future cases.

Several independent elements have recently combined to thrust United States capital punishment into a chaos. Corrections officials and policy makers have attempted to "humanize" capital punishment by evolving into a chemical execution process, and soften the outward appearance. Foreign policies have interrupted chemical protocols by banning key ingredients. These disruptions are spawning new theories of legal challenges in capital punishment. This is a critical time for stakeholders and all members of a civilized society to pause and reflect on the role of capital punishment.