The Scott Panetti Case: Why Executing Mentally Ill Prisoners is Unjust

Last month, the Fifth Circuit Court of Appeals stayed the execution of Scott Panetti, a Texas man diagnosed with schizophrenia clearly suffering from mental illness, including delusions about his case and the State’s motivations for putting him to death. In doing so, the court has given itself the opportunity to exercise fairness and compassion toward death row inmates with mental illness.

While legal consensus has been slow to build on this issue, there is now a growing recognition that it is not just to kill prisoners who do not fully understand the reason for their execution. Panetti’s case deserves a closer look.

After Panetti killed the parents of his second wife, he was allowed to represent himself at his 1995 trial, during which he dressed in a colorful cowboy costume and attempted to call John F. Kennedy and Jesus Christ as witnesses. One consequence was many of his medical records were not admitted into evidence at trial, in part because he scribbled all over them.

Prosecutors had argued that Panetti was faking his illness, but there is extensive evidence that he was extremely ill well before he killed Joe and Amanda Alvarado. Panetti was haunted by paranoid delusions that the devil was hunting him. He buried furniture in his backyard, conducted exorcisms by spraying water over his valuables, and swung a sword around the house threatening to kill his wife and baby. He was repeatedly hospitalized, starting in 1986, a full six years prior to the murders.

During the trial, Panetti was allowed to dismiss his court-appointed counsel and represent himself. He dressed as a cowboy and occasionally claimed that his alter-ego, “Sgt. Ranahan Ironhose,” committed the murders. In addition to JFK and Jesus Christ, he tried to call more than 200 witnesses, including the pope. Not surprisingly, he was convicted, though subsequent appeals took the case to the U.S. Supreme Court and made it a landmark case, Panetti v. Quaterman, in mental health law.

The case now hinges on a question: Just how much understanding about the execution does a person with mental illness need to have? In other words, what counts as competency to be executed? Panetti recognizes that he committed the murders, but he has repeatedly stated that he believes Texas plans to execute him to prevent him from preaching to other inmates.

Experts in his case have also testified that Panetti believes his execution is part of “spiritual warfare” between the “demons and the forces of the darkness and God and the angels and the forces of light.” According to the State, though, it is enough that Panetti knows the barest of facts: That he is aware of the connection between the murders and the punishment, regardless of the underlying delusions that color this understanding.

Indeed, despite the high proportion of mentally ill defendants on death row — as high as 10% by some estimates — the Fifth Circuit, which oversees Texas and neighboring states, has never found any defendant incompetent for execution due to mental illness.

The legal question has its roots in a 1986 Supreme Court case, Ford v. Wainwright, in which the court held that “The Eight Amendment prohibits a State from carrying out a sentence of death upon a prisoner who is insane.” As the numbers above imply, the legal definition of insanity in this context is limited to the simplest essentials.

Should mentally ill prisoners face the death penalty?

On appeal of Panetti’s case, however, the Supreme Court found that the Fifth Circuit was too restrictive in their definition of insanity. In a 5–to-4 ruling, it found that “A prisoner’s awareness of the State’s rationale for an execution is not the same as a rational understanding of it.”

In other words, simply recognizing the facts of the case might not be enough, requiring more for a “rational understanding.” The Supreme Court left the issue somewhat unresolved; it did not specifically require that a “rational understanding” be necessary to find a defendant competent to be executed, but it did say that it would be a mistake not to consider this.

Much like the insanity defense before it, the understanding of “insanity” as regards competency to be executed is evolving.  The insanity defense has had a longer history, dating back to 18th century English law, when the “wild beast” test was the legal standard. A defendant had to be so totally deprived of understanding and memory so as to not know what he was doing, “no more than an infant, a brute, or a wild beast.”

With time, and better understanding of the nature of mental illness, the ethical circle of law was expanded and the insanity defense was made available to people who were not that severely impaired, but still ill enough to qualify for special consideration. For example, people who understand the basic facts (e.g., that they attempted to injure someone), but who are motivated to do so by underlying delusions (e.g., they made the attempt because they thought someone was an agent of the devil).

It is perverse to execute someone whose understanding of the situation is colored by delusional thinking, regardless of whether they can state the basic facts of the situation. Panetti’s case is occurring against the broader backdrop of debates about the death penalty in the United States. Does the death penalty really serve the purpose of deterrence? Is eye-for-an-eye retribution just?

No matter what purpose the death penalty might serve, the execution of someone with delusions about the State’s motivations for killing him is purposeless. If it is true that Panetti is delusional about the Texas’ underlying motivations for putting him to death, he should not be executed.

What’s more, why are there so many mentally ill prisoners on death row in the first place? When a person with severe mental illness murders someone, society should first ask about whether it failed in its responsibility toward the person with the illness. Public opinion seems to recognize this responsibility. In a recent national survey, 58% of people opposed capital punishment for the mentally ill. Only 28% were in favor, with 14% not sure.

If even some tragedies could have been avoided through better psychiatric care, but were not because of stigma, budget cuts, or poor coordination of care, then part of the onus is on society to help those who have difficulty helping themselves. It’s time to ask whether the standards of decency for mentally ill prisoners on death row need to evolve.

Carl Erik Fisher, MD, is a psychiatrist in private practice and a professor in the Division of Law, Ethics, and Psychiatry at Columbia University in New York City. He also studies legal, ethical, and social issues in psychiatry and neuroscience.