Suffering Unto Death – Untreated Psychosis on Death Row
Michael A. Norko MD, MAR, Professor of Psychiatry at Yale University School of Medicine in the Law and Psychiatry Division; Director of Forensic Services for the Connecticut Department of Mental Health and Addiction Services; Editor of the Journal of the American Academy of Psychiatry and the Law
In 1986, the U.S. Supreme Court held that the execution of “the insane” was barred by the 8th Amendment prohibition of cruel and unusual punishment. Since then, death row inmates experiencing profound psychosis have been caught in a snare of legal arguments and the ethics challenges facing the physicians caring for them. The condemned prisoner who refuses antipsychotic medications may be granted a stay of execution, which is usually contested vigorously by the state, because of their inability to rationally understand the reasons for their execution. The state may choose not to press for a warrant of execution for a death row inmate who is chronically psychotic, anticipating the burdensome and likely fruitless appeals process. Physicians are ethically prohibited from involuntarily treating psychotic prisoners to restore them to competence to be executed, although interventions to mitigate the level of suffering may be permissible. The physician attempting to discern what actions constitute the latter, without creating the iatrogenic risk of the former, is faced with a considerable dilemma. What most often happens is that the prisoner’s illness goes untreated, with little for healthcare professionals to do but witness to the individual’s suffering and offer whatever kindness or professional or personal ministry is possible without violating role boundaries or altering the legal status quo.
In this presentation I will offer the narrative of my witness to the suffering of one psychotic death row inmate whom I evaluated for forensic purposes and review some of the important appellate level decisions of other such individuals. I will also describe the distressing experiences of a state hospital staff compelled to treat a death row inmate’s psychosis to restore him to competence for execution. I will outline the opinions of the American Medical Association, the National Medical Association, the American Psychiatric Association and the American Academy of Psychiatry and the Law related to this ethics challenge, including the single solution to this ethics dilemma that has been adopted by only one state that authorizes the death penalty. Finally, I will offer some reflections on the spirituality of compassion in the medical profession, and its expression in the accompaniment of psychotic suffering among condemned prisoners.
In this presentation I will offer the narrative of my witness to the suffering of one psychotic death row inmate whom I evaluated for forensic purposes and review some of the important appellate level decisions of other such individuals. I will also describe the distressing experiences of a state hospital staff compelled to treat a death row inmate’s psychosis to restore him to competence for execution. I will outline the opinions of the American Medical Association, the National Medical Association, the American Psychiatric Association and the American Academy of Psychiatry and the Law related to this ethics challenge, including the single solution to this ethics dilemma that has been adopted by only one state that authorizes the death penalty. Finally, I will offer some reflections on the spirituality of compassion in the medical profession, and its expression in the accompaniment of psychotic suffering among condemned prisoners.