Treating those found incompetent for execution: ethical chaos with only one solution

Bull Am Acad Psychiatry Law. 1988;16(4):297-308.


In early 1988 the population on America's death rows climbed above the 2,000 mark for the first time in history. In 1986 the United States Supreme Court firmly stated that the Constitution will have been violated if any of these prisoners is put to death while mentally incompetent for execution. In this article we discuss the case of Gary Alvord, the only inmate to be formally found incompetent for execution in modern times. Interviews with psychiatrists and mental health professionals at the Florida psychiatric hospital where Alvord was treated between 1984 and 1987 reveal much ambivalence and anger about the case. We conclude that, out of respect for the rights of these mental health professionals and the ethical codes of their professions, any prisoner found incompetent for execution should have his or her death sentence commuted to long-term imprisonment before treatment is requested or given.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Beneficence
  • Capital Punishment / legislation & jurisprudence*
  • Commitment of Mentally Ill / legislation & jurisprudence*
  • Ethics, Medical*
  • Expert Testimony / legislation & jurisprudence
  • Florida
  • Forensic Psychiatry*
  • Homicide
  • Humans
  • Insanity Defense*
  • Male
  • Mentally Ill Persons
  • Paternalism