586 U.S. ___ (2019)
ALABAMA VERNON MADISON, PETITIONER
October 2, 2018
WRIT OF CERTIORARI TO THE CIRCUIT COURT OF ALABAMA, MOBILE
In Ford v. Wainwright, 477 U.S. 399, this Court
held that the Eighth Amendment's ban on cruel and
unusual punishments precludes executing a prisoner who has
"lost his sanity" after sentencing. Id.,
at 406. And in Panetti v. Quarterman, 551 U.S.
930, the Court set out the appropriate competency standard:
A State may not execute a prisoner whose "mental state
is so distorted by a mental illness" that he lacks a
"rational understanding" of "the State's
rationale for [his] execution." Id., at
Petitioner Vernon Madison was found guilty of capital
murder and sentenced to death. While awaiting execution, he
suffered a series of strokes and was diagnosed with
vascular dementia. In 2016, Madison petitioned the state
trial court for a stay of execution on the ground that he
was mentally incompetent, stressing that he could not
recollect committing the crime for which he had been
sentenced to die. Alabama responded that Madison had a
rational understanding of the reasons for his execution,
even assuming he had no memory of committing his crime. And
more broadly, the State claimed that Madison failed to
implicate Ford and Panetti because both
decisions concerned themselves with gross delusions, which
Madison did not have. Following a competency hearing, the
trial court found Madison competent to be executed. On
federal habeas review, this Court summarily reversed the
Eleventh Circuit's grant of relief, holding that, under
the "demanding" and "deferential
standard" of the Anti-terrorism and Effective Death
Penalty Act of 1996 (AEDPA), "[n]either
Panetti nor Ford 'clearly established
that a prisoner is incompetent to be executed" because
of a simple failure to remember his crime. Dunn v.
Madison, 583 U.S.___, ___. But the Court "ex-
press[ed] no view" on the question of Madison's
competency outside of the AEDPA context. Id., at
___. When Alabama set a 2018 execution date, Madison
returned to state court, arguing once more that his mental
condition precluded the State from going forward. The state
court again found Madison mentally competent.
1. Under Ford and Panetti, the Eighth
Amendment may permit executing a prisoner even if he cannot
remember committing his crime. Panetti asks only
about a person's comprehension of the State's reasons
for resorting to punishment, not his memory of the crime
itself. And the one may exist without the other. Such memory
loss, however, still may factor into the analysis
Panetti demands. If that loss combines and interacts
with other mental shortfalls to deprive a person of the
capacity to comprehend why the State is exacting death as a
punishment, then the Panetti standard will be
satisfied. Pp. 9-11.
2. Under Ford and Panetti, the Eighth
Amendment may prohibit executing a prisoner even though he
suffers from dementia or another disorder rather than
psychotic delusions. The Panetti standard focuses on
whether a mental disorder has had a particular
effect; it has no interest in establishing any
precise cause. Panetti's references to
"gross delusions," 551 U.S., at 960, are no more
than a predictable byproduct of that case's facts.
Ford and Panetti hinge on the
prisoner's "[incomprehension of why he has been
singled out" to die, 477 U.S., 409, and kick in if and
when that failure of understanding is present, irrespective
of whether one disease or another is to blame. In evaluating
competency, a judge must therefore look beyond any given
diagnosis to a downstream consequence. Pp. 12-14.
3. Because this Court is uncertain whether the state
court's decision was tainted by legal error, this case is
remanded to that court for renewed consideration of
Madison's competency. The state court's brief 2018
ruling-which states only that Madison "did not prove a
substantial threshold showing of insanity "-does not
provide any assurance that the court knew a person with
dementia, and not psychotic delusions, might receive a stay
of execution. Nor does that court's initial 2016 opinion.
The sole question on which Madison's competency depends
is whether he can reach a rational understanding of why the
State wants to execute him. In answering that question-on
which this Court again expresses no view-the state court may
not rely on any arguments or evidence tainted with the legal
errors addressed by this Court. Pp. 14-18.
J., delivered the opinion of the Court, in which ROBERTS, C.
J., and GINSBURG, BREYER, and SOTOMAYOR, JJ., joined. ALITO,
J., filed a dissenting opinion, in which THOMAS and GORSUCH,
JJ., joined. KAVANAUGH, J., took no part in the consideration
or decision of the case.
Eighth Amendment, this Court has held, prohibits the
execution of a prisoner whose mental illness prevents him
from "rational [ly] understanding" why the State
seeks to impose that punishment. Panetti v.
Quarterman, 551 U.S. 930, 959 (2007). In this case,
Vernon Madison argued that his memory loss and dementia
entitled him to a stay of execution, but an Alabama court
denied the relief. We now address two questions relating to
the Eighth Amendment's bar, disputed below but not in
this Court. First, does the Eighth Amendment forbid execution
whenever a prisoner shows that a mental disorder has left him
without any memory of committing his crime? We (and, now, the
parties) think not, because a person lacking such a memory
may still be able to form a rational understanding of the
reasons for his death sentence. Second, does the Eighth
Amendment apply similarly to a prisoner suffering from
dementia as to one experiencing psychotic delusions? We (and,
now, the parties) think so, because either condition may-or,
then again, may not-impede the requisite comprehension of his
punishment. The only issue left, on which the parties still
disagree, is what those rulings mean for Madison's own
execution. We direct that issue to the state court for
further consideration in light of this opinion.
Court decided in Ford v. Wainwright, 477 U.S. 399
(1986), that the Eighth Amendment's ban on cruel and
unusual punishments precludes executing a prisoner who has
"lost his sanity" after sentencing. Id.,
at 406. While on death row, Alvin Ford was beset by
"pervasive delusion[s]" associated with
"[p]aranoid [s]chizophrenia." Id., at
402-403. Surveying both the common law and state statutes,
the Court found a uniform practice against taking the life of
such a prisoner. See id., at 406-409. Among the
reasons for that time-honored bar, the Court explained, was a
moral "intuition" that "killing one who has no
capacity" to understand his crime or punishment
"simply offends humanity." Id., at 407,
409; see id., at 409 (citing the "natural
abhorrence civilized societies feel" at performing such
an act). Another rationale rested on the lack of
"retributive value" in executing a person who has
no comprehension of the meaning of the community's
judgment. Ibid.; see id., at 421 (Powell,
J., concurring in part and concurring in judgment) (stating
that the death penalty's "retributive force 
depends on the defendant's awareness of the penalty's
existence and purpose"). The resulting rule, now stated
as a matter of constitutional law, held "a category of
defendants defined by their mental state" incompetent to
be executed. Id., at 419.
Court clarified the scope of that category in Panetti v.
Quarterman by focusing on whether a prisoner can
"reach a rational understanding of the reason for [his]
execution." 551 U.S., at 958. Like Alvin Ford, Scott
Panetti suffered from "gross delusions" stemming
from "extreme psychosis." Id., at 936,
960. In reversing a ruling that he could still be executed,
the Panetti Court set out the appropriate
"standard for competency." Id., at 957.
Ford, the Court now noted, had not provided
"specific criteria." 551 U.S., at 957. But
Ford had explored what lay behind the Eighth
Amendment's prohibition, highlighting that the execution
of a prisoner who cannot comprehend the reasons for his
punishment offends moral values and "serves no
retributive purpose." 551 U.S., at 958. Those
principles, the Panetti Court explained, indicate
how to identify prisoners whom the State may not execute. The
critical question is whether a "prisoner's mental
state is so distorted by a mental illness" that he lacks
a "rational understanding" of "the State's
rationale for [his] execution." Id., at
958-959. Or similarly put, the issue is whether a
"prisoner's concept of reality" is "so
impair[ed]" that he cannot grasp the execution's
"meaning and purpose" or the "link between
[his] crime and its punishment." Id., at 958,
Madison killed a police officer in 1985 during a domestic
dispute. An Alabama jury found him guilty of capital murder,
and the trial court sentenced him to death. He has spent most
of the ensuing decades on the State's death row.
recent years, Madison's mental condition has sharply
deteriorated. Madison suffered a series of strokes, including
major ones in 2015 and 2016. See Tr. 19, 46-47 (Apr. 14,
2016). He was diagnosed as having vascular dementia, with
attendant disorientation and confusion, cognitive impairment,
and memory loss. See id., at 19-20, 52-54. In
particular, Madison claims that he can no longer recollect
committing the crime for which he has been sentenced to die.
See Tr., Pet. Exh. 2, p. 8.
his 2016 stroke, Madison petitioned the trial court for a
stay of execution on the ground that he had become mentally
incompetent. Citing Ford and Panetti, he
argued that "he no longer understands" the
"status of his case" or the "nature of his
conviction and sentence." Pet. for Suspension in No.
CC-85-1385.80 (C. C. Mobile Cty., Ala., Feb. 12, 2016), pp.
11, 14. And in a later filing, Madison emphasized that he
could not "independently recall the facts of the offense
he is convicted of." Brief Pursuant to Order (Apr. 21,
2016), p. 8. Alabama countered that Madison had "a
rational understanding of [the reasons for] his impending
execution," as required by Ford and
Panetti, even assuming he had no memory of
committing his crime. Brief on Madison's Competency
(April 21, 2016), pp. 4-5, 8. And more broadly, the State
claimed that Madison could not possibly qualify as
incompetent under those two decisions because both
"concerned themselves with '[g]ross
delusions'"-which all agree Madison does not have.
Id., at 2; see ibid. (Madison "failed
to implicate" Ford and Panetti because
he "does not suffer from psychosis or delusions").
reports from two psychologists largely aligned with the
parties' contending positions. Dr. John Goff,
Madison's expert, found that although Madison
"understood] the nature of execution" in the
abstract, he did not comprehend the "reasoning
behind" Alabama's effort to execute him.
Tr., Pet. Exh. 2 (Apr. 14, 2016), p. 8; see id., at
9. Goff stated that Madison had "Major Vascular
Neurological Disorder"-also called vascular dementia-
which had caused "significant cognitive decline."
Ibid. And Goff underscored that Madison
"demonstrate[d] retrograde amnesia" about his
crime, meaning that he had no "independent recollection[
]" of the murder. Id., at 8; see id.,
at 9. For his part, Dr. Karl Kirkland, the court-appointed
expert, reported that Madison "was able to discuss his
case" accurately and "appear[ed] to understand his
legal situation." Tr., Ct. Exh. 1, pp. 10-11. Although
Kirkland acknowledged that Madison's strokes had led to
cognitive decline, see id., at 10, the psychologist
made no mention of Madison's diagnosed vascular dementia.
Rather, Kirkland highlighted that "[t]here was no
evidence of psychosis, paranoia, or delusion."
Id., at 9; see ibid. (Madison "did not
seem delusional at all").
competency hearing, Alabama similarly stressed Madison's
absence of psychotic episodes or delusions. The State asked
both experts to affirm that Madison was "neither
delusional [n]or psychotic." Tr. 56; see id.,
at 22. And its closing argument focused on their agreement
that he was not. As the State summarized: "He's not
psychotic. He's not delusional." Id., at
81. On the State's view, that fact answered the
competency question because "[t]he Supreme Court is
looking at whether someone's delusions or someone's
paranoia or someone's psychosis is standing in the way
of" rationally understanding his punishment.
Id., at 82. Madison's counsel disputed that
point. "[T]he State would like to say, well, he's
not delusional, he's not psychotic," the attorney
recapped. Id., at 83. But, she continued,
"[t]hat's not really the criteria" under
Panetti. Tr. 83. Rather, the Court there barred
executing a person with any mental
illness-"dementia" and "brain injuries"
no less than psychosis and delusions-that prevents him from
comprehending "why he is being executed."
trial court found Madison competent to be executed. Its order
first recounted the evidence given by each expert witness.
The summary of Kirkland's report and testimony began by
stating that the psychologist had "found no evidence of
paranoia[, ] delusion [or] psychosis." Order (Apr. 29,
2016), p. 5 (2016 Order). The court then noted Kirkland's
view that Madison could "give details of the history of
his case" and "appear[ed] to understand his legal
situation." Ibid. Turning to the Goff report,
the court noted the expert's finding that Madison was
"amnesic" and could not recollect his crime.
Id., at 6; see id., at 7. In a single,
final paragraph, the court provided both its ruling and its
reasoning. Madison had failed to show, the court wrote, that
he did not "rationally understand the punishment he is
about to suffer and why he is about to suffer it."
Id., at 10. The court "accept[ed] the testimony
of Dr. Kirkland as to the understanding Madison has
concerning the situation." Ibid.
"Further," the court concluded, "the evidence
does not support that Mr. Madison is delusional."
next sought habeas relief in federal court, where he faced
the heavy burden of showing that the state-court ruling
"involved an unreasonable application of clearly
established federal law" or rested on an
"unreasonable determination of the facts."
Antiterrorism and Effective Death Penalty Act of 1996
(AEDPA), 28 U.S.C. §2254(d). The District Court rejected
his petition, but the Court of Appeals for the Eleventh
Circuit ruled that Madison had demonstrated both kinds of
indisputable error. See Madison v. Commissioner, 851
F.3d 1173 (2017). This Court then summarily reversed the
appeals court's decision. See Dunn v. Madison,
583 U.S. ___ (2017) (per curiam). We
explained, contrary to the Eleventh Circuit's principal
holding, that "[n]either Panetti nor
Ford 'clearly established' that a prisoner
is incompetent to be executed" because of a simple
failure to remember his crime. Id., at ___ (slip
op., at 4). And we found that the state court did not act
unreasonably-otherwise put, did not err "beyond any
possibility for fairminded disagreement"-when it found
that Madison had the necessary understanding to be executed.
Ibid, (internal quotation marks omitted). But we
made clear that our decision was premised on AEDPA's
"demanding" and "deferential standard."
Id., at ___, ___ (slip op., at 3, 4). "We
express[ed] no view" on the question of Madison's
competency "outside of the AEDPA context."
Id., at ___ (slip op., at 4).
Alabama set an execution date in 2018, Madison returned to
state court to argue again that his mental condition
precluded the State from going forward. In his petition,
Madison reiterated the facts and arguments he had previously
presented to the state court. But Madison also claimed that
since that court's decision (1) he had suffered further
cognitive decline and (2) a state board had suspended
Kirkland's license to practice psychology, thus
discrediting his prior testimony. See Pet. to Suspend
Execution in No. CC-85-1385.80 (C. C. Mobile Cty., Ala., Dec.
18, 2017), pp. 1-2, 16-19. Alabama responded that nothing material
had changed since the court's first competency hearing.
See Motion to Dismiss (Dec. 20, 2017), p. 9. The State also
repeated its argument that Panetti permits executing
Madison, pointing to the experts' agreement that he is
"not delusional or psychotic" and asserting that
neither "memory impairment [n]or dementia [could]
suffice to satisfy the Panetti and Ford
standards" without "an expansion" of those
decisions. Motion to Dismiss 4, 10. A week before the
scheduled execution, the state court again found Madison
mentally competent. Its brief order stated only that Madison
"did not provide a substantial threshold showing of
insanity[ ] sufficient to convince this Court to stay the
execution." App. A to Pet. for Cert.
then filed in this Court a request to stay his execution and
a petition for certiorari. We ordered the stay on the
scheduled execution date and granted the petition a few weeks
later. See 583 U.S.___, ___ (2018). Because the case now
comes to us on direct review of the state court's
decision (rather than in a habeas proceeding), AEDPAs
deferential standard no longer governs. (And for that
reason-contrary to the dissent's suggestion,
post, at 12-our decision on Madison's habeas
petition cannot help resolve the questions raised here.)
issues relating to Panetti's application are
before us. Recall that our decision there held the Eighth
Amendment to forbid executing a prisoner whose mental illness
makes him unable to "reach a rational understanding of
the reason for [his] execution." 551 U.S., at 958; see
supra, at 2-3. The first question presented is
whether Panetti prohibits executing Madison merely
because he cannot remember committing his crime. The second
question raised is whether Panetti permits executing
Madison merely because he suffers from dementia, rather than
psychotic delusions. In prior stages of this case, as we have
described, the parties disagreed about those matters. See
supra, at 4-8. But at this Court, Madison accepted
Alabama's position on the first issue and Alabama
accepted Madison's on the second. See, e.g., Tr.
of Oral Arg. 11, 36. And rightly so. As the parties now
recognize, the standard set out in Panetti supplies
the answers to both questions. First, a person lacking memory
of his crime may yet rationally understand why the State
seeks to execute him; if so, the Eighth Amendment poses no
bar to his execution. Second, a person suffering from
dementia may be unable to rationally understand the reasons
for his sentence; if so, the Eighth Amendment does not allow
his execution. What matters is whether a person has the
"rational understanding" Panetti
requires-not whether he has any particular memory or any
particular mental illness.
initially a person who cannot remember his crime because of a
mental disorder, but who otherwise has full cognitive
function. The memory loss is genuine: Let us say the person
has some kind of amnesia, which has produced a black hole
where that recollection should be. But the person remains
oriented in time and place; he can make logical connections
and order his thoughts; and he comprehends familiar concepts
of crime and punishment. Can the State execute him for a
murder? When we considered this case before, using the
deferential standard applicable in habeas, we held that a
state court could allow such an execution without committing
inarguable error. See Madison, 583 U.S., at ___(slip
op., at 4) (stating that no prior decision had "clearly
established" the opposite); supra, at 6. Today,
we address the issue straight-up, sans any deference to a
state court. Again, is the failure to remember committing a
crime alone enough to prevent a State from executing a
not, under Panetti's own terms. That decision
asks about understanding, not memory-more specifically, about
a person's understanding of why the State seeks capital
punishment for a crime, not his memory of the crime itself.
And the one may exist without the other. Do you have an
independent recollection of the Civil War? Obviously not. But
you may still be able to reach a rational-indeed, a
sophisticated-understanding of that conflict and its
consequences. Do you recall your first day of school?
Probably not. But if your mother told you years later that
you were sent home for hitting a classmate, you would have no
trouble grasping the story. And similarly, if you somehow
blacked out a crime you committed, but later learned what you
had done, you could well appreciate the State's desire to
impose a penalty. Assuming, that is, no ...