PubMed2002
Many medical organizations have passed resolutions banning participation of psychiatrists in legal executions, such as the Madrid Declaration of World Psychiatric Association. The Criminal Procedure Act of Japan prohibits the execution of the insane. Although the USA and Japan are both among the few so-called developed countries that have a system of capital punishment, many disputes about psychiatrists' participation in death penalty cases have occurred in the US, but few in Japan. This author has reviewed papers addressing this issue. The U.S. Supreme Court decided in Ford v. Wainwright that the execution of an "insane" inmate was not constitutional. The rationale for excluding the mentally incompetent from execution, however, is not completely clear. The most compelling reason is that execution does not satisfy the requirement for "effective retribution," since the insane criminal is not capable of understanding the implications of the death penalty. Nonetheless, there are those who dispute this interpretation and offer other explanations. Psychiatrists may be called upon to assess a criminal's competency for execution. Some find no problem with this practice, while others object to it stating that it conflicts with the ethical tenet to "first do no harm." Those who argue from a middle position insist on assessing competency while recognizing the existence of problems in making such an assessment. Furthermore, there is controversy over which factors exactly constitutes "competency to be executed." Usually, it is thought to be one's capacity to understand the nature of the death penalty and the reasons why the penalty is to be inflicted, but other arguments exist, including the capacity to assist legal counsel in last minute appeals. The question of whether to offer treatment to death row inmates who have been found incompetent to be executed is also under debate. The first position argues that they should "never be treated", because such prisoners would be executed when treatment restores competency. The second, always-treat-position, asserts that psychiatrists are responsible for treating severe mental illness whenever possible. The third, intermediate position, insists upon treatment with several conditions, which entail, for example, respecting the prisoner's autonomy and/or selecting forms of treatment that are unlikely to restore competency. When treatment is given, assessment as to whether competency has been restored is then required. This is still a troublesome issue. The decision in Perry v. Louisiana dealt with the question of whether the state may forcibly treat prisoners incompetent for execution. There were reports about ambivalence and anger among the staff of a psychiatric hospital where an inmate found incompetent for execution was treated. More than a few disputes insist that the ethical dilemma can only be resolved by commuting the sentences of incompetent death row prisoners to life imprisonment. This author further asserts that the secretiveness with which the Ministry of Justice of Japan handles these types of cases should be abolished as soon as possible.