Death row syndrome and demoralization: psychiatric means to social policy ends.

Choosing death, whether as a terminally ill patient refusing further treatment or as a death row inmate refusing further appeals of a death sentence, invariably raises questions of mental state. In answering them, we strive to assess diagnoses objectively and employ competency criteria that balance preservation of autonomous decision-making with more paternalistic goals. Two recent developments suggest the risk that novel psychiatric diagnoses may be employed to support findings of incompetence, diminishing the freedom to relinquish medical and legal interventions at these critical junctures, thereby achieving social policy goals that might otherwise be stymied. In the first case, Michael Ross, a sexually sadistic serial killer and rapist on Connecticut’s death row for many years, decided to forgo further appeals and proceed to execution. Through numerous interviews and legal proceedings, Ross stated his position that, while he would accept a sentence of life in prison without parole, he did not wish to put the families of his victims through the further torment of additional hearings on appeals or another penalty phase. He had been represented by an attorney of his own choosing who agreed to support him in his quest to achieve his own execution. He was examined for four hours by Dr. Michael Norko, an experienced forensic psychiatrist, who had examined him in the past. Dr. Norko found no active major psychiatric illness (other than sexual sadism) and suggested that Mr. Ross was competent to decide to forgo appeals. Mr. Ross was found competent by the Connecticut Supreme Court and a date was set for execution. Mr. Ross’s former public defenders intervened with a series of challenges that reached the U.S. Supreme Court, to no avail. But with only 75 minutes remaining until Ross was to be executed, his attorney, T. R. Paulding, after months of representation of Mr. Ross’s wishes based on his belief that Ross was competent, called the execution to a halt, citing his own conflict of interest in representing Mr. Ross’s desire to proceed with execution. Mr. Paulding’s turn-around followed a telephone conversation with Chief U.S. District Judge Robert N. Chatigny, in which the judge berated him (and threatened his law license) for his failure to meet his obligation adequately to ensure Mr. Ross’s competence. In court the following Monday, Mr. Paulding moved for a stay of execution, citing evidence of “death row syndrome” and concerns brought to his attention over the weekend about two letters that Mr. Ross had written. In one, written six years earlier, Mr. Ross stated that, while he cared for the welfare of his victims’ families, he was driven primarily by a desire to end his own life. In the second, written in 2003, he noted, “I honestly don’t think that I can do much more of this,” and explained that he could understand why some death row inmates volunteer for execution. In addition, Dr. Norko provided an affidavit stating that he would have questioned Mr. Ross about this new evidence had it been available to him, and that it was possible that Mr. Ross’s answers to those questions would have influenced his assessment. Dr. Schwartz is Psychiatrist-in-Chief and Vice-President, Behavioral Health, Institute of Living/Hartford Hospital, Hartford, CT, and Professor of Psychiatry, University of Connecticut School of Medicine, Farmington, CT. Address correspondence to: Harold I. Schwartz, MD, Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06106.