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In February 2019, the Supreme Court of the United States (SCOTUS) addressed whether dementia and/or dementia-related amnesia of the crime precluded a defendant from being executed ( Madison v. Alabama, 2019). Consistent with their previous holdings in Ford v. Wainwright (1986) and Panetti v. Quarterman (2007), SCOTUS reaffirmed the prohibition on the execution of an individual who lacks a rational understanding of the crime he or she committed and their impending punishment. However, SCOTUS did not make a direct determination in Madison’s case and instead remanded the case to lower courts to decide his fate. Two important rulings were proffered: (a) failing to remember the crime does not preclude an individual from execution, and (b) mental illnesses other than psychotic disorders may render an individual incompetent for execution. This article explores the confluence of factors underpinning Madison’s case and the important consequences of these rulings for mental health professionals working with the growing aging prisoner population. More specifically, this article traces the evolution of the competency for execution (CFE) standard, explores dementia and associated effects within the context of the Madison ruling, and discusses Madison v. Alabama and its implications for CFE and forensic evaluators.

Vernon Madison is a 68-year-old man who has been on Alabama’s death row for over three decades. In 1985, he was convicted of murdering a Mobile County Police Officer. While his case was retried on two occasions because of prosecutorial misconduct, his conviction and death sentence were twice affirmed (Madison v. State, 1997).  ^{[  1  ]}  In May, 2015, Madison suffered a severe stroke that rendered him legally blind with significantly impaired memory and motor function. Court filings noted Madison repeatedly asked prison staff to inform his mother (who was several years deceased) about his stroke. Less than 1 year later, in January 2016, Mr. Madison suffered a second stroke. Jail staff discovered...