Dementia Patients Can Stand Trial — Maybe

December 12, 2008

A Washington state court decided yesterday that a 91 year-old man with dementia and demonstrated delusions was competent to stand trial for second-degree murder.  The accused, Joe Conway, allegedly shot and killed a staff member at the nursing home where he lived when the victim brought food into Mr. Conway’s room.  After a two-day evidentiary trial, the court found Mr. Conway competent, and put his case on the criminal docket.  

As awful and shocking as this news sounds, it is really not all that surprising given the tortured logic the “insanity defense” has gone through in the last forty years of Supreme Court jurisprudence.  All crimes, in order to be crimes, require an action and a mindset.  If one commits the prohibited action (taking a the purse off a woman on the street) with the prohibited state of mind (with knowledge that it is not one’s own and to deprive the rightful owner enjoyment of the purse) then a crime has be committed.  If one commits the action (snatches the purse) without the mindset (but mistakenly believes it was one’s own to start with) no crime has been committed.  This the foundation of the insanity defense.  Essentially, it says that a person is incapable of forming the prohibited mindset, thus their actions are not criminal.  

Sounds simple, and if Mr. Conway has a dementia diagnosis, it would seem impossible for him to form the requisit intent for second-degree murder.  However, intent can only ever be inferred, and the several states and the Supreme Court have devised many different tests for inferring such intent: 1) the M’Naghten test: the defense will hold if at the time of the misconduct, the defendant (accused) lacked the ability to know the wrongfulness of his actions or understand the nature and quality of his actions (i.e. “does not know right from wrong”); 2) the Irresistible Impulse test: the defense will hold if the defendant was unable to control his actions or conform his conduct to the law (i.e. lacked self control and free will; suffered an impulse he could not resist); 3) the Durham test: the defense will hold if the defendant’s conduct was a product of mental illness (i.e. but for the mental illness, the defendant would not have done the act); 4) the Model Penal Code test: the defense only holds if the defendant lacked the substantial capacity to appreciate the criminality of his conduct, or conform his conduct to the requirements of the law (i.e. a combination of the M’Naghten and Irresistible Impulse tests).  Different states use different tests, but as is fairly clear even on first reading, there is a lot of wiggle room in the language of all of the tests. 

So, how does a 91 year-old dementia patient not fail these tests and be found competent?  Unfortunately, the theoretical underpinning for the defense does not really support the court’s finding.  But the tests likely do.  If Mr. Conway had in his mind to kill a person, even if he was delusional as to who the person was or why he was killing him, then, all things being equal, the M’Naghten would not save him.  Dementia standing alone would likely not hold the defense under any of the other three.  Dementia, generally, does not create an impulse to kill, nor is it a mental illness which channels someone towards murder.  I suspect, though, the Supreme Court will revisist these tests in the next few years – – and it will probably be a case like Mr. Conway’s that presents the issue.  Age related dementia is unique enough from other mental illnesses that the Court may carve out some special consideration in the “insanity defense.”  With the next crest of seniors reaching old-old age, the issues may come to a head fairly soon.

*On a totally unrelated note, the insanity defense was first suggested in Anglo-American legal theory by Lord Chief Justice Tindal of the Court of Common Pleas – – this guy was an absolute genius, though he is best known for acting as Queen Caroline’s defense attorney (successful) in her adultery suit.  His wikipedia entry can be found here.

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2 Responses to “Dementia Patients Can Stand Trial — Maybe”


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    Frith Law Firm, PC

  2. nursinghomeadministrator Says:

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