Page:Vernon Madison v. Alabama.pdf/14

12 Next consider a prisoner who suffers from dementia or a similar disorder, rather than psychotic delusions. The dementia, as is typical, has compromised this prisoner’s cognitive functions. But it has not resulted in the kind of delusional beliefs that Alvin Ford and Scott Panetti held. May the prisoner nonetheless receive a stay of execution under Ford and Panetti? Or instead, is a delusional disorder a prerequisite to declaring a mentally ill person incompetent to be executed? We did not address that issue when we last considered this case, on habeas review; in that sense, the question is one of first impression. See supra, at 6, n. 1.

But here too, Panetti has already answered the question. Its standard focuses on whether a mental disorder has had a particular effect: an inability to rationally understand why the State is seeking execution. See supra, at 2–3. Conversely, that standard has no interest in establishing any precise cause: Psychosis or dementia, delusions or overall cognitive decline are all the same under Panetti, so long as they produce the requisite lack of comprehension. To be sure, Panetti on occasion spoke of “gross delusions” in explaining its holding. 551 U. S., at 960. And similarly, Ford talked about the “insane,” which sometimes refers to persons holding such irrational beliefs. See, e. g., 477 U. S., at 401, 410. But those references are no more than a predictable byproduct of the two cases’ facts. At the same time (and interchangeably), Panetti used more inclusive terms, such as “mental