RT Journal Article SR Electronic T1 Evaluating Competency for Execution after Madison v. Alabama JF Journal of the American Academy of Psychiatry and the Law Online JO J Am Acad Psychiatry Law FD American Academy of Psychiatry and the Law SP 530 OP 535 DO 10.29158/JAAPL.200003-20 VO 48 IS 4 A1 Alexander H. Updegrove A1 Michael S. Vaughn YR 2020 UL http://jaapl.org/content/48/4/530.abstract AB This article summarizes the evolution of the U.S. Supreme Court's standard for assessing defendants' competency for execution. In Ford v. Wainwright (1986), the Court categorically exempted insane defendants from execution but failed to agree on how to define insanity. In Panetti v. Quarterman (2007), the Court ruled that defendants may be executed only if they rationally understand why they are being punished. In its most recent decision, the Supreme Court ruled in Madison v. Alabama (2019) that defendants who cannot remember committing the original crime may be executed, but dementia may prevent defendants from rationally understanding why they are being punished. The Court remanded the case to Alabama's trial court with instructions to re-determine Mr. Madison's competency. This article concludes by recommending best practices for those who evaluate defendants for competency to be executed.