prosecution to evaluate the intellectual competence of John Stone, a 50-year-old
man convicted of first-degree murder of a guard during a bank robbery. John had
claimed he was innocent throughout the trial. In the state in which the trial was
conducted, individuals convicted of such an offense face the death penalty. John’s
attorney challenged the death penalty option for his client, claiming that the defendant
is intellectually disabled. The U.S. Supreme Court ruled in Atkins v. Virginia
(2002) that the execution of those with intellectual disability (formerly known as
mental retardation) is unconstitutional. Dr. Romaro had worked with the prosecution
before on intellectual disability cases, but this is the first time he had been
retained for a capital punishment case. He is personally ambivalent about whether
states should implement the death penalty.
The psychologist meets John in a private room in the prison and administers a
battery of intellectual and adaptive behavior tests with proven psychometric validity
for determining forensically relevant intellectual ability. Just as he ends the formal
test administration, John becomes distraught and appears to be experiencing
an anxiety attack. In his distress the psychologist hears the prisoner repeatedly
asking God for forgiveness for killing the guard and for murdering another person,
who he keeps calling “the boy waiting for the bus.” The psychologist shifts into an
emergency crisis intervention mode to help calm the defendant and rings for assistance.
Dr. Romaro was shocked to hear John “confess” not only to the bank murder
but also to the murder of a “boy waiting for a bus.”
The Diagnostic and Statistical Manual of Mental Disorders, fourth edition
(DSM-IV-TR) diagnosis of intellectual disability (currently termed “mental retardation
developmental disability”) requires that individuals demonstrate significantly
sub-average intellectual functioning, impairments in adaptive functioning,
and onset before 18 years of age. Similarly, the state standard for intellectual disability
includes a developmental history of intellectual impairment. Prior to testing,
Dr. Romaro had asked the prosecutor for all available childhood mental health or
school records to determine if John meets these criteria. No formal educational
or psychological evaluations were included in the materials he received. The
records indicated that John had a poor academic record, was retained in fifth
grade, was suspended several times for coming to school drunk, and had left
school when he was 15. State criteria also include an IQ score less than 70 and
poor adaptive skills.
That evening Dr. Romaro scores the test battery. John’s IQ score is 71, his performance
on other cognitive tests fell close to the intellectual disability cutoff score
(some above, some below). His adaptive functioning score is a standard deviation
below average. However, given the prisoner’s age, without a more detailed set of
childhood records, it is difficult to clearly conclude that he meets the DSM-IV-TR
or state legal criteria for intellectual disability. Dr. Romaro had not been asked to
administer assessments for mood, schizophrenia, or other psychotic disorders that
might impair intellectual and adaptive performance.
Dr. Romaro is not sure what forensic opinion to give regarding whether or not
John meets the legal criteria for intellectual disability. Without evidence of intellectual
disability in his youth, a diagnosis of intellectual disability may not be possible
and, thus, could not be used to support John’s death penalty appeal. He is also
unsure whether he has an ethical responsibility to include in his report John’s
“confession” or John’s statement about the “boy waiting for a bus.”
Case Study One Worksheet
Respond to the following questions in 1,250 to 1,500 words.
1. Why is this an ethical dilemma? Which APA Ethical Principles help frame the nature of the dilemma?
2. How might Dr. Romaro’s ambivalence toward the death penalty influence his decision to offer a forensic diagnosis of intellectual disability? How might John’s “confession” or his comment about the “boy waiting for the bus” influence the decision? To what extent should these factors play a role in Dr. Romaro’s report?
3. How are APA Ethical Standards 2.0f, 3.06, 4.04, 4.05, 5.01, 9.01a and 9.06 relevant to this case? Which other standards might apply?
4. What steps should Dr. Romaro take to ethically implement his decision and monitor its effect?
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