It is perhaps one of the ultimate moral questions: Should doctors try to restore the competency of a death-row inmate diagnosed as mentally ill so he can be executed?
That's the dilemma facing authorities in Arizona in a case that pits lawyers against doctors and is being closely watched across the United States.
Claude Eric Maturana was sentenced to die in 1992 in connection with the murder of a 16-year-old two years earlier. But because he has been diagnosed with "severe mental illness," the state is barred from carrying out the execution under a landmark 1986 Supreme Court ruling.
For now, state doctors are prescribing daily medication to control Mr. Maturana's condition - but nothing more. They say trying to restore his mental competency so he could be put to death would be unethical - and unthinkable.
But Arizona prosecutors claim that anything less is an outrage to the criminal-justice system that gave Maturana what he deserved.
Thus, the case sets up a rare clash over how far states should go in carrying out a punishment that itself has always been the subject of great moral debate.
It is a battle that may ultimately be decided by the courts, providing a new test of the 1986 ruling. As a result, the dispute could affect doctors, lawyers, and death-row inmates nationwide.
"The commutation of death sentences is very rare; the release of the mentally ill from prison to be placed in a mental hospital is even rarer," says Hugo Bedau, a death-penalty expert at Tufts University in Medford, Mass.
Because a considerable percentage of death-row inmates have a claim of some mental illness, he says, "we're witnessing a surfacing of these issues."
THE idea of executing the mentally ill has always been controversial. In fact, on Tuesday, the Texas Court of Criminal Appeals stayed an execution, ordering a judge to decide whether a condemned man is competent to face execution.
But the Arizona case is further along in that process. A judge already found Maturana incompetent after two psychiatrists reviewed his mental state. By law, the condemned have to understand their conviction and punishment.
So for now, Jerry Dennis, the Arizona State Hospital's chief medical officer, will continue to make court-mandated visits every few weeks to observe and evaluate any changes to his patient's condition.
His diagnosis has never altered. He believes Maturana suffers from "severe mental illness." Dr. Dennis could treat his patient more aggressively, giving him two or three times his current dosage or switch to more effective medication. But this is a patient whose mental health could cost him his life.
"I'm frustrated because I'm trying to do what's right and what's ethical," he says. "The question here is, 'How can I restore him to competency so he can be killed?' I just can't do that. I just won't do that. I'd resign first."
Dennis is not alone. Hospital administrators have tried to find a replacement to treat Maturana. There have been no takers. Medical professionals say anyone who takes the job could be stripped of their medical license. In this arena, there are no gray areas.
"It would be a breach of our ethics," says Lisa Jones, Arizona Psychiatric Society president.
"There are high penalties for us as providers for ethical violations, as there should be."
Dr. Jones, who has served in Dennis's position, says it is important for physicians to draw the line firmly in cases such as this. "What the state is doing is asking us to violate one of our core values. It strikes at the heart of why we're all in health care."
The American Medical Association has spoken clearly on the issue. Its policy states, "If treatment is primarily directed to restore competency to be executed, it is ethically unacceptable."
Herbert Rakatansky, chairman of the AMA Council on Ethical and Judicial Affairs, says his group has a growing concern about courts treading where only doctors should go.
That concern was the driving force behind strict new guidelines, which include making sure doctors are involved in the diagnosis and treatment of a criminal. Executions are not included.
But Arizona contends that doctors at the state hospital must, under law, make every attempt to restore Maturana to mental competency.
Paul McMurdie, head of the criminal-appeals section for the state attorney general, says he plans to prove in court next month that Maturana is faking his so-called mental illness.
"It's the excuse of the month," he says. "All of a sudden everyone on death row is incompetent to be executed. We're trying to make sure the law is carried out. We're not going to stick our heads in the sand simply because a doctor believes he has an ethical concern."
Prosecutors maintain that Maturana deserves to die for the July murder of Glenn Estes, whose bullet-ridden body was found outside of Tucson, Ariz.
But Carla Ryan, Maturana's Tucson attorney, says she believes executing him for the crime would serve no purpose. She wants his sentence commuted to life in custody without parole.
"It was a terrible crime, but how can you execute this man when he's not even going to understand what's happening?" she says. "What good does that do?"
(c) Copyright 1999. The Christian Science Publishing Society