As Americans become increasingly aware of the role of combat trauma in the development of Post-Traumatic Stress Disorder (PTSD) and other mental health disorders, the shift in public perceptions towards veterans suffering from these disorders has played out in the courts in recent death penalty cases. In 2018, at least four military veterans facing death sentences have instead been sentenced to life in prison, and another two veterans won relief in their death-penalty cases. One military veteran has been executed so far this year.

In January, retired Marine Corps Lieutenant General John Castellaw (pictured) wrote in support of exempting mentally ill veterans from capital punishment, saying, "we can do better at recognizing the invisible wounds that some of our veterans still carry while ensuring they get the treatment that they deserve and that we owe them for their sacrifice. ...[W]e can do better by staying tough on crime but becoming smarter on sentencing those whose actions are impacted by severe mental illness." Prosecutors and juries in Indiana, Florida, Colorado, and Virginia have considered the military service and service-related disorders of murder defendants and determined that life sentences were more appropriate than the death penalty. In the Virginia trial of Iraq war veteran Ronald Hamilton, his attorneys presented evidence that he had been a model soldier who had saved the life of a fellow serviceman, but faced PTSD-related disorders and a deteriorating family life when he returned home. At Glen Law Galloway's trial in Colorado, Denver public defender Daniel King presented four days of testimony about Galloway’s character and background, including how the former Army veteran “snapped” following the collapse of his relationship with his girlfriend. King argued, “Mr. Galloway is not just the worst thing that he’s done. He’s committed many acts of kindness, friendship, service, love and duty.” In May, prosecutors withdrew the death penalty in exchange for guilty pleas in two unrelated cases involving military veterans Darren Vann in Indiana and Esteban Santiago in Florida. Santiago faced federal charges for a mass shooting, but prosecutors agreed to a plea deal because Santiago, an Iraq war veteran, suffers from schizophrenia and auditory hallucinations, had unsuccessfully sought treatment and assistance from the Veterans Administration, and had been committed to a mental hospital because of the seriousness of his mental illness.

Two death-sentenced prisoners were granted relief this year as a result of failures by their defense counsel to investigate and present mitigating evidence related to their military service and their service-related mental health disorders. Andrew Witt, an air force veteran who had been on U.S. military death row, received a life sentence after a court found his attorneys ineffective for failing to present mitigating evidence that he had suffered a traumatic brain injury. Robert Fisher's death sentence was reversed by a Pennsylvania federal court in part because his lawyer did not investigate or present evidence related to his service in Vietnam. Fisher was a Purple Heart recipient who struggled with brain damage, drug abuse, and mental health problems after his service.

On July 18, Ohio executed Robert Van Hook, an honorably discharged veteran who was suffering from long-term effects of physical and sexual abuse as a child and untreated mental health issues at the time of the offense. Van Hook had been unable to obtain care for his mental health and addiction issues from veterans service agencies after his discharge.

A 2015 report by the Death Penalty Information Center, Battle Scars: Military Veterans and the Death Penalty, estimated that approximately 300 veterans are on death row across the United States, many suffering from mental illness caused or exacerbated by their military service.

The U.S. Supreme Court heard oral argument on November 6, 2018 in Bucklew v. Precythe on whether the use of lethal injection to execute a Missouri prisoner with a rare medical condition would cause him unnecessary and excruciating pain and suffering and whether he was constitutionally required to provide the state with a different way for it to kill him. Media reports suggested that the Court was sharply divided on the issue with newly appointed Justice Brett Kavanaugh likely to provide the deciding vote. 

Russell Bucklew (pictured) suffers from cavernous hemangioma, a rare disorder that has caused blood-filled tumors to form, primarily in his head, neck, and mouth. Doctors have said that an execution by lethal injection could cause those tumors to rupture, causing him excruciating pain as he dies from suffocation and drowning in his own blood. Justice Kavanaugh, in his first question in his first death-penalty case since joining the Court, asked Missouri Solicitor General D. John Sauer, "Are you saying even if the method creates gruesome and brutal pain you can still do it because there’s no alternative?" When Kavanaugh pressed Sauer for a direct answer, Missouri's solicitor said yes, so long as the state did not "attempt to deliberately inflict pain for the sake of pain." 

Bucklew challenged the requirement, announced in the Court's 2015 lethal-injection decision in Glossip v. Gross, that prisoners who are challenging the cruelty of a state's execution method must offer an alternative method of execution that is reasonably available to the state. Nonetheless, to comply with the requirement, Bucklew proposed asphyxiation by nitrogen gas. Chief Justice John Roberts seemed skeptical of that proposal, asking "how can it be a reasonable alternative if it's never been used before? ... Things can go wrong regardless of the method of execution. It seems to me that if you have a method that no state has ever used, that that danger is magnified." Justice Sonia Sotomayor, who has raised serious concerns about lethal injection in past cases, questioned the legitimacy of the Court's requirement that prisoners who challenge execution methods must present an alternative method. “I don’t actually know where in the Eighth Amendment and its history the court made up this alternative remedy idea,” she said, “because the Constitution certainly doesn’t prohibit cruel and unusual punishment unless we can’t kill you at all.”

Missouri has set execution dates for Bucklew twice, but both dates were stayed as a result of legal challenges to the execution method. Public health experts and the Association for Accessible Medicines (AAM)—a professional association representing generic and biosimilar drug manufacturers and distributors—filed amicus briefs in Bucklew's case, calling the planned use of "essential medicines" in executions "medically irresponsible," and warning of public health risks caused by states' efforts to obtain lethal-injection drugs.

With newly discovered confessions and DNA evidence pointing to the prosecution’s chief witness as the actual killer, prosecutors dropped all charges against Clemente Javier Aguirre (pictured, center, at his exoneration) in a Seminole County, Florida courtroom on November 5, 2018. The dismissal of the charges made Aguirre the 164th wrongfully convicted death-row prisoner to be exonerated in the United States since 1973 and the 28th in Florida. The announcement that prosecutors were dropping all charges against Aguirre came after jury selection for his retrial had already begun. The Florida Supreme Court unanimously overturned his conviction in 2016. “Mr. Aguirre was nearly executed for a crime he didn’t commit,” said Joshua Dubin, one of Aguirre's attorneys. “While we are overjoyed that his ordeal is finally over, the case of Clemente Aguirre should serve as a chilling cautionary tale about how dangerous it is when there is a rush to judgment in a capital case.”

Aguirre was convicted and sentenced to death in 2006 for the murder of two neighbors: an elderly woman and her adult daughter. He steadfastly maintained his innocence, saying he had discovered the women only after they had been killed. He did not report the murders to authorities, he said, because he was an undocumented immigrant and feared deportation. Evidence has increasingly pointed to the victims' daughter and granddaughter, Samantha Williams, as the likely perpetrator, and an affidavit filed last week undermined Williams's alibi. DNA testing had revealed Williams's blood in several locations at the crime scene but had found none of Aguirre’s blood. Williams also has reportedly confessed to the crime on at least five occasions. A sworn affidavit from the wife of Mark Van Sandt, Williams’s boyfriend at the time of the crime and her key alibi witness, says that Van Sandt told his wife he saw Williams crawling out of his bedroom window on the night of the murders. Prosecutors said that they dropped charges “based upon new evidence that materially affects the credibility of a critical State witness.”

Aguirre is an undocumented immigrant from Honduras, and his attorneys say they plan to file an asylum application on his behalf. Joshua Dubin said in a statement: “If there were ever a person that deserved a chance to become a United States citizen, it is Clemente Aguirre. He has been fully exonerated, so we are going to be asking the immigration judge to set a bond and allow Clemente to be released while his application for asylum proceeds.” Aguirre is the third foreign national to be exonerated in the last year. Gabriel Solache was exonerated in Illinois on December 21, 2017 and Vicente Benavides was released on April 19, 2018 after nearly 26 years on California's death row. Both Solache and Benavides are Mexican nationals. While there has been one exoneration for about every nine executions in the U.S. overall, there has been one exoneration of a foreign national for every 6.17 executions of a foreign national, suggesting that foreign nationals may be more likely to face wrongful convictions and death sentences than U.S. citizens.

A divided Arkansas Supreme Court has struck down the state’s death-penalty mental competency law, holding that statutory provisions giving the state’s prison director exclusive authority to determine a death-row prisoner’s competency to be executed violate due process. The 4-3 rulings on November 1, 2018 were a victory for two mentally ill death-row prisoners, Bruce Ward (pictured, left) and Jack Greene (pictured, right), who had come within days of execution in 2017. The appeals court directed the Arkansas trial courts to conduct hearings to determine the men’s mental status and their competency to be executed.

Ward, who has been diagnosed with paranoid schizophrenia, was scheduled to be executed on Monday, April 17, 2017. A Pulaski County trial court had denied his motion for a hearing to determine his competency to be executed, saying it had no legal authority to rule on the issue. The state supreme court stayed Ward's execution on April 14 to decide whether counsel should be permitted to litigate Ward’s competency to be executed. Greene suffers from psychotic delusions and, according to court pleadings, believes that his attorneys and prison officials are conspiring to torture him. His delusions include that “his spinal cord has been removed and his central nervous system has been destroyed,” in response to which, his lawyers say, Greene “constantly twist[s] his body and stuff[s] his ear and nose with toilet paper to cope with the pain.” Arkansas had scheduled his execution for November 9, but the Arkansas Supreme Court granted a stay on November 7 to resolve whether the state's mechanism to determine competency was constitutional.

The court’s two rulings determined that Arkansas’s competency law violated the two prisoners’ rights to due process under both the United States and Arkansas constitutions. The statute, Chief Justice John Kemp wrote, failed to “provide for an evidentiary hearing that comports with the fundamental principles of due process,” as set forth in the U.S. Supreme Court’s competency decisions in Ford v. Wainwright and Panetti v. Quarterman. John C. Williams, a federal public defender representing the inmates, told Associated Press that the defense was “pleased the court held the statute unconstitutional, and we look forward to litigating our clients’ competence.”