To see why, consider a hypothetical defendant (not Madison) claiming "alcoholic blackout." Dr. Park Dietz explains this poorly named phenomenon by analogy to a computer. A drunk killer might be fully conscious, aware of what he is doing, and intending to do it while the event is in his short-term memory, analogous to RAM. The alcohol interferes with writing the memory to the hard drive. Just like your computer cannot remember your document if the power fails before you save to disk, so the brain sometimes cannot remember what happened while intoxicated. Our hypothetical drunk killer is fully responsible for what he intentionally did and deserves to be punished for it. He can understand that while sober, even if he does not remember it.

Madison has had multiple strokes with resulting vascular dementia and memory loss. A narrow extension of Ford v. Wainwright phrased in terms sufficiently concrete that it will not sprawl to more common situations would likely not do much damage.

Amy notes that remand to the state court is a possible disposition, and a SCOTUS "win" for Madison might not even prevent execution in his case.

The U.S. Supreme Court took this case directly from the state court rather than letting it go to federal habeas corpus. That allows the high court to review the issue directly without "AEDPA deference." That's fine. Limiting U.S. Supreme Court review of state cases never was the purpose of the AEDPA reforms. Reining in the lower federal courts, especially circuits divisible by 3, was the purpose. We have seen more of these direct-from-the-state-court cases in recent years, and the trend will probably continue.