An inmate suffering from dementia may not be executed if his disease is so severe that he is not able to rationally understand the reason for his punishment, the Supreme Court ruled Wednesday.

Chief Justice John G. Roberts Jr. joined the court’s four liberals in saying Alabama death-row inmate Vernon Madison deserves another chance to prove that strokes and worsening vascular dementia have left him unable to remember his crime or why the state wants to execute him.

The court previously has ruled that the Eighth Amendment’s prohibition on cruel and unusual punishment means those who suffer from pervasive delusions associated with schizophrenia and psychosis may not be put to death.

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Justice Elena Kagan, delivering the opinion for the majority in the 5-to-3 ruling, said the same logic applies to those who cannot understand the link between their crimes and punishment because of dementia.

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“If a person suffering from any mental disorder — dementia included — is unable to rationally understand why the state wants to execute him, then the Eighth Amendment doesn’t allow the execution,” Kagan said in reading a summary of the opinion from the bench.

In previous cases, the court has said that there is no “retributive value” in executing someone who does not understand the meaning of the community’s judgment and that it “simply offends humanity” to kill someone who does not comprehend the crime or punishment.

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The court had taken the case to decide a second issue — whether the fact that Madison cannot remember committing his crime meant that he could not be executed. The court ruled that, on its own, it did not.

“A person lacking memory of his crime may yet rationally understand why the state seeks to execute him; if so, the Eighth Amendment poses no bar to his execution,” Kagan wrote. Besides Roberts, she was joined in the opinion by Justices Ruth Bader Ginsburg, Stephen G. Breyer and Sonia Sotomayor.

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The court’s ruling does not automatically spare Madison from execution. It said the case has to go back to a lower court to determine the extent of Madison’s dementia; it said there was reason to believe the lower court had not performed that task.

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In briefs and during oral arguments in the case, Madison’s attorneys said their client can no longer state the season or the day of the week or recite the alphabet beyond G.

After 33 years in solitary confinement, two strokes and vascular dementia, they said that, if reminded, he knows he might be executed for killing a police officer in 1985. But the next day, he will have to be reminded again.

Breyer, who has questioned in the past whether the death penalty can be applied in a constitutional way, said during oral arguments that the issues in Madison’s case are likely to recur.

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“There are many, many, many prisoners on death row under threat of execution who are in their 40s, 50s, 60s, 70s, possibly 80s, who have been there for 20, 30, 40 years, perhaps,” Breyer said. “So this will become a more common problem.”

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The court’s three most conservative members — Clarence Thomas, Samuel A. Alito Jr. and Neil M. Gorsuch — dissented. (The case was argued before Brett M. Kavanaugh was confirmed to the court.) Those three had also objected when the Supreme Court in 2018 blocked Madison’s execution.

In a sharply worded opinion, Alito said that “what the court has done in this case makes a mockery of our rules.”

He said the court accepted the case to decide the discrete question of whether Madison could be executed for a crime he no longer remembered. But Alito said that when Madison’s attorney saw he could not prevail on that question, he persuaded the court to focus on the dementia issue.

“The majority rewards counsel’s trick,” Alito wrote. Madison was represented by Bryan A. Stevenson, executive director of the anti-death-penalty Equal Justice Initiative in Montgomery, Ala.

But Kagan said Alito’s “high dudgeon” was unwarranted.

Madison’s petition “presented two questions — the same two we address here,” she wrote.

The case is Madison v. Alabama.

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