Because psychiatric judgments are imprecise and the determination of sanity or insanity means life or death in a case like Ford, it is likely that death row sanity disputes will become increasingly more formalized in the future. The role of the psychiatrist in diagnosis and treatment will become increasingly complex. Psychiatrists could become involved in Ford-type cases at three stages: in evaluating a claim that a prisoner under sentence of death has been found to be insane, and in certifying that a previously insane death row inmate has regained sanity. The article discusses six rationales that are used to explain the rule against executing insane persons: exculpation, proportionality, deterrence, humaneness, theologic, and retribution. The death penalty reflects more symbolic opposition to crime than meaningful deterrent. 111 footnotes.