The discussion first presents background facts on capital punishment and a summary of the research on the stresses of confinement. It then briefly reviews some aspects of the legal background pertinent to competency to be executed. Some views of the psychiatric community are examined as well as ethical questions. Almost every State, either by statute or through case law, requires that a person not be "insane" at the time of execution. The standard of competency typically used is similar to that used to determine competency to stand trial, with the additional requirement of an understanding of the crime and the punishment to be faced. A number of issues associated with competency determinations arise for the psychiatrists involved. The American Psychiatric Association has a standard that states "A psychiatrist should not be participant in a legally authorized execution." This raises the question as to when the psychiatrist who participates in execution competency proceedings becomes involved in the infliction of death. Also, once the finding of incompetency to be executed has been made, the State requires that the prisoner be treated. Appelbaum (1987) holds that a psychiatrist should not treat an incompetent death row prisoner unless the sentence is commuted to life imprisonment prior to the commencement of treatment. The authors of this chapter hold that psychiatrists should not participate in evaluations of competency to be executed under current conditions. 41 references