The controversy over the rule has led to periodic efforts to change or abolish it. The State Supreme Courts of the two States which tried to abolish the plea ruled that the statutes were unconstitutional. Some States have adopted an alternative plea of 'guilty but mentally ill.' In Alaska, suggestions for change have included shifting the burden of proof of intent from the prosecution to the defense, reducing the degree of certainty to a preponderance of the evidence, adopting the more conservative M'Naghten rule to replace the rule of the American Law Institute, and providing the court with the plea of guilty but mentally ill. The small number of defendants involved in insanity pleas and the scarcity of research in the area indicate that policymakers should await the outcome of further research. They may find that a greater focus on treatment alternatives and treatment planning following an acquittal based on insanity would be of help in attempting to address the shortcomings of existing insanity laws. A total of 68 reference notes are provided.