That's the question asked by longtime capital punishment lawyer Marc Bookman in an essay published this week in Mother Jones about Texas death row inmate Andre Thomas.
In 2004, Thomas killed his estranged wife, his 4-year-old son and her 13-month-old daughter "in the most bizarre case in Grayson County history," Bookman writes.
Andre had cut out the children's hearts and returned home with the organs in his pockets ... he was careful to use three different knives so that the blood from each body would not cross-contaminate, thereby ensuring that the demons inside each of them would die. He then stabbed himself in the chest, but he did not die as he had hoped. In fact, he was well enough to leave a message on his wife's parents' phone explaining that he thought he was in hell, and he managed to confess to the police what he had done before they took him in for emergency surgery.
Bookman, who has never represented Thomas, told The Huffington Post he believes the 29-year-old defendant, who was convicted and sentenced to death in 2005, will eventually be spared from execution. He points out that, while behind bars, Thomas gouged out each of his eyes in two separate incidents, and on the most recent occasion ate his left eye.
Thomas "didn't want the government to read his thoughts, so he ate the eye because he was certain they would figure out some way to put it back in," Bookman writes.
"I'm hoping at this point, someone will take a step back and say it's just not civilized to seek someone's execution when that person is so profoundly mentally ill," Bookman told HuffPost. "He wasn't culpable in the way that someone who is not mentally ill would be."
In order to be found not guilty by reason of insanity, the defense's case "hinges on a defendant's inability to connect his crime with the consequences," Bookman writes. In Texas, a suspected killer whose insanity was caused by voluntary intoxication can't use insanity as a defense.
That's exactly what the prosecution in Thomas' case successfully argued. Grayson County district attorneys said the crimes were likely sparked by Thomas' ingestion of cough medicine, alcohol and marijuana.
Bookman said Thomas' trial attorneys didn't bring up their client's long personal and family history of mental illness.
"As with many of these cases, the defense at trial did not do a particularly great job," Bookman said. "They didn't have much of the evidence of his mental illness. It wasn't until his federal lawyers got involved that these records came to light."
Thomas, as Bookman documents, comes from at least two generations of family members with serious mental health problems.
Maurie Levin, Thomas' lead attorney handling his appeal, said her client has been hearing voices in his head since he was 9 years old.
Thomas said he killed his three victims because he believed he heard a message from God telling him to kill "Jezebel, the Antichrist, and a related evil spirit," Bookman writes. He also notes that even doctors representing the state have diagnosed him as a paranoid schizophrenic.
"I don't think he knew right from wrong," Bookman said. "He has been under the sway of delusions for a large part of his life. At some point he says when he hears voices, he's not sure who's speaking, if it's his voice or if it's someone else's voice."
Grayson County District Attorney Joe Brown said there was ample evidence presented at trial that showed Thomas knew what he was doing was wrong.
"He ran away from the crime scene and tried to avoid detection. He took equipment to the scene to cover up what he was doing, and there was planning of the deaths," Brown said. "When he's going away from the scene, he hears sirens and runs away. If you don't know you've done something wrong, then why would you run?"
Brown also said Thomas turned down a plea deal for life in prison.
"He had mental illness, but that's not the standard for exoneration in the case. And his mental illness was caused or at least exacerbated by heavy drug use," Brown said.
Levin said she knows she faces extra hurdles in Texas, a state responsible for 37 percent of all executions in America since 1977, but she's cautiously optimistic her client will stave off lethal injection.
"I have to have faith that any reasonable judge will see the travesty of pressing the execution of somebody as mentally ill as Andre," Levin said.
Read the whole thing: How Crazy Is Too Crazy to Be Executed?