NOTICE: This opinion is subject to formal revision before publication in the preliminary print of the United States Reports. Readers are requested to notify the Reporter of Decisions, Supreme Court of the United States, Washington, D. C. 20543, of any typographical or other formal errors, in order that corrections may be made before the preliminary print goes to press.
SUPREME COURT OF THE UNITED STATES
_________________
No. 15–797
_________________
BOBBY JAMES MOORE, PETITIONER
v. TEXAS
on writ of certiorari to the court of criminal appeals of texas
[March 28, 2017]
Justice Ginsburg delivered the opinion of the Court.
Bobby James Moore fatally shot a store clerk during a botched robbery. He was convicted of capital murder and sentenced to death. Moore challenged his death sentence on the ground that he was intellectually disabled and therefore exempt from execution. A state habeas court made detailed factfindings and determined that, under this Court’s decisions in
Atkins v.
Virginia,
536 U. S. 304 (2002), and
Hall v.
Florida, 572 U. S. ___ (2014), Moore qualified as intellectually disabled. For that reason, the court concluded, Moore’s death sentence violated the
Eighth Amendment’s proscription of “cruel and unusual punishments.” The habeas court therefore recommended that Moore be granted relief.
The Texas Court of Criminal Appeals (CCA)[
1] declined to adopt the judgment recommended by the state habeas court.[
2] In the CCA’s view, the habeas court erroneously employed intellectual-disability guides currently used in the medical community rather than the 1992 guides adopted by the CCA in
Ex parte Briseno, 135 S. W. 3d 1 (2004). See
Ex parte Moore, 470 S. W. 3d 481, 486–487 (2015). The appeals court further determined that the evidentiary factors announced in
Briseno “weigh[ed] heavily” against upsetting Moore’s death sentence. 470 S. W. 3d, at 526.
We vacate the CCA’s judgment. As we instructed in
Hall, adjudications of intellectual disability should be “informed by the views of medical experts.” 572 U. S., at ___ (slip op., at 19); see
id., at ___ (slip op., at 7). That instruction cannot sensibly be read to give courts leave to diminish the force of the medical community’s consensus. Moreover, the several factors
Briseno set out as indicators of intellectual disability are an invention of the CCA untied to any acknowledged source. Not aligned with the medical community’s information, and drawing no strength from our precedent, the
Briseno factors “creat[e] an unacceptable risk that persons with intellectual dis- ability will be executed,” 572 U. S., at ___ (slip op., at 1). Accordingly, they may not be used, as the CCA used them, to restrict qualification of an individual as intellectually disabled.
I
In April 1980, then-20-year-old Bobby James Moore and two others were engaged in robbing a grocery store.
Ex parte Moore, 470 S. W. 3d 481, 490–491 (Tex. Crim. App. 2015); App. 58. During the episode, Moore fatally shot a store clerk. 470 S. W. 3d, at 490. Some two months later, Moore was convicted and sentenced to death. See
id., at 492. A federal habeas court later vacated that sentence based on ineffective assistance of trial counsel, see
Moore v.
Collins, 1995 U. S. Dist. LEXIS 22859, *35 (SD Tex., Sept. 29, 1995), and the Fifth Circuit affirmed, see
Moore v.
Johnson, 194 F. 3d 586, 622 (1999). Moore was resentenced to death in 2001, and the CCA affirmed on direct appeal. See
Moore v.
State, 2004 WL 231323, *1 (Jan. 14, 2004), cert. denied,
543 U. S. 931 (2004).
Moore subsequently sought state habeas relief. In 2014, the state habeas court conducted a two-day hearing on whether Moore was intellectually disabled. See
Ex parte Moore, No. 314483–C (185th Jud. Dist., Harris Cty., Tex., Feb. 6, 2015), App. to Pet. for Cert. 129a. The court received affidavits and heard testimony from Moore’s family members, former counsel, and a number of court-appointed mental-health experts. The evidence revealed that Moore had significant mental and social difficulties beginning at an early age. At 13, Moore lacked basic understanding of the days of the week, the months of the year, and the seasons; he could scarcely tell time or comprehend the standards of measure or the basic principle that subtraction is the reverse of addition.
Id., at 187a. At school, because of his limited ability to read and write, Moore could not keep up with lessons.
Id., at 146a, 182a–183a. Often, he was separated from the rest of the class and told to draw pictures.
Ibid. Moore’s father, teachers, and peers called him “stupid” for his slow reading and speech.
Id., at 146a, 183a. After failing every subject in the ninth grade, Moore dropped out of high school.
Id., at 188a. Cast out of his home, he survived on the streets, eating from trash cans, even after two bouts of food poisoning.
Id., at 192a–193a.
In evaluating Moore’s assertion of intellectual disability, the state habeas court consulted current medical diagnostic standards, relying on the 11th edition of the American Association on Intellectual and Developmental Disabilities (AAIDD) clinical manual, see AAIDD, Intellectual Disability: Definition, Classification, and Systems of Supports (2010) (hereinafter AAIDD–11), and on the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association (APA), see APA, Diagnostic and Statistical Manual of Mental Disorders (2013) (hereinafter DSM–5). App. to Pet. for Cert. 150a–151a, 202a. The court followed the generally accepted, uncontroversial intellectual-disability diagnos- tic definition, which identifies three core elements: (1) intellectual-functioning deficits (indicated by an IQ score “approximately two standard deviations below the mean”—
i.e., a score of roughly 70—adjusted for “the standard error of measurement,” AAIDD–11, at 27); (2) adaptive deficits (“the inability to learn basic skills and adjust behavior to changing circumstances,”
Hall v.
Flor- ida, 572 U. S. ___, ___ (2014) (slip op., at 8)); and (3) the onset of these deficits while still a minor. See App. to Pet. for Cert. 150a (citing AAIDD–11, at 1). See also
Hall, 572 U. S., at ___ (slip op., at 8).[
3]
Moore’s IQ scores, the habeas court determined, established subaverage intellectual functioning. The court credited six of Moore’s IQ scores, the average of which (70.66) indicated mild intellectual disability. App. to Pet. for Cert. 167a–170a.[
4] And relying on testimony from several mental-health experts, the habeas court found significant adaptive deficits. In determining the significance of adaptive deficits, clinicians look to whether an individual’s adaptive performance falls two or more standard deviations below the mean in any of the three adaptive skill sets (conceptual, social, and practical). See AAIDD–11, at 43. Moore’s performance fell roughly two standard deviations below the mean in
all three skill categories. App. to Pet. for Cert. 200a–201a. Based on this evidence, the state habeas court recommended that the CCA reduce Moore’s sentence to life in prison or grant him a new trial on intellectual disability. See
id., at 203a.
The CCA rejected the habeas court’s recommendations and denied Moore habeas relief. See 470 S. W. 3d 481. At the outset of its opinion, the CCA reaffirmed
Ex parte Briseno, 135 S. W. 3d 1 (Tex. Crim. App. 2004), as paramount precedent on intellectual disability in Texas capital cases. See 470 S. W. 3d, at 486–487.
Briseno adopted the definition of, and standards for assessing, intellectual disability contained in the 1992 (ninth) edition of the American Association on Mental Retardation (AAMR) manual, predecessor to the current AAIDD–11 manual. See 135 S. W. 3d, at 7 (citing AAMR, Mental Retardation: Definition, Classification, and Systems of Supports (9th ed. 1992) (hereinafter AAMR–9)).
Briseno incorporated the AAMR–9’s requirement that adaptive deficits be “related” to intellectual-functioning deficits. 135 S. W. 3d, at 7 (quoting AAMR–9, at 25).[
5] To determine whether a defendant has satisfied the relatedness requirement, the CCA instructed in this case, Texas courts should attend to the “seven evidentiary factors” first set out in
Briseno. 470 S. W. 3d, at 489.[
6] No citation to any authority, medical or judicial, accompanied the
Briseno court’s recitation of the seven factors. See 135 S. W. 3d, at 8–9.
The habeas judge erred, the CCA held, by “us[ing] the most current position, as espoused by AAIDD, regarding the diagnosis of intellectual disability rather than the test . . . in
Briseno.” 470 S. W. 3d, at 486. This Court’s decision in
Atkins v.
Virginia,
536 U. S. 304 (2002), the CCA emphasized, “left it to the States to develop appropriate ways to enforce the constitutional restriction” on the execution of the intellectually disabled. 470 S. W. 3d, at 486. Thus, even though “[i]t may be true that the AAIDD’s and APA’s positions regarding the diagnosis of intellectual disability have changed since
Atkins and
Briseno,” the CCA retained
Briseno’s instructions, both because of “the subjectivity surrounding the medical diagnosis of intellectual disability” and because the Texas Legislature had not displaced
Briseno with any other guideposts. 470 S. W. 3d, at 486–487. The
Briseno inquiries, the court said, “remai[n] adequately ‘informed by the medical community’s diagnostic framework.’ ” 470 S. W. 3d, at 487 (quoting
Hall, 572 U. S., at ___ (slip op., at 19–20)).
Employing
Briseno, the CCA first determined that Moore had failed to prove significantly subaverage intellectual functioning. 470 S. W. 3d, at 514–519. Rejecting as unreliable five of the seven IQ tests the habeas court had considered, the CCA limited its appraisal to Moore’s scores of 78 in 1973 and 74 in 1989.
Id., at 518–519. The court then discounted the lower end of the standard-error range associated with those scores.
Id., at 519; see
infra, at 10–11 (describing standard error of measurement). Regarding the score of 74, the court observed that Moore’s history of academic failure, and the fact that he took the test while “exhibit[ing] withdrawn and depressive behavior” on death row, might have hindered his performance. 470 S. W. 3d, at 519. Based on the two scores, but not on the lower portion of their ranges, the court concluded that Moore’s scores ranked “above the intellectually disabled range” (
i.e., above 70).
Ibid.; see
id., at 513.
“Even if [Moore] had proven that he suffers from significantly sub-average general intellectual functioning,” the court continued, he failed to prove “significant and related limitations in adaptive functioning.”
Id., at 520. True, the court acknowledged, Moore’s and the State’s experts agreed that Moore’s adaptive-functioning test scores fell more than two standard deviations below the mean.
Id., at 521; see
supra, at 4. But the State’s expert ultimately discounted those test results because Moore had “no exposure” to certain tasks the testing included, “such as writing a check and using a microwave oven.” 470 S. W. 3d, at 521–522. Instead, the expert emphasized Moore’s adaptive strengths in school, at trial, and in prison.
Id., at 522–524.
The CCA credited the state expert’s appraisal.
Id., at 524. The habeas court, the CCA concluded, had erred by concentrating on Moore’s adaptive weaknesses.
Id., at 489. Moore had demonstrated adaptive strengths, the CCA spelled out, by living on the streets, playing pool and mowing lawns for money, committing the crime in a sophisticated way and then fleeing, testifying and representing himself at trial, and developing skills in prison.
Id., at 522–523. Those strengths, the court reasoned, undercut the significance of Moore’s adaptive limitations.
Id., at 524–525.
The habeas court had further erred, the CCA determined, by failing to consider whether any of Moore’s adaptive deficits were related to causes other than his intellectual- functioning deficits.
Id., at 488, 526. Among alterna- tive causes for Moore’s adaptive deficits, the CCA suggested, were an abuse-filled childhood, undiagnosed learning disorders, multiple elementary-school transfers, racially motivated harassment and violence at school, and a his- tory of academic failure, drug abuse, and absenteeism.
Ibid. Moore’s significant improvement in prison, in the CCA’s view, confirmed that his academic and social difficulties were not related to intellectual-functioning deficits.
Ibid. The court then examined each of the seven
Briseno evidentiary factors, see
supra, at 5–6, and n. 6, concluding that those factors “weigh[ed] heavily” against finding that Moore had satisfied the relatedness requirement. 470 S. W. 3d, at 526–527.
Judge Alcala dissented.
Atkins and
Hall, she would have held, require courts to consult current medical standards to determine intellectual disability. 470 S. W. 3d, at 530. She criticized the majority for relying on manuals superseded in the medical community,
id., at 530–534, 536–539, and for disregarding the habeas court’s credibility determinations,
id., at 535–536, 538–539. Judge Alcala questioned the legitimacy of the seven
Briseno factors, recounting wide criticism of the factors and explaining how they deviate from the current medical consensus. See 470 S. W. 3d, at 529–530, and n. 5. Most emphatically, she urged, the CCA “must consult the medical community’s current views and standards in determining whether a defendant is intellectually disabled”; “reliance on . . . standard[s] no longer employed by the medical community,” she objected, “is constitutionally unaccept- able.”
Id., at 533.
We granted certiorari to determine whether the CCA’s adherence to superseded medical standards and its reliance on
Briseno comply with the
Eighth Amendment and this Court’s precedents. 578 U. S. ___ (2016).
II
The
Eighth Amendment prohibits “cruel and unusual punishments,” and “reaffirms the duty of the government to respect the dignity of all persons,”
Hall, 572 U. S., at ___ (slip op., at 5) (quoting
Roper v.
Simmons,
543 U. S. 551, 560 (2005)). “To enforce the Constitution’s protection of human dignity,” we “loo[k] to the evolving standards of decency that mark the progress of a maturing society,” recognizing that “[t]he
Eighth Amendment is not fastened to the obsolete.”
Hall, 572 U. S., at ___ (slip op., at 5) (internal quotation marks omitted).
In
Atkins v.
Virginia, we held that the Constitution “restrict[s] . . . the State’s power to take the life of”
any intellectually disabled individual. 536 U. S., at 321. See also
Hall, 572 U. S., at ___ (slip op., at 6);
Roper, 543 U. S., at 563–564. Executing intellectually disabled individuals, we concluded in
Atkins, serves no penological purpose, see 536 U. S., at 318–320; runs up against a national consensus against the practice, see
id., at 313–317; and creates a “risk that the death penalty will be imposed in spite of factors which may call for a less severe penalty,”
id., at 320 (internal quotation marks omitted); see
id., at 320–321.
In
Hall v.
Florida, we held that a State cannot refuse to entertain other evidence of intellectual disability when a defendant has an IQ score above 70. 572 U. S., at ___–___ (slip op., at 21–22). Although
Atkins and
Hall left to the States “the task of developing appropriate ways to enforce” the restriction on executing the intellectually disabled, 572 U. S., at ___ (slip op., at 17) (quoting
Atkins, 536 U. S., at 317), States’ discretion, we cautioned, is not “unfettered,” 572 U. S., at ___ (slip op., at 17)
. Even if “the views of medical experts” do not “dictate” a court’s intellectual-disability determination,
id., at ___ (slip op., at 19), we clarified, the determination must be “informed by the medical community’s diagnostic framework,”
id., at ___–___ (slip op., at 19–20). We relied on the most recent (and still current) versions of the leading diagnostic manuals—the DSM–5 and AAIDD–11.
Id., at ___, ___, ___–___, ___–___ (slip op., at 3, 8, 10–11, 20–21). Florida, we concluded, had violated the
Eighth Amendment by “disregard[ing] established medical practice.”
Id., at ___ (slip op., at 10). We further noted that Florida had parted ways with practices and trends in other States.
Id., at ___–___ (slip op., at 12–16).
Hall indicated that being informed by the medical community does not demand adherence to everything stated in the latest medical guide. But neither does our precedent license disregard of current medical standards.
III
The CCA’s conclusion that Moore’s IQ scores established that he is not intellectually disabled is irreconcilable with
Hall.
Hall instructs that, where an IQ score is close to, but above, 70, courts must account for the test’s “standard error of measurement.” See
id., at ___–___, ___–___ (slip op., at 10–11, 21–22). See also
Brumfield v.
Cain, 576 U. S. ___, ___ (2015) (slip op., at 10) (relying on
Hall to find unreasonable a state court’s conclusion that a score of 75 precluded an intellectual-disability finding). As we explained in
Hall, the standard error of measurement is “a statistical fact, a reflection of the inherent imprecision of the test itself.” 572 U. S., at ___ (slip op., at 10). “For purposes of most IQ tests,” this imprecision in the testing instrument “means that an individual’s score is best understood as a range of scores on either side of the recorded score . . . within which one may say an individual’s true IQ score lies.”
Id., at ___ (slip op., at 11). A test’s standard error of measurement “reflects the reality that an individual’s intellectual functioning cannot be reduced to a single numerical score.”
Ibid. See also
id., at ___–___ (slip op., at 10–12); DSM–5, at 37; AAIDD, User’s Guide: Intellectual Disability: Definition, Classification, and Systems of Supports 22–23 (11th ed. 2012) (hereinafter AAIDD–11 User’s Guide).
Moore’s score of 74, adjusted for the standard error of measurement, yields a range of 69 to 79, see 470 S. W. 3d, at 519, as the State’s retained expert acknowledged, see Brief for Petitioner 39, n. 18; App. 185, 189–190. Because the lower end of Moore’s score range falls at or below 70, the CCA had to move on to consider Moore’s adaptive functioning. See
Hall, 572 U. S., at ___–___ (slip op., at 21–22); 470 S. W. 3d, at 536 (Alcala, J., dissenting) (even if the majority correctly limited the scores it would consider, “current medical standards . . . would still require [the CCA] to examine whether [Moore] has adaptive deficits”).
Both Texas and the dissent maintain that the CCA properly considered factors unique to Moore in disregarding the lower end of the standard-error range.
Post, at 14–15; Brief for Respondent 41–42; see
supra,
at 6–7; 470 S. W. 3d, at 519. But the presence of other sources of imprecision in administering the test to a particular individual, see
post, at 14–16, and n. 3, cannot
narrow the test-specific standard-error range.[
7]
In requiring the CCA to move on to consider Moore’s adaptive functioning in light of his IQ evidence, we do not suggest that “the
Eighth Amendment turns on the slightest numerical difference in IQ score,”
post, at 15–16.
Hall invalidated Florida’s strict IQ cutoff because the cutoff took “an IQ score as final and conclusive evidence of a defendant’s intellectual capacity, when experts in the field would consider other evidence.” 572 U. S., at ___ (slip op., at 10). Here, by contrast, we do not end the intellectual-disability inquiry, one way or the other, based on Moore’s IQ score. Rather, in line with
Hall, we require that courts continue the inquiry and consider other evidence of intellectual disability where an individual’s IQ score, adjusted for the test’s standard error, falls within the clinically established range for intellectual-functioning deficits.
IV
The CCA’s consideration of Moore’s adaptive functioning also deviated from prevailing clinical standards and from the older clinical standards the court claimed to apply.
A
In concluding that Moore did not suffer significant adaptive deficits, the CCA overemphasized Moore’s perceived adaptive strengths. The CCA recited the strengths it perceived, among them, Moore lived on the streets, mowed lawns, and played pool for money. See 470 S. W. 3d, at 522–523, 526–527. Moore’s adaptive strengths, in the CCA’s view, constituted evidence adequate to overcome the considerable objective evidence of Moore’s adaptive deficits, see
supra, at 4; App. to Pet. for Cert. 180a–202a. See 470 S. W. 3d, at 522–524, 526–527. But the medical community focuses the adaptive-functioning inquiry on adaptive
deficits.
E.g., AAIDD–11, at 47 (“significant limitations in conceptual, social, or practical adaptive skills [are] not outweighed by the potential strengths in some adaptive skills”); DSM–5, at 33, 38 (inquiry should focus on “[d]eficits in adaptive functioning”; deficits in only one of the three adaptive-skills domains suffice to show adaptive deficits); see
Brumfield, 576 U. S., at ___ (slip op., at 15) (“[I]ntellectually disabled persons may have ‘strengths in social or physical capabilities, strengths in some adaptive skill areas, or strengths in one aspect of an adaptive skill in which they otherwise show an overall limitation.’ ” (quoting AAMR, Mental Retardation: Definition, Classification, and Systems of Supports 8 (10th ed. 2002)).[
8]
In addition, the CCA stressed Moore’s improved behavior in prison. 470 S. W. 3d, at 522–524, 526–527. Clinicians, however, caution against reliance on adaptive strengths developed “in a controlled setting,” as a prison surely is. DSM–5, at 38 (“Adaptive functioning may be difficult to assess in a controlled setting (e.g., prisons, detention centers); if possible, corroborative information reflecting functioning outside those settings should be obtained.”); see AAIDD–11 User’s Guide 20 (counseling against reliance on “behavior in jail or prison”).
B
The CCA furthermore concluded that Moore’s record of academic failure, along with the childhood abuse and suffering he endured, detracted from a determination that his intellectual and adaptive deficits were related. See 470 S. W. 3d, at 488, 526;
supra, at 5, 7–8. Those traumatic experiences, however, count in the medical community as “
risk factors” for intellectual disability. AAIDD–11, at 59–60 (emphasis added). Clinicians rely on such factors as cause to explore the prospect of intellectual disability further, not to counter the case for a disability determination. See
id., at 60 (“[A]t least one or more of the risk factors [described in the manual] will be found in every case of” intellectual disability.).
The CCA also departed from clinical practice by requiring Moore to show that his adaptive deficits were not related to “a personality disorder.” 470 S. W. 3d, at 488; see
id., at 526 (Moore’s problems in kindergarten were “more likely cause[d]” by “emotional problems” than by intellectual disability). As mental-health professionals recognize, how- ever, many intellectually disabled people also have other mental or physical impairments, for example, attention-deficit/hyperactivity disorder, depressive and bipolar dis- orders, and autism. DSM–5, at 40 (“[c]o-occurring men- tal, neurodevelopmental, medical, and physical conditions are frequent in intellectual disability, with rates of some conditions (e.g., mental disorders, cerebral palsy, and epilepsy) three to four times higher than in the general population”); see AAIDD–11, at 58–63. Coexisting conditions frequently encountered in intellectually disabled individ- uals have been described in clinical literature as “[c]omorbidit[ies].” DSM–5, at 40. See also Brief for AAIDD et al. as
Amici Curiae 20, and n. 25. The existence of a personality disorder or mental-health issue, in short, is “not evidence that a person does not also have intellectual disability.” Brief for American Psychological Association, APA, et al. as
Amici Curiae 19.
C
The CCA’s attachment to the seven
Briseno evidentiary factors further impeded its assessment of Moore’s adaptive functioning.
1
By design and in operation, the
Briseno factors “creat[e] an unacceptable risk that persons with intellectual dis- ability will be executed,”
Hall, 572 U. S., at ___ (slip op., at 1). After observing that persons with “mild” intellectual disability might be treated differently under clinical standards than under Texas’ capital system, the CCA defined its objective as identifying the “consensus of
Texas citizens” on who “should be exempted from the death penalty.”
Briseno, 135 S. W. 3d, at 6 (emphasis added). Mild levels of intellectual disability, although they may fall outside Texas citizens’ consensus, nevertheless remain intellectual disabilities, see
Hall, 572 U. S., at ___–___ (slip op., at 17–18);
Atkins, 536 U. S., at 308, and n. 3; AAIDD–11, at 153, and States may not execute anyone in “the
entire category of [intellectually disabled] offenders,”
Roper, 543 U. S., at 563–564 (emphasis added); see
supra, at 9.
Skeptical of what it viewed as “exceedingly subjective” medical and clinical standards, the CCA in
Briseno advanced lay perceptions of intellectual disability. 135 S. W. 3d, at 8; see
supra, at 5–6, and n. 6.
Briseno asks, for example, “Did those who knew the person best during the developmental stage—his family, friends, teachers, employers, authorities—think he was mentally retarded at that time, and, if so, act in accordance with that determination?” 135 S. W. 3d, at 8. Addressing that question here, the CCA referred to Moore’s education in “normal classrooms during his school career,” his father’s reactions to his academic challenges, and his sister’s perceptions of Moore’s intellectual abilities. 470 S. W. 3d, at 526–527. But the medical profession has endeavored to counter lay stereotypes of the intellectually disabled. See AAIDD–11 User’s Guide 25–27; Brief for AAIDD et al. as
Amici Cu- riae 9–14, and nn. 11–15. Those stereotypes, much more than medical and clinical appraisals, should spark skepticism.[
9]
2
The
Briseno factors are an outlier, in comparison both to other States’ handling of intellectual-disability pleas and to Texas’ own practices in other contexts. See
Hall, 572 U. S., at ___ (slip op., at 12) (consensus in the States provides “objective indicia of society’s standards in the context of the
Eighth Amendment” (internal quotation marks omitted)). No state legislature has approved the use of the
Briseno factors or anything similar. In the 12 years since Texas adopted the factors, only one other state high court and one state intermediate appellate court have authorized their use. See,
e.g.,
Commonwealth v.
Bracey, 632 Pa. 75, ___–___, 117 A. 3d 270, 286–287 (2015);
Howell v.
State, 2011 WL 2420378, *18 (Tenn. Crim. App., June 14, 2011).
Indeed, Texas itself does not follow
Briseno in contexts other than the death penalty. See Brief for Constitution Project as
Amicus Curiae 14–17. For example, the related-ness requirement Texas defends here, see
supra, at 5–6, is conspicuously absent from the standards the State uses to assess students for intellectual disabilities. See 19 Tex. Admin. Code §89.1040(c)(5) (2015). And even within Texas’ criminal-justice system, the State requires the intellectual-disability diagnoses of juveniles to be based on “the latest edition of the DSM.” 37 Tex. Admin. Code §380.8751(e)(3) (2016). Texas cannot satisfactorily explain why it applies current medical standards for diagnosing intellectual disability in other contexts, yet clings to superseded standards when an individual’s life is at stake.[
10]
V
As noted
supra, at 9, States have some flexibility, but not “unfettered discretion,” in enforcing
Atkins’ holding.
Hall, 572 U. S., at ___ (slip op., at 17). “If the States were to have complete autonomy to define intellectual disability as they wished,” we have observed, “
Atkins could become a nullity, and the
Eighth Amendment’s protection of human dignity would not become a reality.”
Id., at ___–___ (slip op., at 18–19).
The medical community’s current standards supply one constraint on States’ leeway in this area. Reflecting improved understanding over time, see DSM–5, at 7; AAIDD–11, at xiv–xv, current manuals offer “the best available description of how mental disorders are expressed and can be recognized by trained clinicians,” DSM–5, at xli. See also
Hall, 572 U. S., at ___, ___, ___, ___–___, ___–___ (slip op., at 2, 3, 8, 10–11, 20–21) (employing current clinical standards);
Atkins, 536 U. S., at 308, n. 3, 317, n. 22 (relying on then-current standards).
In Moore’s case, the habeas court applied current medical standards in concluding that Moore is intellectually disabled and therefore ineligible for the death penalty. See,
e.g., App. to Pet. for Cert. 150a–151a, 200a–203a. The CCA, however, faulted the habeas court for “disregarding [the CCA’s] case law and employing the definition of intellectual disability presently used by the AAIDD.” 470 S. W. 3d, at 486. The CCA instead fastened its intellectual-disability determination to “the AAMR’s 1992 definition of intellectual disability that [it] adopted in
Briseno for
Atkins claims presented in Texas death-penalty cases.”
Ibid. By rejecting the habeas court’s application of medical guidance and clinging to the standard it laid out in
Briseno, including the wholly nonclinical
Briseno factors, the CCA failed adequately to inform itself of the “medical community’s diagnostic framework,”
Hall, 572 U. S., at ___–___ (slip op., at 19–20). Because
Briseno pervasively infected the CCA’s analysis, the decision of that court cannot stand.
* * *
For the reasons stated, the judgment of the Texas Court of Criminal Appeals is vacated, and the case is remanded for further proceedings not inconsistent with this opinion.
It is so ordered.