In three separate cases, beginning nine years ago, Paul Dennis Reid was found competent to stand trial.
His mental health was not an issue for three separate juries which convicted him of seven counts of murder and sentenced him to death seven times so why should his mental health matter now?
It is a question many people who remember the fear that resulted from the chain of fast food murders in 1997 may be asking.
"This is part of what's required of a civilized, decent society that cares about how we treat people," said Terry Maroney, law professor at Vanderbilt University. "Mr. Reid may or may not have cared about how he treated people but we do... We care very much and we should."
Under the law, anyone convicted of a crime has the right to an appeal, from those who are unknown to society to those who are notorious, such as Reid.
Maroney said if they decide not to appeal and they know what they're doing that is fine.
"That's part of our human dignity," she said. "We have the right to give up sometimes however what we don't do is allow people to give up when we think it's not a rational decision, its being driven by some kind of mental illness, some kind of delusion, some kind of depression."
Reid's sister believes that applies to her brother, and wants to gain control of his appeals.
Maroney said Reid's competence could become an issue before the courts one more time; at the point of execution.
She said the Supreme Court has ruled that it's "unseemly", as she put it, to kill someone who is delusional.
Maroney said at all three stages, from hearings on mental status before a trial begins to hearings before death, the standards before the court are different.
"People can feel that it's needless. It's costly. It's unfair. We can't operate the system in any other way and have it be fair. It has to be fair for him and it has to be fair for everybody. We don't get to make special rules for the people who appear particularly guilty," she said.
Wednesday, Reid spent the day at a competency hearing in Clarksville where he is accused of killing two Baskin Robbins employees.
For the first time, his sister apologized to the mother of one of Reid's victims.
Dr. George Woods, a licensed psychiatrist, also took the stand and testified that Reid was delusional from May 2005 to 2006.
A separate competency hearing in Nashville ended earlier this week. The judge has not yet made her decision.