Title: Commonwealth v. Toolan

State: massachusetts

Issuer: Massachusetts Supreme Court

Document:

NOTICE:  All slip opinions and orders are subject to formal 
revision and are superseded by the advance sheets and bound 
volumes of the Official Reports.  If you find a typographical 
error or other formal error, please notify the Reporter of 
Decisions, Supreme Judicial Court, John Adams Courthouse, 1 
Pemberton Square, Suite 2500, Boston, MA, 02108-1750; (617) 557-
1030; SJCReporter@sjc.state.ma.us 
 
SJC-11589 
 
COMMONWEALTH  vs.  THOMAS E. TOOLAN, THIRD. 
 
 
 
Nantucket.     May 4, 2022. - September 23, 2022. 
 
Present:  Budd, C.J., Lowy, Cypher, Kafker, & Georges, JJ. 
 
 
Homicide.  Assault and Battery by Means of a Dangerous Weapon.  
Drug Addiction.  Criminal Responsibility.  Mental 
Impairment.  Malice.  Intoxication.  Practice, Criminal, 
Capital case, Instructions to jury, Request for jury 
instructions.  Words, "Mental disease or defect." 
 
 
 
Indictments found and returned in the Superior Court 
Department on January 10, 2005. 
 
Following review by this court, 460 Mass. 452 (2011), the 
cases were tried before Gary A. Nickerson, J. 
 
 
Michelle Menken for the defendant. 
Elizabeth A. Sweeney, Assistant District Attorney, for the 
Commonwealth. 
 
 
 
GEORGES, J.  This case is before the court on the 
defendant's direct appeal from his convictions of murder in the 
first degree and assault and battery by means of a dangerous 
weapon in the stabbing death of Elizabeth Locktefeld, his former 
2 
 
 
 
girlfriend, on October 25, 2004.  Locktefeld was found dead on 
the floor of her home in Nantucket, having been stabbed twenty-
three times, a few days after she ended her relationship with 
the defendant due to what she described as his excessive 
consumption of alcohol. 
 
In this appeal, the defendant raises a number of challenges 
to the jury instructions given and the absence of requested 
instructions.  He maintains that the judge should have clarified 
the legal definition of "mental disease or defect" after the 
Commonwealth's expert testified inappropriately by referencing a 
statutory definition, and that the absence of a clarifying 
instruction created a substantial likelihood of a miscarriage of 
justice.  The defendant argues also that the judge's 
instructions did not adequately explain the difference between a 
lack of criminal responsibility and diminished capacity, such 
that the jury might not have understood that, if they found the 
defendant had been criminally responsible, they nonetheless 
could find the defendant had had a diminished capacity at the 
time of the stabbing.  In addition, the defendant contends that 
it was error to instruct the jury that they could infer malice 
from the intentional use of a dangerous weapon.  The defendant 
also maintains that the judge abused his discretion in not 
instructing the jury, as the defendant requested, to consider 
whether the defendant was incapable of resisting the urge to use 
3 
 
 
 
drugs or alcohol, and thus that any knowledge the defendant 
might have had about the effect of intoxication upon his mental 
conditions should not have been considered in the determination 
whether the defendant had had a mental impairment at the time.  
Finally, the defendant asks us to exercise our extraordinary 
authority to grant him relief under G. L. c. 278, § 33E. 
Having carefully reviewed the arguments and the record, we 
discern no error warranting a new trial and no reason to 
exercise our extraordinary authority under G. L. c. 278, § 33E, 
to order a new trial or to reduce the degree of guilt.  
Accordingly, we affirm the convictions. 
 
1.  Background.  a.  Facts.  The jury could have found the 
following.  In the fall of 2004, the defendant was living in New 
York City, where he had grown up, and the victim was living in 
Nantucket, where she had moved from New York earlier that year.  
On September 4, 2004, a mutual friend introduced the defendant 
and the victim to each other.  Shortly thereafter, they began 
dating; the relationship deepened very quickly, such that the 
defendant and the victim were discussing marriage.  Over the 
course of a few days in late October of 2004, however, while the 
victim was visiting the defendant in New York, the relationship 
degenerated rapidly, due to the defendant's excessive drinking.  
On around October 23, 2004, the victim ended the relationship 
4 
 
 
 
for that reason, removed her belongings from the defendant's 
apartment, and returned to her home in Nantucket. 
On October 23, 2004, the defendant called a long-time 
friend, Mark Mitchell, from a bar.  The defendant sounded 
confused, and his speech was slurred.  Mitchell was concerned 
and went to the bar, where he found the defendant drinking 
vodka.  The defendant went to the rooftop of the building and 
threatened to commit suicide.  Mitchell convinced him to come 
down from the roof and took the defendant to an Alcoholics 
Anonymous meeting.  After the meeting, the defendant purchased 
two bottles of vodka from different stores.  Mitchell took each 
bottle from him.  Mitchell brought the defendant to the 
defendant's apartment, and there the defendant fell asleep. 
The next day, on October 24, 2004, the defendant went to 
LaGuardia Airport and purchased a one-way ticket to Nantucket.  
He was detained while going through security before boarding the 
plane because he had placed a large kitchen knife in a security 
bin, along with his coat and carry-on luggage, where it was 
detected by a scanner.  Airport security officials noted that 
the defendant's breath smelled of alcohol, his eyes were glassy, 
his speech was slurred, and he appeared to be under the 
influence of alcohol.  When asked about the knife, the defendant 
gave four differing reasons for having brought it with him.  The 
defendant was issued a summons for possessing a knife with a 
5 
 
 
 
blade more than four inches in length.  He then went to a bar at 
another terminal. 
The following day, October 25, 2004, the defendant returned 
to LaGuardia Airport and again purchased a ticket to Nantucket.  
This time, he successfully boarded the plane.  When he reached 
Nantucket, he rented a bright-colored sport utility vehicle 
(SUV) and drove to a surf shop.  He asked a salesperson where 
the scallop knives were kept.  The salesperson told the 
defendant that the store did not sell any knives, and directed 
him to a nearby marine store.  There, the defendant purchased 
two scallop knives and a longer, sheathed knife with an orange 
handle. 
The defendant then drove to the victim's cottage, which was 
located on the same property as the main house where the 
landlord lived.  He parked across the street, at an angle that 
partly obstructed passing traffic.  He approached the landlord, 
who was working outside in the yard, and asked whether the 
victim was home.  Although the landlord had just spoken to the 
victim and had seen her go inside the cottage, the defendant's 
appearance concerned her, and she replied that she did not know.  
The defendant headed to the cottage, where the door was standing 
open and the shades were not drawn.  The defendant entered and, 
during an encounter that left blood on the walls, floor, and 
furniture in several rooms, stabbed the victim twenty-three 
6 
 
 
 
times in the torso, chest, back, nose, arms, and hands.  Before 
he left the cottage, the defendant pulled the shades and closed 
the door.  He discarded a beer bottle and a vodka bottle outside 
the kitchen door.  He drove back to the airport, where he left 
the rental SUV,1 and flew to Hyannis, where he rented another 
vehicle and started driving toward New York. 
Shortly after the defendant left the cottage, the victim's 
landlord noticed that the curtains were drawn and the door was 
shut, contrary to the victim's usual practice.  Concerned, the 
landlord telephoned the victim's brother.  The brother called 
911 and asked police to conduct a wellness check.  After 
officers found the victim's bloodied body, the brother assisted 
them in obtaining the defendant's full name and address, and 
they issued an alert to look for the defendant's rental vehicle.  
The defendant was located by Rhode Island State police driving 
on Route 95 in Rhode Island.  While troopers were following the 
defendant's vehicle to an exit where they had set up a 
roadblock, the defendant drove appropriately, without crossing 
any marked lanes and without speeding.  When he was stopped at 
the roadblock, the defendant appeared lethargic and bewildered; 
he was unable to follow officers' commands to unlock the 
 
 
1 Police later found the knife and the victim's wallet in a 
bush next to the vehicle, and bottles of beer inside the 
vehicle. 
7 
 
 
 
driver's door.  The defendant was arrested on suspicion of 
operating a motor vehicle while under the influence of alcohol 
and taken to the Hope Valley barracks of the Rhode Island State 
police. 
Troopers found a prescription bottle of ninety Klonopin 
tablets in the defendant's vehicle.2  The prescription had been 
filled five days earlier, and the bottle contained sixty-two 
Klonopin pills.  The defendant was given a breathalyzer test 
approximately two hours after his arrest.  At that time, the 
test indicated a blood alcohol level of 0.185. 
Troopers from the Massachusetts State police arrived, read 
the defendant the Miranda warnings, and told him that they were 
there to discuss the victim.  The defendant called a friend and 
asked the friend to tell the victim to call police and tell them 
that she was okay.  The defendant then continued talking to the 
officers and said that he had not seen the victim for three 
 
2 One of the defendant's experts testified at trial 
concerning the medications the defendant had been prescribed, 
their side effects, and their potential interactions.  Klonopin 
is a brand of clonazepam.  It can be used to treat seizures, 
panic disorders, anxiety, and mania.  It may cause paranoia and 
impair memory, judgment, and coordination.  Clonazepam is a 
benzodiazepine and should not be mixed with alcohol.  Doing so 
may slow or suppress breathing, possibly resulting in death.  
See United States Food and Drug Administration, Klonopin Tablets 
(clonazepam), https://www.accessdata.fda.gov/drugsatfda_docs 
/label/2021/017533s061lbl.pdf [https://perma.cc/CSV9-CZXM]; 
National Library of Medicine, Clonazepam, https://www.ncbi.nlm 
.nih.gov/books/NBK556010 [https://perma.cc/T7HK-L73S]. 
8 
 
 
 
days.  The clothes the defendant was wearing at the time of his 
arrest subsequently tested positive for the victim's blood.  
Officers also searched the defendant's apartment and found "a 
few" empty bottles of vodka, empty beer bottles, and 
prescription bottles of Zoloft and Klonopin.3. 
 
b.  Prior proceedings.  On January 10, 2005, the defendant 
was indicted on charges of murder in the first degree, G. L. 
c. 265, § 1; and assault and battery by means of a dangerous 
weapon, G. L. c. 265, § 15A.  At his first trial in 2007, the 
Commonwealth proceeded on theories of deliberate premeditation 
and extreme atrocity or cruelty.  The defendant was convicted 
under both theories. 
The defendant appealed on the grounds, inter alia, of 
improprieties in jury selection and the denial of his motion for 
a change in venue due to extensive pretrial publicity.  In 
 
3 Zoloft is a selective serotonin reuptake inhibitor that 
can be used to treat depression, obsessive-compulsive disorder, 
posttraumatic stress disorder, and panic disorder.  It should 
not be mixed with alcohol.  See United States Food and Drug 
Administration, Sertraline (marketed as Zoloft) Information, 
https://www.fda.gov/drugs/postmarket-drug-safety-information-
patients-and-providers/sertraline-marketed-zoloft-information 
[https://perma.cc/P3TR-DWAT]; National Library of Medicine, 
Sertraline, https://www.ncbi.nlm.nih.gov/books/NBK547689 
[https://perma.cc/CY2Z-DBGL].  There was no testimony at trial 
as to the dosage of the Klonopin pills in the bottle found in 
the defendant's rental vehicle or how much he was supposed to 
take each day.  There was testimony as to the amount of Zoloft 
he was to take per day; in June of 2004, that dosage had been 
increased from fifty to one hundred milligrams. 
9 
 
 
 
addition, the defendant challenged the instructions on mental 
defect.  See Commonwealth v. DiPadova, 460 Mass. 424, 430-433, 
439-440 (2011); Commonwealth v. Berry, 457 Mass. 602, 617-618 & 
n.9 (2010), S.C., 466 Mass. 763 (2014).  He also challenged 
evidence presented to the jury concerning his exercise of his 
Miranda rights.  We vacated the convictions and ordered a new 
trial.  See Commonwealth v. Toolan, 460 Mass. 452, 472-473 
(2011).  At his second trial, the defendant relied upon a 
defense of a lack of criminal responsibility due to mental 
disease or defect and intoxication.  He again was convicted of 
both charges and under both theories of murder. 
 
2.  Discussion.  The defendant's arguments on appeal relate 
to specific jury instructions given or to instructions that were 
requested but not given; all of the challenged instructions 
involve issues concerning the defendant's mental state.  Jury 
instructions are evaluated as a whole, and as a reasonable juror 
would have interpreted them.  See Commonwealth v. Odgren, 483 
Mass. 41, 46 (2019).  A reviewing court presumes that the jury 
understood and followed the trial judge's instructions.  See 
Commonwealth v. Donahue, 430 Mass. 710, 718 (2000). 
At trial, the defense relied upon a theory of a lack of 
criminal responsibility or diminished capacity.  Where a 
defendant offers a defense of lack of criminal responsibility, 
the burden rests on the Commonwealth to "prove beyond a 
10 
 
 
 
reasonable doubt that the defendant was criminally responsible 
at the time the alleged crime was committed."  Commonwealth v. 
Dunphe, 485 Mass. 871, 878 (2020), quoting Model Jury 
Instructions on Homicide 1 (2018).  The Model Jury Instructions 
on Homicide provide that a "person is not criminally responsible 
for his conduct if he has a mental disease or defect, and, as a 
result of that mental disease or defect, lacks substantial 
capacity either to appreciate the criminality or wrongfulness of 
his conduct or to conform his conduct to the requirements of the 
law."  Model Jury Instructions on Homicide 2. 
In support of his theory of mental incapacity to have 
formed the necessary intent, or the existence of a mental 
impairment, the defendant called three expert witnesses:  Dr. 
Anthony Joseph, a practicing neuropsychiatrist and professor of 
psychiatry at Harvard Medical School and McLean Hospital; Dr. 
Donald Davidoff, a neuropsychologist and chief of 
neuropsychology at McLean Hospital; and Dr. Robert Tittman, a 
psychiatrist in private practice who also worked at Boston 
College's counseling service.  The Commonwealth called one 
mental health expert, Dr. Martin Kelly, and also called a 
physician, Richard Neufeld, who had treated the defendant from 
1999 until his arrest in October of 2004.  Kelly was a 
psychiatrist and professor at Harvard Medical School; Neufeld 
had prescribed the defendant Zoloft, Klonopin, and other 
11 
 
 
 
medications for mental health conditions.  The defendant had 
been prescribed fifty milligrams of Zoloft daily; that dosage 
was doubled to one hundred milligrams in late June of 2004. 
Joseph, the neuropsychiatrist, opined that, at the time of 
the stabbing, the defendant had not been legally sane, and had 
lacked the capacity to conform his conduct to the requirements 
of the law due to a mental disease or defect.  Joseph described 
the disease or defect as "a number of processes occurring at 
that time which rendered [the defendant] unable to conform his 
behavior to the law, and which also caused substantial disorders 
of memory, perception, thought, and mood."  Joseph described the 
defendant's prior mental health history as including diagnoses 
of "polysubstance abuse," depression, and psychosis.  Joseph 
also described potential side effects from taking Klonopin and 
Zoloft, including agitation, mania, and psychosis, and said that 
an increase in dose made the potential that an individual would 
experience such side effects more likely. 
In addition to conducting a neuropsychiatric interview of 
the defendant, Davidoff administered a series of standard 
neuropsychological tests in order to gain an over-all 
understanding of the defendant's psychological functioning at 
the time of the interview in 2007.  Davidoff offered no opinion 
with respect to the defendant's criminal responsibility at the 
time of the stabbing in 2004.  Davidoff determined that, when he 
12 
 
 
 
interviewed the defendant in 2007, the defendant's "executive 
functions were not operating efficiently," and he was 
experiencing difficulties with memory, processing "visual 
information," and being able to remember and use facts "in an 
efficient, productive way."  These problems indicated damage to 
the frontal lobe, likely from damage due to "chronic alcohol 
abuse." 
Tittmann testified specifically as to the effect of 
multiple medications, including Zoloft and Klonopin, on the 
brain, and stated that they could cause confusion, increase the 
risk of suicide, or aggravate psychosis.  He also testified that 
the use of these substances with others, or with alcohol, would 
have an "additive or synergistic effect" and would exacerbate 
the effects of the consumption of alcohol alone.  He did not 
offer an opinion with respect to the defendant's mental state or 
degree of criminal responsibility at the time of the stabbing. 
 
Kelly, the Commonwealth's psychiatric expert, opined that 
the defendant suffered from a "personality disorder" with 
"features of narcissistic personality disorder and antisocial 
personality disorder."  Kelly also opined that the defendant had 
addictions to alcohol and to benzodiazepines.  Kelly did not 
believe that these mental health issues were a mental disease or 
defect that would interfere with the defendant's ability to 
understand the wrongfulness of his conduct or to conform his 
13 
 
 
 
conduct to the requirements of the law.  Kelly pointed to a 
number of the defendant's actions the day before the stabbing 
and on the day of the stabbing as indicating an ability to 
understand wrongfulness; these included hiding a knife in a coat 
while going through airport security, drawing the curtains at 
the victim's house, and disposing of items taken from the house 
before leaving for the mainland. 
 
On cross-examination, Kelly did agree that the defendant 
previously had attempted suicide and had been committed to 
psychiatric hospitals on at least three prior occasions with 
diagnoses of substance abuse disorder and major depressive 
disorder.  Kelly also agreed that, in 2004, the United States 
Food and Drug Administration had issued warnings about the risks 
of increased suicidal behavior, as well as the potential for 
triggering manic episodes, in individuals taking Zoloft, either 
at the beginning of treatment or when the dosage was increased. 
 
a.  Instruction on mental disease or defect.  The defendant 
contends that the judge should have clarified the legal meaning 
of "mental disease or defect" after Kelly gave both a legal 
definition and then, after objection by defense counsel and 
instruction by the judge, his professional, clinical definition 
of that term.  As the defendant did not object at trial to the 
definition of "mental disease or defect" the jury were provided, 
we review for a substantial likelihood of a miscarriage of 
14 
 
 
 
justice.  See Commonwealth v. Niemic, 427 Mass. 718, 720 (1998), 
S.C., 451 Mass. 1008 (2008). 
 
Under Commonwealth v. McHoul, 352 Mass. 544, 546-547 
(1967), a lack of criminal responsibility is defined as follows: 
"A person is not responsible for criminal conduct if at the 
time of such conduct as a result of mental disease or 
defect he [or she] lacks substantial capacity either to 
appreciate the criminality [wrongfulness] of his conduct or 
to conform his conduct to the requirements of law" 
(citation omitted). 
 
The Model Jury Instructions on Homicide do not define the term 
"mental disease or defect."  See Dunphe, 485 Mass. at 878-879.  
The instructions do clarify, however, that the phrase is a legal 
term that "need not fit into a formal medical diagnosis" 
(citation omitted).  Id. 
 
Kelly initially described a mental disease or defect as 
"words in the statute that determine criminal responsibility, 
so-called insanity in the state.  And these terms were terms 
that were written in the early '60's, in which period of time 
mental diseases meant serious psychiatric conditions such as 
schizophrenia and manic depressive disorder, now bi-polar 
disorder."  The defendant argues that, absent a curative 
instruction or further clarification from defense counsel, the 
jury would not have understood that they were not required to 
adopt any particular definition, or that experts differ in their 
definitions. 
15 
 
 
 
When Kelly mentioned "the statute" in describing a mental 
disease or defect, defense counsel objected on the ground that 
it was legal analysis.  The prosecutor then asked Kelly to 
testify as to what the term "mental disease or defect" meant as 
a psychiatrist.  Kelly explained that the term had been used in 
the early Twentieth Century and meant "serious mental conditions 
such as the model being diseases . . . includ[ing] conditions 
such as . . . schizophrenia, such as manic depressive 
disorder . . . .  And those would be serious conditions that 
tend to have a biological component."  Kelly then stated that, 
in his opinion, the defendant did not suffer from a mental 
disease or defect.  Defense counsel did not object to this 
second definition. 
 
Defense counsel later asked the judge to clarify for the 
jury the legal definition of "mental disease or defect."  After 
the judge read aloud the model jury instruction on mental 
disease or defect, defense counsel apparently decided that the 
model instruction would sufficiently clarify the definition, and 
that his best course would be to comment on the definition in 
his closing.  Thus, in his final charge, the judge instructed, 
"The phrase 'mental disease or defect' is a legal term, not a 
medical term.  It need not fit into a formal medical 
diagnosis. . . .  It is for you to determine in light of all the 
evidence whether the Defendant had a mental disease or defect." 
16 
 
 
 
 
If a defense expert has testified concerning the McHoul 
test, see McHoul, 352 Mass. at 546-547, a Commonwealth expert 
may testify in rebuttal even if, in that expert's opinion, the 
defendant was not suffering from a mental disease or defect at 
the time of the commission of the offense.  See Commonwealth v. 
Laliberty, 373 Mass. 238, 242 n.2 (1977).  An expert's 
definition of "mental disease or defect" may be helpful to the 
jury, but the jury are not required to adopt any particular 
definition.  Id. at 242.  "The sole restriction placed on the 
admission of an expert's opinion concerning a defendant's mental 
state is that he [or she] may express an opinion only in 
accordance with the standard of the McHoul case."  Id. at 243.  
While an expert may frame his or her testimony in terms of the 
McHoul test, it is preferable that the testimony be given in 
purely medical or psychological terms.  See Commonwealth v. 
Shelley, 381 Mass. 340, 348 n.4 (1980), S.C., 411 Mass. 692 
(1992). 
Examining his testimony as a whole, Kelly permissibly 
defined the term "mental disease or defect."  See Laliberty, 373 
Mass. at 242.  Kelly's testimony fit within Laliberty's sole 
restriction, as his description and his opinion addressed the 
defendant's mental state in accordance with the McHoul standard.  
See id. at 243.  Although Kelly should not have mentioned the 
legal definition ("the statute"), the statement was brief, and 
17 
 
 
 
he then reframed the definition in accordance with that used by 
a psychiatrist.  To the extent that defense counsel was 
concerned that the jury would adopt the Commonwealth's 
definition, counsel could have asked any of the defendant's 
three expert witnesses to define the term.  Moreover, the judge 
instructed the jury that the phrase "mental disease or defect" 
is a legal term that differs from the medical meaning of those 
words. 
In sum, the expert's brief testimony concerning the legal 
definition of a mental disease or defect did not rise to the 
level of a substantial likelihood of a miscarriage of justice. 
b.  Instruction distinguishing between lack of criminal 
responsibility and diminished capacity.  The defendant argues 
that the judge abused his discretion by not providing the jury a 
supplemental instruction distinguishing between a lack of 
criminal responsibility and diminished capacity.  The defendant 
maintains that the failure to distinguish these concepts might 
have confused the jury and could have caused them to disregard 
evidence of diminished capacity if they first found that the 
defendant's mental condition did not rise to the level of a 
mental disease or defect.  Because defense counsel requested 
such a supplemental instruction, we review for prejudicial 
error.  See Commonwealth v. Biancardi, 421 Mass. 251, 253-254 
(1995). 
18 
 
 
 
Judges have broad discretion in framing jury instructions, 
including determining the appropriate degree of elaboration.  
See Commonwealth v. Kelly, 470 Mass. 682, 688 (2015).  Here, the 
judge asked defense counsel whether he believed that the 2013 
Model Jury Instructions on Homicide adequately distinguished 
between a lack of criminal responsibility and diminished 
capacity.  In response, counsel requested that the judge 
instruct the jury more clearly how they could distinguish 
between these concepts.  The judge ultimately did not provide 
the requested supplemental instruction. 
In his final charge, the judge instructed, based on the 
then newly adopted 2013 Model Jury Instructions on Homicide, 
that it was the Commonwealth's burden to prove 
"One, that at the time of the alleged crime, the Defendant 
did not suffer from a mental disease or defect, or; 
 
"Two, that if the Defendant did suffer from a mental 
disease or defect, he nonetheless retained the substantial 
capacity to appreciate the wrongfulness or criminality of 
his conduct and to conform his conduct to the requirements 
of the law, or; 
 
"Three, that if the Defendant lacked the substantial 
capacity to appreciate the wrongfulness or criminality of 
his conduct, and to conform his conduct to the requirements 
of the law, his lack of such capacity was solely the result 
of voluntary intoxication by alcohol or other drugs, or; 
 
"Four, that if the Defendant lacked the substantial 
capacity I have just described due to a combination of 
mental disease or defect and his voluntary consumption of 
alcohol or other drugs, then he knew or should have known 
that his use of the substances would interact with his 
19 
 
 
 
mental disease or defect and cause him to lose such 
capacity. 
 
"If one of those four circumstances have been proved beyond 
a reasonable doubt, then the government has satisfied its 
burden beyond a reasonable doubt to establish the 
Defendant's legal sanity." 
 
The judge then went on to explain that a mental disease or 
defect is a legal term, and that the Commonwealth was required 
to prove that the defendant had not been suffering from a mental 
disease or defect at the time of the stabbing. 
 
The judge later instructed on mental impairment as follows: 
"In deciding whether the Defendant intended to kill the 
victim . . . and whether he formed that intent with 
deliberate premeditation, you may consider any credible 
evidence that the Defendant suffered a mental impairment or 
was affected by his consumption of alcohol or drugs.  A 
Defendant may form the required intent and act with 
deliberate premeditation even if he suffered from a mental 
impairment . . . ." 
 
The judge also explained that the jury could consider evidence 
of the defendant's mental impairment in determining whether he 
had acted with deliberate premeditation or extreme atrocity or 
cruelty. 
 
While perhaps less than pellucid, the judge's instructions 
adequately distinguished between the concepts of mental disease 
or defect and mental impairment.  Considering the instructions 
as a whole, these two concepts were presented to the jury as two 
different factors they should consider.  The jury were told 
that, to prove the defendant was criminally responsible, the 
20 
 
 
 
Commonwealth bore the burden of proving, beyond a reasonable 
doubt, that the defendant did not have a mental disease or 
defect.  They later were instructed that the defendant's mental 
impairment could have affected his ability to form the required 
intent. 
 
It is possible that the jury confused these two concepts, 
as the distinction between them is elusive.  See Commonwealth v. 
Bishop, 461 Mass. 586, 600 (2012).  To the extent that the jury 
did confuse these issues, any such confusion was unlikely to 
rise to the level of prejudicial error.  The Commonwealth's case 
was very strong, and throughout the trial, the jury heard 
extensive evidence concerning the defendant's premeditated 
intent.  On the day before the stabbing, for instance, the 
defendant tried to fly to Nantucket with a large kitchen knife, 
and proffered four different explanations, none of them 
reasonable, when airport security asked why he had had the 
knife.4  The jury also heard that, on the day of the stabbing, 
immediately after arriving on Nantucket, the defendant drove to 
a surf shop and purchased several knives; he had obtained 
directions to that shop from another store, which did not sell 
knives.  Moreover, the jury heard that, before going to the 
 
4 The defendant variously said that he brought the knife to 
cut a cake, that he was taking it to go fishing or to cut fish, 
that he forgot he had the knife with him, and that his sister 
had asked him to bring a knife to cut a turkey. 
21 
 
 
 
cottage, the defendant approached the victim's landlord and 
inquired whether the victim was at home, and then headed toward 
the cottage notwithstanding the landlord's equivocal response.  
In addition, the nature of the twenty-three stab wounds covering 
the victim's torso, nose, arms, and hands, and the 
deoxyribonucleic acid match between the victim and the blood 
found on one of the knives the defendant had purchased, would 
have allowed the jury to infer an intent to kill, as they were 
instructed they could do, from the use of a dangerous weapon in 
this manner. 
 
In sum, while the judge chose not to provide an additional 
instruction distinguishing between mental impairment and mental 
disease or defect, the judge did define both of those terms in 
language consistent with the Model Jury Instructions on 
Homicide.  There was no error. 
 
c.  Inferring malice from the use of a dangerous weapon.  
The defendant argues that the judge should not have instructed 
the jury that they could infer malice from the intentional use 
of a dangerous weapon.  Specifically, the defendant contends 
that the instruction impermissibly elevated the element of 
malice above other elements of murder in the first degree, and 
that it relieved the Commonwealth of its burden to prove malice.  
The defendant also maintains that the instruction subverted 
testimony by his expert that, at the time of the stabbing, the 
22 
 
 
 
defendant was incapable of understanding the consequences of his 
actions.  Because the defendant objected to the provision of 
this instruction, we review for prejudicial error.  See Odgren, 
483 Mass. at 46. 
Under our existing jurisprudence, a jury may infer an 
intent to kill from the use of a dangerous weapon against 
another, even where there is evidence of a defendant's 
intoxication or mental impairment.  See id.  See also 
Commonwealth v. Miller, 457 Mass. 69, 74-75 (2010).  The 
instruction on such an inference must tell the jury that they 
may infer malice, and may not instruct the jury that they must 
draw such an inference.  Odgren, supra at 47. 
Here, the judge instructed the jury on the elements of 
murder in the first degree, on theories of premeditation and 
extreme atrocity or cruelty.  The judge then instructed on the 
three prongs of malice and the elements of murder in the second 
degree.  Before instructing on the inference that they could 
draw from the use of a dangerous weapon, the judge explained: 
"If the Commonwealth has proved beyond a reasonable doubt 
the two elements necessary for second degree murder and has 
proved beyond a reasonable doubt the Defendant's legal 
sanity, then you may convict.  If the Commonwealth has 
failed to prove any of those matters beyond a reasonable 
doubt, then you may not convict of second degree murder." 
 
The judge then gave the disputed instruction regarding the 
inference that the jury could draw from the intentional use of a 
23 
 
 
 
dangerous weapon against another, in language that hewed closely 
to the wording that then had been newly modified in the 2013 
Model Jury Instructions on Homicide: 
"As a general rule, ladies and gentlemen, you are 
permitted, but are not required[,] to infer that a person 
who intentionally uses a dangerous weapon on another person 
intends to kill that person or cause him grievous bodily 
harm or intends to do an act which in the circumstances 
known to him a reasonable person would know creates a plain 
and strong likelihood that death would result." 
 
The judge also later instructed the jury that they could 
consider manslaughter if the Commonwealth failed to prove murder 
in the first degree and murder in the second degree.  He 
described the elements of voluntary manslaughter and explained 
that the Commonwealth had to prove each of those elements, and 
the defendant's legal sanity, beyond a reasonable doubt. 
 
There was no error in the instruction that the jury could, 
but need not, infer an intent to kill from the intentional use 
of a dangerous weapon in the circumstances here.  The 
instruction essentially quoted the then-applicable Model Jury 
Instructions on Homicide concerning the use of a dangerous 
weapon.  See Model Jury Instructions on Homicide 92 (2013).  We 
previously have noted with approval the inference that may be 
drawn from the use of a dangerous weapon, even where there is 
evidence of a defendant's intoxication or mental impairment.  
See, e.g., Odgren, 483 Mass. 47-49; Miller, 457 Mass. at 74; 
Commonwealth v. Oliveira, 445 Mass. 837, 842-845 (2006). 
24 
 
 
 
 
Beginning in 2013, the introduction to the supplemental 
instruction on the inference the jury might draw from the use of 
a dangerous weapon against the person of another added a 
requirement that, before instructing on such an inference, the 
judge had to determine from the evidence at trial that "the 
nature of the dangerous weapon used and the manner of its use 
reasonably supports" the inference.  The 2013 Model Jury 
Instructions on Homicide also noted that, before giving the 
instruction, the judge should consider "the type of dangerous 
weapon and the manner in which it was used in the circumstances 
of the case, and should only give this instruction where the 
nature of the weapon and the manner of its use reasonably 
supports the inference."  See Commonwealth v. Colas, 486 Mass. 
831, 842-843 (2021), citing Commonwealth v. Tu Trinh, 458 Mass. 
776, 784 nn.12, 13 (2011) ("As a general rule, the jury are 
permitted to infer an intent to kill from the use of a dangerous 
weapon. . . .  The reasonableness of this inference depends, as 
set forth in the model jury instructions on homicide, upon 'the 
nature of the dangerous weapon and the manner of its use'" 
[citation omitted]). 
 
While the judge did not make an explicit finding to this 
effect, the nature of the twenty-three penetrating stab wounds 
all over the victim's torso, nose, hands, and arms, the blood on 
walls, floors, and surfaces throughout the cottage, and the 
25 
 
 
 
newly purchased knife that was discarded in the bushes near 
where the defendant left his rental vehicle fully support a 
determination that the circumstances warranted giving this 
instruction.  At a sidebar discussion concerning the judge's 
final charge, the attorneys and the judge discussed at some 
length the changes in this instruction, favorable to defendants, 
to remove the use of the word "malice," which had appeared in 
the prior version of the instructions. 
 
As the defendant points out, courts in some jurisdictions 
have discontinued the use of such an inference.  See, e.g., 
State v. Burdette, 427 S.C. 490, 504-505 (2019) ("Regardless of 
the evidence presented at trial, trial courts shall not instruct 
a jury that the element of malice may be inferred when the deed 
is done with a deadly weapon").  In reaching this decision, the 
South Carolina Supreme Court explained, "When the trial court 
tells the jury it may use evidence of the use of a deadly weapon 
to establish the existence of malice, a critical element of the 
charge of murder, the trial court has directly commented upon 
facts in evidence, elevated those facts, and emphasized them to 
the jury."  Id. at 502.  The Appeals Court similarly has held 
that "the court in all cases should be scrupulously careful not 
to invade the province of the jury by undertaking to decide on 
the weight or effect of evidence."  Commonwealth v. Cote, 5 
Mass. App. Ct. 365, 369-370 (1977) (judge "shall not charge 
26 
 
 
 
juries with respect to matters of fact" or "direct what 
inferences the jury should draw from certain evidence" [citation 
omitted]). 
 
Of course, the instruction on the inference that may be 
drawn does not direct the jury to make such an inference.  And 
here, the evidence of malice was overwhelming, and there was no 
need to draw an inference from the use of a knife that the 
defendant intended to kill the victim.  The twenty-three wounds 
to the victim's torso, nose, arms, and hands, leaving blood on 
walls, floors, and fixtures throughout the cottage, in 
conjunction with the defendant's efforts to obtain the knife on 
arrival, to delay discovery of the victim's body by closing up 
the cottage, to dispose of the weapon after the attack, and to 
flee the scene all supported a finding of an intent to kill. 
The defendant also argues that certain instructions 
differed impermissibly from the instructions given in Miller.  
In Miller, 457 Mass. at 70, 72, the defendant was being tried on 
a charge of murder in the first degree and pursued a defense of 
intoxication and mental impairment.  Because the victim had been 
killed with a hammer, the judge also instructed on the inference 
the jury could draw from the use of a dangerous weapon.  Id. 
at 71-74.  Following that instruction, the judge told the jury, 
"I reiterate, whenever the Commonwealth must prove that the 
defendant intended to do something . . . , you may consider any 
27 
 
 
 
credible evidence of mental impairment . . . in 
determining . . . the defendant's intent or knowledge beyond a 
reasonable doubt." 
The defendant contends that the judge should have provided 
a similar instruction in this case, which would have directed 
the jury to consider mental impairment and intoxication whenever 
the Commonwealth was required to prove intent.  We do not agree.  
Prior to instructing on the elements of murder, the judge gave 
an instruction, following the 2013 Model Jury Instructions on 
Homicide, that the jury "may consider any credible evidence that 
the Defendant suffered a mental impairment or was affected by 
his consumption of alcohol or drugs."  We previously have 
affirmed the use of such an instruction.  See Oliveira, 445 
Mass. 845-846.  Moreover, immediately prior to, and immediately 
following, the instruction on the possible inference to be drawn 
from the use of a dangerous weapon, the judge instructed the 
jury that the Commonwealth was required to prove the defendant's 
mental state beyond a reasonable doubt. 
Accordingly, there was no error in the instruction on the 
inference of an intent to kill that the jury could draw from the 
use of a dangerous weapon. 
 
d.  Instruction that defendant was incapable of resisting 
urge to consume drugs and alcohol.  The defendant also contends 
that the jury should have been instructed to consider whether he 
28 
 
 
 
was incapable of resisting the urge to consume drugs or alcohol, 
regardless of whether he was aware of negative interactions 
between his consumption of drugs or alcohol and his mental 
state.  The defendant maintains that such an instruction should 
have been given when the jury were instructed that he was 
criminally responsible if he knew that substances such as drugs 
and alcohol would interact with his mental disease or defect and 
would cause him to lose the capacity to conform his conduct to 
the law.  See DiPadova, 460 Mass. at 439-440 (Appendix) 
(establishing so-called DiPadova instruction).  In the 
alternative, the defendant argues that the DiPadova instruction 
should have been omitted entirely.  We do not agree. 
 
As the defendant did not request a DiPadova instruction, 
and did not object to the instruction given, we review to 
determine whether the absence of the requested instruction 
created a substantial likelihood of a miscarriage of justice. 
See Commonwealth v. The Ngoc Tran, 471 Mass. 179, 183-184 
(2015). 
 
For almost fifty years, we have held that drug addiction, 
by itself, does not qualify as a mental disease or defect that 
could support a finding of a lack of criminal responsibility.  
See Commonwealth v. Sheehan, 376 Mass. 765, 767-769 (1978).  A 
drug-induced or exacerbated mental disease or defect, however, 
ultimately may result from the use of a prescription drug, an 
29 
 
 
 
illegal drug, the chronic abuse of alcohol, a physical illness, 
or a genetic disorder.  See Dunphe, 485 Mass. at 880-881.  The 
origins of the disease or defect are irrelevant.  See id.  
Moreover, where a defendant has a mental disease or defect such 
that the defendant lacks the capacity to conform his or her 
conduct to the law, the consumption of alcohol or drugs does not 
preclude the defense of a lack of criminal responsibility.  See 
Commonwealth v. Muller, 477 Mass. 415, 428 (2017). 
A lack of criminal capacity, arising from the long-term 
abuse of alcohol, has been recognized as establishing a lack of 
criminal responsibility.  See Dunphe, 485 Mass. at 880-881, and 
cases cited.  In addition, where a defendant has a mental 
disease or defect that, by itself, does not render the defendant 
incapable of understanding the wrongfulness of his or her 
conduct, and conforming that conduct to the law, the consumption 
of drugs or alcohol in conjunction with the mental disease or 
defect may result in the defendant being unable to do so.  When 
the consumption of drugs or alcohol exacerbates a mental 
condition such that the interaction of the drugs or alcohol with 
the condition causes a defendant to lack the substantial 
capacity, and the defendant does not know, or have reason to 
know, that the consumption of drugs or alcohol would trigger the 
exacerbation in his or her mental condition, the defendant is 
not criminally responsible.  See id. at 882.  By contrast, if 
30 
 
 
 
the Commonwealth were able to prove, beyond a reasonable doubt, 
that a defendant knew or had reason to know that the consumption 
of alcohol or drugs would so exacerbate his or her mental 
condition, then the defendant would be criminally responsible.  
See id. 
In response to the defendant's request, the judge here gave 
the DiPadova instruction, including the following: 
"A Defendant who lost the substantial capacity I have just 
described after he consumed drugs or alcohol and who knew 
or had reason to know that his consumption would trigger or 
intensify in him a mental disease or defect that could 
cause him to lack that capacity is criminally responsible 
for his resulting conduct." 
 
This instruction properly informed the jury of their ability to 
determine the defendant's degree of criminal responsibility by 
considering his mental disease or defect and its interaction 
with his consumption of drugs and alcohol.  The defendant points 
to no case, in the Commonwealth or in any other jurisdiction, 
where the requested instruction -- that the jury consider 
whether the defendant was incapable of resisting the urge to use 
substances -- has been given, and we are aware of none.  Rather, 
the defendant's requested instruction in some respects 
contravenes this court's holding in Sheehan, 376 Mass. at 767-
769, that drug addiction, standing alone, and being "blacked 
out" from drug addiction does not establish a mental disease or 
31 
 
 
 
defect that would warrant a finding of not guilty by reason of 
insanity. 
In support of his argument that the additional instruction 
should have been given, the defendant points out that the 
science relied upon in Sheehan is outdated and no longer 
reflects current scientific understanding.  In Sheehan, 
376 Mass. at 766-767, the defendant argued that drug addiction 
was a mental disease that, without more, would warrant a finding 
of not guilty by reason of a lack of criminal responsibility.  
Rejecting this argument, the court explained: 
"The essential consideration is not whether the medical 
profession characterizes drug addiction as a mental disease 
or defect but rather whether our society should relieve 
from criminal responsibility a drug addict who at the time 
of the commission of the crime was unable to conform his 
conduct to the requirements of law because of his 
addiction." 
 
Id. at 769.  The court noted that, in some circumstances, an 
individual with a substance use disorder may be relieved of 
responsibility for criminal conduct, such as when the user's 
lack of criminal capacity is not a result of the addiction.  Id.  
But the court rejected the view that addiction alone is 
sufficient to support a finding that the consumption of the 
drugs was involuntary.  Id. at 771.  In support, the court 
pointed to research by Herbert Fingarette.  See Fingarette, 
Addiction and Criminal Responsibility, 84 Yale L.J. 413, 443 
(1975).  Fingarette's findings regarding addiction subsequently 
32 
 
 
 
have been widely denounced.  See, e.g., Roberts, Herbert 
Fingarette, Contrarian Philosopher on Alcoholism, Dies at 97, 
N.Y. Times, Nov. 15, 2018. 
 
As the defendant emphasizes, a number of decisions by this 
court and the Appeals Court since Sheehan was issued have 
recognized addiction as a disease that "may affect an 
individual's urge to use substances."  Commonwealth v. Eldred, 
480 Mass. 90, 94 n.6 (2018).  See, e.g., Dunphe, 485 Mass. 
at 880-883, and cases cited; Commonwealth v. Peno, 485 Mass. 
378, 388 (2020); Commonwealth v. Plasse, 481 Mass. 199, 205-208 
(2019), and cases cited.  The defendant's argument that there 
was a substantial likelihood of a miscarriage of justice because 
the requested instruction was not given, however, is unavailing. 
 
Regardless of whether the science relied upon in Sheehan is 
outdated, there was ample evidence before the jury to support a 
finding that the defendant's conduct was knowing and 
intentional, and undertaken after substantial planning, 
notwithstanding his evident intoxication at the time of the 
attack.  On this record, the jury could have found that the 
defendant's level of intoxication, in conjunction with his 
mental health issues, did not negate his ability to plan and 
carry out a premeditated attack on the victim, attempt to 
conceal the evidence of the attack, and then drive a vehicle on 
a State highway with no apparent impairment in his ability to 
33 
 
 
 
comply with the traffic laws.  The judge did not err in 
instructing the jury consistently with DiPadova, and certainly 
did not create a substantial likelihood of a miscarriage of 
justice in relying upon instructions we recently affirmed. 
e.  Review under G. L. c. 278, § 33E.  The defendant also 
asks that we exercise our authority under G. L. c. 278, § 33E, 
to grant him extraordinary relief.  Having carefully reviewed 
the record, we discern no reason to order a new trial or to 
reduce the degree of guilt. 
 
 
 
 
 
 
Judgments affirmed.