As Luigi Mangione’s state murder trial approached, his attorneys had decisions to make.

One of the most consequential was whether he should argue he killed UnitedHealthcare CEO Brian Thompson because of an “extreme emotional disturbance.”

That strategy, if successful, could have spared the 28-year-old Ivy League graduate from the lengthiest possible sentence in state prison. But it also posed a serious risk, because it would essentially require Mangione to admit he’d committed the killing before he faced a separate trial in federal court, where there is no extreme emotional disturbance defense. His lawyers wanted to keep it a secret that he was even considering such a strategy.

Attorney Karen Friedman Agnifilo told a state judge in early June that any publicity about a mental health defense could hurt her client and taint the jury pool.

“And this is important, because we are still in the process of testing Mr. Mangione to determine what we will be doing,” she said, according to the transcripts.

The new details came to light in recent court filings and newly unsealed transcripts in the state case. Taken together, they offer a glimpse into the complicated calculations Mangione’s attorneys were making in the months leading up to his federal guilty plea. A spokesperson for the defense team declined to comment on the new filings.

Prosecutors have accused Mangione of following the health insurance executive to New York City and fatally shooting him outside a Midtown hotel in December 2024. A security camera captured the shooting, and the footage quickly went viral. Police arrested Mangione in Altoona, Pennsylvania, days later, after the manager of a local McDonald’s recognized him. Mangione has become an international celebrity, with fans who consider him a hero for those plagued by the healthcare industry, and critics who condemn what they see as a celebration of violence.

In the lead-up to the state trial, which was scheduled to begin in September, Justice Gregory Carro revealed in court that Mangione planned to pursue a mental health defense — a dramatic twist in the closely watched legal saga. The revelation dominated the news cycle before Mangione’s defense attorneys doubled back on those plans just a day later.

New York law allows people accused of crimes to argue that they were extremely emotionally disturbed when they committed a crime and should face less serious punishment.

Friedman Agnifilo told the state judge in early June that it was “pretty self-evident” the case “had a potential for a psychiatric defense,” according to a transcript of a June 3 court conference. She cited Mangione’s medical records and “extensive writings.” Prosecutors said police found a notebook and a letter addressed “To the Feds” when they arrested him.

But the attorney said she had faced “immense” logistical hurdles as she tried to secure psychological testing for her client, the transcripts show. Friedman Agnifilo said the testing was necessary to figure out the extent of any mental health issues Mangione may have been facing at the time of the crime. Some doctors who treated him in the past had also “refused to cooperate,” she told Carro, “because of the notoriety of this case.”

Gary Galperin, an adjunct professor at Cardozo Law School and former prosecutor in the Manhattan district attorney's office, said using an extreme emotional disturbance defense would have put Mangione in a bind. If he had gone with that tactic, he would essentially have to admit that he was guilty, the former prosecutor said. That information could have been used against him at his federal trial, Galperin said.

“ That could be very prejudicial to Mangione, because the defense means that he's implicitly, or I would say directly, acknowledging he committed the crime,” he said.

Galperin said pleading guilty in federal court, then trying to get the state charges dismissed, became Mangione’s best option — but the path ahead was still uncertain.

As the state trial approached, he said, it was “time to face the music, time to bite the bullet.”