An Army sergeant charged with fatally shooting five service members at a combat stress clinic in Iraq does not deserve the death penalty, a defense attorney said Thursday, arguing his client's actions could not have been premeditated because of his deteriorating mental health.

Sgt. John Russell, 46, is accused of carrying out the deadliest act of soldier-on-soldier violence in the war in Iraq as he was nearing the end of his third tour in 2009. He's been charged with five counts of premeditated murder, two counts of attempted premeditated murder and one count of assault.

The government wants to pursue his prosecution as a capital case.

The Army concluded a four-day hearing Thursday on whether Russell should face a court martial. The presiding officer will recommend whether a trial should go forward or whether the charges should be modified or dismissed.

Russell's attorneys have used testimony to suggest that he was under stress from multiple deployments in Iraq and frustrated with what they have described as inadequate mental health treatment. One of them, Capt. Larris Hutton, said during closing arguments that Russell's mind "was cracking, and it cracked and cracked again."

"Sergeant Russell didn't calculate. Sergeant Russell didn't evaluate. Sergeant Russell didn't premeditate," Hutton said.

Government attorneys sought to show that whatever stress he faced, Russell remained coherent enough just before the shootings in May 2009 to reflect on his actions.

"There's no doubt that Sergeant Russell murdered five people," said one of the prosecuting attorneys, Capt. Patrick Scudieri. "He went down to the combat stress clinic, where he knew everyone in that clinic was unarmed."

Killed in the shooting were Navy Cmdr. Charles Springle, 52, of Wilmington, N.C., and four Army service members: Pfc. Michael Edward Yates Jr., 19, of Federalsburg, Md.; Dr. Matthew Houseal, of Amarillo, Texas; Sgt. Christian E. Bueno-Galdos, 25, of Paterson, N.J.; and Spc. Jacob D. Barton, 20, of Lenox, Mo.

Russell's case has raised questions about the mental problems for soldiers caused by repeated tours of duty in Iraq and Afghanistan and whether the Army's mental health care is adequate. The case led to an investigation and a critical report.

An August 2009 memo, admitted as evidence near the end of the hearing, showed that a three-member evaluation panel from the Walter Reed Army Medical Center in Washington found that Russell suffered from severe depression "With Psychotic Features" and chronic post-traumatic stress disorder. It also said Russell was "unable to cooperate intelligently" in his own evaluation.

A later evaluation, dated March 2011, said Russell was suffering from those conditions at the time of the shooting. The report said his major depression with psychotic features was "In Partial Remission."

And a statement, signed by attorneys for both sides and admitted as evidence, said Russell underwent treatment at a federal prison medical center in Butner, N.C., starting in August 2009 and the warden didn't consider him "restored to competency" until July 2010.

In an interview after the hearing ended, two of Russell's sisters, Suzanne Laugner, of Dennison, Texas, and Jennifer Young, of Colbert, Okla., said he'd had mental health issues after his second tour of duty in Iraq in 2005 and 2006. Russell grew up near Sherman, Texas, about 60 miles north of Dallas.

When Russell's sisters visited him in the North Carolina medical center in October 2009, they found, according to Young, "He was gone."

"He didn't look at us," Young said. "He's got a blank stare. He couldn't make a complete sentence or thought."

During the hearing, witnesses offered some conflicting testimony about Russell's interactions with the combat stress clinic in the days before the shootings. His attorneys presented testimony suggesting that two officers there treated him poorly, dismissing his mental health concerns.

James Culp, another one of Russell's attorneys, called the government's pursuit of the death penalty "unforgiveable" in an interview. Laugner said the Army needs to acknowledge mistakes by its personnel in her brother's care and learn from them.

"If you don't learn from them, you're going to make those mistakes over and over," she said. "It's going to happen over and over."

Members of victims' families also attended the hearing but did not respond to a request for interviews made through Army officials.

But Scudieri said defense attorneys are trying to pin blame on the people Russell encountered at Camp Liberty, outside Baghdad. Scudieri said Russell dealt with experienced mental health professionals and noted that Russell went back to the clinic for help within several days.

"The only person to blame for these five, cold-blooded murders is seated three seats behind me," Scudieri said, referring to Russell.

Hutton said defense attorneys are not dismissing the seriousness of Russell's actions, nor the scope of the tragedy or the loss to the other service members' families. But, Hutton said, Russell was "wounded," needed immediate help and did not get the assistance he needed.

Witnesses on Thursday included Capt. David Vasquez, the second in command of Russell's unit, the 54th Engineer Battalion, based in Bamberg, Germany. He said Russell was upset the day before the shootings and again on the morning of the shootings, when he looked as though he had not slept.

"He was just rambling on about how we all had just given up on him and didn't like him at all," Vasquez said, testifying by phone from Afghanistan.

But during cross-examination by Scudieri, Vasquez acknowledged that Russell was coherent.

"I could understand him," he said.