Medical diagnosis of legal culpability: the impact of early psychiatric testimony in the 19th century English criminal trial

Fast-paced developments in psychiatry, neuroscience and emerging neuroimaging technologies place continual pressure on the legal recognition of mental illness and disease across jurisdictional boundaries. Nevertheless, the Canadian legal definition of exculpatory mental disease in the context of criminal liability has remained largely static, sheltered from the immediate influence of medical theory and advancements. In order to effectively reflect on the intersection of mental health and criminal justice systems in this area, it is important to understand its historical development and the English common law origins of the current approach. Specifically turning to the early 19th century, documented history and accounts of early medical witness testimony on the mental state of the accused provide a unique opportunity to understand the initial collision between fundamental concepts of moral and legal culpability and new scientific understandings of mental function and disease. In this article, I suggest that early psychiatric testimony to the accused's mental state challenged the evolving criminal law of 19th century England to reconcile its restrictive definition of "insanity" with expanding scientific reasoning and accounts of mental disease. The trial of Edward Oxford, an attempted royal assassination case of 1840, is examined as a symbolic height in this conflict prior to the first common law pronouncement of the current approach in 1843. As debate continues on the role of medical advancement in the identification of exculpatory medical disorders in law, this historical perspective may serve as a touchstone in balancing the enforcement of legal culpability with our society's greater appreciation for mental illness.     

Recent developments in German health law

Health law provides the regulatory constitution for the medical and healthcare system. It covers individual medical treatment as well as public healthcare provision and is insofar medical law as well as social security law (statutory health insurance law). The medical and health sciences (public health sciences) are the main complementary disciplines of health law. This article gives an account of some representative developments in both fields which have taken place in the last three years.     

The past, present and future of mental health law: a therapeutic jurisprudence analysis

This article uses a therapeutic jurisprudence perspective to review the evolution of mental health law in the Western world by examining developments at various stages in history, in particular the 20th century. It suggests that one of the major challenges for the future, from a therapeutic jurisprudence perspective, will be to help minimise the stigma, prejudice and discrimination associated with mental health law. The article concludes with the suggestion that the question of whether mental health law itself, because it contributes to discrimination against mentally disordered people, may be anti-therapeutic requires more investigation and consideration.     

Causality and Causation in Law, Medicine, Psychiatry, and Psychology: Progression or Regression?

In this article, I review recent developments in the areas of law, medicine, psychiatry, and psychology concerning causality and causation. I analyze the validity of the 2008 edition of the American Medical Association (AMA)’s guides to the evaluation of permanent impairment and its accompanying volume on causation. I conclude with recommendations for a synthetic approach to causality in the legal field and a more consistent model of impairment in the mental health one. The AMA’s book on medical causation needs careful revision.     

Recent developments in the transracial adoption debate.

This article places the controversy over transracial adoption (TRA) in its historical context and analyzes recent developments in the law governing TRA policy. Because unfounded "authority" from the field of mental health infuses current debate, the authors alert psychiatrists to two powerful forces that improperly influence today's legal arena: community preference for same-race families and biased professional norms of mental health professionals.     

Mental health law and the EU: the next new regulatory frontier?

Over the last decade the EU's engagement with health law and policy has rapidly increased and there is now a growing body of literature highlighting this evolution and the impact of legal and regulatory structures in this area. In contrast the specific impact of EU law and policy in relation to the area of mental health remains the subject of comparatively little engagement. The aim of this paper is to examine whether mental health law and policy will become a major site for EU policy and law in the future. It examines the development of EU policy in this area. It sets this in the context of related legal developments such as the Charter of Fundamental Rights and the new EU Patients Rights Directives. It suggests that while it might be at present premature to envisage that a single body of EU mental health law itself may be unlikely that nonetheless the EU presents what is a potentially very influential site for regulation, law and policy in this area in the years to come.     

Privacy and research involving humans

Human research ethics committees in Australia are required to consider compliance with privacy law as an element of the ethics of research. Recent legislation has introduced federal private sector privacy protection, as well as privacy protection at State and Territory levels. In Victoria, which is used as an example in this article, State privacy legislation covers public sector information and health records. This article considers the implications for research involving human participants and for ethics committees of the new privacy regimes. Although privacy law is a potential barrier to research about humans, the need for exceptions has been dealt with effectively in the context of medical or health research. However, privacy law and its chilling effect could potentially be a serious impediment to some forms of non-health-related research, such as social and socio-legal research.     

Human rights and health law

Important statutory and common law developments are changing the landscape of health law in Australia. Human rights considerations are formally included amongst the factors to be applied in the interpretation of statutory provisions and evaluating the lawfulness of actions on the part of government instrumentalities. The Human Rights Act 2004 (ACT) and the Charter of Human Rights and Responsibilities Act 2006 (Vic) create limited bills of rights at State/Territory level in two Australian jurisdictions. Although neither is entrenched, they have the potential to make it more difficult for government to promulgate laws that are inconsistent with human rights, as defined. They will have important repercussions for the evolution of health law in these jurisdictions. The decision of Royal Women's Hospital v Medical Practitioners Board (Vic) [2006] VSCA 85 by the Victorian Court of Appeal has also provided a legitimation for parties to incorporate human rights perspectives in submissions about the interpretation of statutory provisions where health rights are in conflict.     

The future of informed consent in British common law

Within the common law world, the use of the term informed consent implies the American doctrine. Informed consent as a doctrine is not part of the law in the United Kingdom. However, it is possible to predict a way forward in disclosure cases yet to be heard in the courts of the United Kingdom. These predictions are based on current developments in the common law in the United Kingdom as well as those in Canada and Australia, on the European Convention on Human Rights and Biomedicine and on trends within the medical profession itself in the light of the Bolam test.     

Saleem A. Shah

This article introduces a special section ofLaw and Human Behavior entitled Commenorative Articles in Memory of Saleem Shah. The six articles that it introduces describe Shah's lifetime contributions to the development of concepts and research in law and mental health, as well as his substantial influence on the quality of forensic mental health services nationally and internationally.     

Psychiatric Darwinism = survival of the fittest + extinction of the unfit

This article is a critical analysis of the American Health Security Act of 1993. Although AHSA was soundly defeated when first proposed, parts of it have been enacted into law in 1996, with the prospect of further piece-meal enactments in the future. It includes matters of fundamental importance to American mental health practitioners, to vulnerable citizens with psychiatric disorders, to their families, and to their few champions in medicine and law. Utilitarianism is the unstated philosophical substructure of AHSA and its legislative progeny, i.e., whatever cuts medical costs and saves money is good. The author delineates AHSA's mental health entitlements and limitations of in-patient, out-patient, and other patient care. She enumerates a dozen major imperfections and dangers of this mental health law, especially its medical utilitarianism emphasizing outcomes and quality of life. Dr. Cosman argues that medical cost, outcome, quality of life, and managed competition threaten the essential liberties and the lives of older persons, persons who are chronically ill, fatally ill, and most particularly those who are mentally impaired. She concludes that if limited money, medicine and time are invested only in inevitable medical success, then America's medicine by its medical law will be Medical Darwinism encouraging survival of the fittest by requiring extinction of the unfit.     

International human rights for mentally ill persons: the Ontario experience

This article is part of a working project which assesses Ontario's mental health legislation and practice vis-à-vis international human rights standards. The paper focuses on procedural safeguards provided by the major international human rights instruments in the field of mental health law such as the UN Principles for the Protection of Persons with Mental Illness (MI Principles) and the European Convention on Human Rights as interpreted by the European Human Rights Court. In analysing Ontario's compliance with international standards, the paper will explore some problems arising from the implementation of the legislation with which the author is familiar with from his experience as counsel for the Consent and Capacity Board. The paper aims to generate discussion for potential reforms in domestic legal systems and to provide a methodology to be used as a tool to assess similar mental health legislation in other local contexts.     

The ADA at three years: a statute in flux

In the three years since the Americans with Disabilities Act (ADA) was enacted, significant developments have occurred in the form of new administrative and judicial interpretations of the Act. The new guidelines and decisions will assist employers in complying with the ambiguous, and sometimes confusing, provisions of the ADA. Recent developments in areas such as the definition of a disability and the permissibility of medical inquiries, along with continuing developments in the areas of mental disabilities and defining reasonable accommodations, give employers insight into the obligations created by the ADA. These developments are a good starting point to understanding the ADA, but there is still a long way to go. This article surveys the recent developments in the law and examines the considerations that have become important to the Equal Employment Opportunity Commission and the courts in interpreting the ADA's provisions.     

Redefining mental health law

Mental health law traditionally focuses on preserving the civil and constitutional rights of people labeled mentally ill. However, because of fundamental changes in the public mental health system. most people labeled mentally ill no longer reside in state psychiatric hospitals. As a result, the core policy issue in mental health today is assuring access to community based services, supports, and housing which enable people to live successfully in the community. Because of this different environment, the definition and scope of mental health law must be expanded dramatically if those interested in the subject are to continue to influence mental health policy. This article examines five contemporary mental health policy issues, including changes in reimbursement systems and the growth of the consumer and family movements, that illustrate the legal, policy, and research questions which will emerge in an expanded and redefined mental health law agenda. The author thanks Ingo Keilitz, Thomas Hafemeister, and Pamela Casey for their review of earlier drafts of this article.     

Community-based care and compulsion: what role for human rights?

This article considers the role of traditional conceptions of human rights in relation to the challenges posed by community treatment orders (CTOs). It explores how traditional rights discourse in mental health, which has focused on the rights of liberty and autonomy, is to be located within the landscape of community-based mental health law. Using jurisprudence arising under the European Convention on Human Rights, it identifies the limitations of traditional rights in this context. However, it argues that traditional concepts such as liberty and privacy still have a role to play.     

Justice and equality in mental health law: the European experience

This is the text of a lecture delivered at the World Conference of the International Academy of Law and Mental Health in Sydney in September 2003 on the occasion of the award to the author of the Prix Philippe Pinel. Its theme is the potential of the European Convention on Human Rights to secure the human rights of people with mental disorders and disabilities, viewed in the context of the legislation on mental health and mental incapacity in England and Wales. Its conclusion is that the Convention is better at protecting them from unwanted or unnecessary treatment and care than it is at securing for them equal access to the treatment and care they want or need. The lecture has been updated to reflect developments in the United Kingdom since 2003.     

Of Eggshells and Thin-skulls: a consideration of racism-related mental illness impacting Black women

Recent research has indicated that the prevalence of mental disorders is estimated to be higher among Blacks than among Whites, most likely due to the nexus of race and socioeconomic disparity. Blacks are under-represented in in-patient populations and more likely than Whites to use the emergency rooms for mental health treatment. Numerous studies confirm that Blacks drop out of mental health services at a significantly higher rate than Whites and use fewer treatment sessions for mental health issues. Furthermore, Blacks enter mental health treatment at a later, more advanced stage than Whites, under-consume community mental health services of all kinds, are misdiagnosed more often than Whites, and are more often diagnosed with a severe mental illness than Whites. People from diverse ethnic backgrounds often are prevented from receiving adequate mental health treatment due to misdiagnoses and lack of access to the services they need. Factors contributing to this disparity include a general mistrust of medical health professionals, cultural barriers, co-occurring disorders, socioeconomic factors, and primary reliance on family and the religious community during times of distress. Unfortunately, the traditional institutions of racialized research largely ignore the disparate social and political exposures confronting people of color, such as residential and occupational segregation, racial profiling, tokenism, discrimination, racism, and the consequential physiological and psychological effects flowing from the macro and micro effects of such interactions and intersectionalities. This article explores these issues and proposes civil law legal frameworks for addressing these disparities. In particular, it is suggested that renewed consideration be made of the Thin-skull and Eggshell doctrines in the United States and comparable traditional international doctrine.     

Mentally ill offenders eligible for diversion at local court in New South Wales (NSW), Australia: factors associated with initially successful diversion

Diversion away from the criminal justice system and into mental health treatment services is a key strategy for addressing the well-established burden of mental illness suffered by those presenting to court. While mental health courts, court liaison and court diversion services have been developed in many jurisdictions internationally, there is limited research evidence to support their effectiveness in identifying those with mental health need and achieving successful diversion. The Statewide Community and Court Liaison Service in New South Wales, Australia, identifies mentally ill offenders likely to meet legal eligibility criteria for diversion at the busiest local courts across the state. Utilising data collected by mental health clinicians working in the service, 8317 individuals were identified as being eligible for court diversion on at least one occasion during the study period (1 July 2008 and the 30 June 2015) and 57.3% were subsequently diverted by Magistrates. Successful diversion at this first step was associated with being female, older, of non-Aboriginal and/or Torres Strait Islander background, and having a serious mental illness, replicated when stratified by sex and by Aboriginal and/or Torres Strait Islander background. There may be barriers to mental health diversion at court for individuals with particular socio-demographic characteristics which future service developments may need to take into account.     

The law and the public's health: a study of infectious disease law in the United States

Law plays crucial roles in the field of public health, from defining the power and jurisdiction of health agencies, to influencing the social norms that shape individual behavior. Despite its importance, public health law has been neglected. Over a decade ago, the Institute of Medicine issued a report lamenting the state of public health administration, generally, and calling, in particular, for a revision of public health statutes. The Article examines the current state of public health law. To help create the conditions in which people can be healthy, public health law must reflect an understanding of how public health agencies work to promote health, as well as the political and social contexts in which these agencies operate. The authors first discuss three prevailing ways in which the determinants of health are conceptualized, and the political and social problems each model tends to create for public health efforts. The analysis then turns to the core functions of public health, emphasizing how law furthers public health work. The Article reports the results of a fifty-state survey of communicable disease control law, revealing that few states have systematically reformed their laws to reflect contemporary medical and legal developments. The Article concludes with specific guidelines for law reform.     

Liberty: human rights and mental health

In this paper, Lord Phillips reflects on the present state of the law relating to mental health; he considers the place of the common law doctrine of necessity as the basis for the detention of patients; he reviews a number of issues arising from the jurisprudence of the European Court of Human Rights in Strasbourg and a number of recent decisions of the Court of Appeal. Finally, he considers the prospects for change in the law foreshadowed in the Government's White Paper on the Reform of Mental Health Law (2000).