Medicine,Science and the Law

A study of 51 consecutive gunshot suicides in the County of Avon, England, between 1974 and 1990 is presented. All cases were male. The majority were married and lived with their spouses. Most suicides occurred in the setting of a domestic dispute, although at least nine had a significant past psychiatric history. Possible implications of firearm legislation and psychiatric treatment on firearm suicide rates are discussed.

A total of 394 individuals died by their own hand in Wolverhampton from the years 1976 to 1990. The rate of suicide was 10.5/100, 000 per year, compared with the official statistics returned by HM Coroner of 232 cases in this 15-year period, or 6.2/100, 000 per year. Suicide does not appear to have increased in the Borough of Wolverhampton over these 15 years but the Coroner's Rules, which at present apply, have the effect of concealing the true numbers of suicides. The Coroner's figures in this series only reflected 59% of the probable true suicide rate.

The ratio of males to females was 1.96:1 and there was no significant difference in the average ages of male and female suicides. Drowning was found to be a common cause of suicide in the elderly population (over 60 years of age) and there was an increased incidence of hanging in Asians, especially young Asian females, as compared with their numbers in the population of the borough. A positive psychiatric history was present in 64.5% of suicides and such a history was more common in deaths due to drug overdose and drowning. There was no obvious seasonal variation found in the suicide rate.

A total of more than 28 chemical entities/reaction products in the form of gases, vapour and particulate matter were reported from the tank E-610 of methyl isocyanate (MIC) storage tank of Union Carbide India Limited on the night of 2/3 December 1984 in Bhopal. In earlier studies, methyl isocyanate and its trimer, with a few other compounds, were reported in the human victims preserved in deep freeze. Randomly selected samples were analysed by gas Chromatograph coupled with mass spectrometer (ITD-800, Finnigan MAT, UK). Four of the cases showed the peaks and fragmentation pattern identified with one of the unidentified compound of molecular weight 269 amu in the Tank Residue, which constituted about 0.2 area per cent on GC-ITD. After isolation by column chromatography and being exposed to characterization, it was identified as a Spiro compound. It was possibly formed by the polymerization of five molecules of methyl isocyanate.

Intra-aortic balloon counterpulsation may result in serious and possibly fatal vascular complications, such as arterial dissection, in as many as 20 per cent of cases. A significant proportion of these complications may go unrecognized clinically.

The following is an account of such a case from Singapore in which an elderly patient with a history of severe ischaemic heart disease died within 25 hours of coronary bypass surgery (resulting from massive intraperitoneal haemorrhage), as a consequence of post-operative intra-aortic balloon counterpulsation. The clinico-pathological and medicolegal aspects of the case are also discussed, together with a brief mention of the role of post-mortem coronary angiography in assessing venous graft patency and integrity.

Since it first became possible to diagnose Post Traumatic Stress Disorder (PTSD) categorically with the advent of DSM-III (American Psychiatric Association, 1980), its use in the American Courts to substantiate civil claims has burgeoned. This situation may be set to repeat itself in the UK Mental health professionals need to be aware that there is a substantial body of evidence supporting the validity of the concept of a DSM diagnosis of PTSD. However, the reliability of such a diagnosis can be called into question. There are legal and ethical issues involved in assessing and interpreting the DSM criteria, some of which may lead the expert witness to make authoritative pronouncements that are outside his legitimate field of expertise. There is a danger that the legal profession will adopt the DSM as a ‘gold standard’ against which to judge expert testimony. The multiaxial classification of the DSM can be a useful framework for presenting a diagnosis of PTSD, but over-rigid adherence to the criteria at the expense of clinical judgement and experience should be avoided.

Four scuba diving deaths investigated by the Forensic Medicine Unit, University of Edinburgh Medical School, are reported. The pathological investigation of such deaths requires that a detailed history of the events prior to death is obtained and that the site of the accident is fully examined with underwater photographic recording where possible.

The diving suits, breathing apparatus and other diving accessories also have to be examined carefully by experts and a complete autopsy with toxicological and histological examination is essential. The causes and mechanisms of death are discussed, as are the importance of special autopsy techniques and investigations. Possible interpretative problems are highlighted.

Despite several studies of absconding from mental hospitals, what the hospitals and the police do following a patient absconding from a mental hospital has been largely ignored. This article fills that gap. It looks at the procedure followed by three conventional mental hospitals in south-east England and the procedure followed by the three Police Forces in those hospitals' catchment areas. It is based on twelve months of fieldwork, during which period the policy files of all the hospitals were studied and, among other things, interviews were carried out with a cross-section of both the hospitals' staff and police officers. The crucial factors determining the type of action taken by the hospitals or the police were found to be whether the matter was one of grave concern and whether the absconder was a compulsory patient. Certain aspects of the procedure were found to be unsatisfactory and suggestions for improving them are made.

This paper examines the diversion of the mentally disordered offender against a background of the treatment of the mentally disordered in general. Some myths about incarceration are explored and the proposal is made that diversion is not a new idea. Finally, caution is expressed in the espousal of diversion in an uncritical fashion.

Procedures relating to Insanity and Fitness to Plead are reviewed with special emphasis on the problems encountered with previous legislation.

The introduction of the new Criminal Procedure (Insanity and Unfitness to Plead) Act 1991, on 1 January 1992, offered greater discretion in the disposal of these defendants, but fell short of many of the recommendations made by those advocating reform. As yet, too few cases have passed through the courts to highlight particular deficiencies in the unreformed parts of the Act, but the benefits are already apparent. Finally, some of the potential pitfalls of supervision and treatment orders and other disposals are discussed and an insanity case, dealt with under the new legislation, is presented.

Details of a research study, funded by MENCAP, on the use of Appropriate Adults are given. A great deal of attention has been given recently to diverting the mentally disordered from the criminal justice system. This preliminary report discusses what happens to those who stay in the system — i.e. who are kept in police custody and eventually appear at court. Facilities are available under the Appropriate Adult Scheme for offenders seen to be mentally disordered or handicapped to have with them a ‘responsible person’ when they are interrogated by the police. The questions now posed are: does such a scheme work, and is the offender given protection under it?

The possible legal implications of the failure of a mechanical prosthetic cardiac valve have been reviewed within the framework of the Nigerian legal system. This is the sequel to a clinical case we had recently, of primary mechanical failure of a cardiac prosthesis which led to the death of a 19-year-old medical student. A short account of the case as reported by the physicians is presented.

As there has been no such case before any Nigerian Court, this review draws heavily upon salutary lessons from the USA and the UK, where such, or related, cases are more prevalent.

The psychology and psychiatry of interrogation, confession and testimony have recently become the subjects of considerable theoretical analysis, research and professional interest (Gudjonsson, 1992). A case study is reported involving a defendant whose testimony under police interrogation incriminated himself and 13 other defendants in a murder trial. Issues of intellectual impairment, memory impairment, confabulation and suggestibility were addressed in voir dire proceedings, and are described in this paper. The case also demonstrates the importance of psychological tests being administered by suitably qualified personnel.