Medico-Legal Questions In Psychiatry

The most important medico-legal questions that may arise in connection with cases of alleged mental disorders are those of necessity of commitment, competence in the management of one's own affairs, testamentary capacity, and criminal responsibility. The mere fact of the existence of a mental disorder, established by a medical diagnosis, is not sufficient to settle these questions.

Commitment

The question of necessity of commitment has already been touched on. The tendency in leading states is to limit as far as possible the practice of committing cases, allowing any suitable case to be admitted to a state hospital on voluntary application, at any time, without special formality.

Psychiatrists are looking forward to even greater facility of obtaining treatment for cases of mental disorders in the future in psychopathic wards to be established in connection with general hospitals: "The details of transfer from the psychopathic ward to the large state institutions should be made as simple as possible. Transfer should be made effective on a certificate of two properly qualified physicians and the matter should not have to come into court at all unless it is brought there by the patient, his relatives, or some friends on his behalf. I would not close the courts to the so-called insane by any means, but I would not insist on a legal process, whether the patient wanted it or not; I would not insist, so to speak, on cramming an alleged constitutional right down the patient'e throat at the expense of his life. We see to-day this process of commitment going on where nobody wants it. The patient does not want it, the patient's friends and relatives do not want it, and anybody who stands and watches it proceed recognizes on the face of it that it is a farce. I would, therefore, proceed in the matter of commitment in the simplest way.

Leave the courts accessible to the patient if he wants to appeal for relief, and it will be surprising how rare such appeals will be." l

Legal Competence - Testamentary Capacity

As regards competence in the management of one's own affairs and testamentary capacity, no difficulty is experienced in the majority of cases of pronounced mental disorder; difficulty is met with rather in connection with milder cases in which there may be room for legitimate difference of ojinion. In cases in which a direct examination of the person whose mentality is in question is not practicable, the opinion of a psychiatrist is of but little more value than that of a lay person; in such cases it would seem best to place the burden of proof on those who allege incompetence or limited testamentary capacity, and to require as proof not merely opinion, however expert, but instances of actual business mismanagement of obviously abnormal degree or nature. Where there is opportunity for direct examination the testimony of a psychiatrist may be of determining value, mainly for the reason that he is better able than a layman to establish or eliminate, as the case may be, the existence of defects of memory, judgment, affectivity, etc., which would have a bearing on the question at issue. Here again facts, as revealed by the examination, rather than opinions, however expert, will be of greatest assistance to the judicial authorities in drawing a just conclusion.

It need hardly be said that here, as under other conditions, the testimony of witnesses, including expert witnesses, is of value according to the degree of freedom from bias. It is, of course, not legal for a court to rule out the testimony furnished by witnesses retained either by the plaintiff or by the defendant; but it is possible, and desirable in the cause of justice, for the court to call experts in order to be sure of securing testimony that is free from even unconscious bias.

1 Wm. A. White. Dividing Line between General Hospital and Hospital for Insane. The Modern Hospital, March, 1914.

A psychiatrist called as an expert ought by right to refrain from giving an opinion on the main question at issue, that of competence or testamentary capacity, that being, strictly speaking, not a medical or scientific question at all, but a question of common sense for the court to determine. The data revealed by his examination and his judgment of their pathological significance are all that he can contribute as an expert; an opinion on competence or testamentary capacity that might be elicited from him should not be considered as being of greater value than one offered by anyone else.