Proof that Evidence-Based Medicine can make you a bit loony?

Proof that Evidence-Based Medicine can make you a bit loony?

I have discussed the strange mentality that EBM can incubate in certain individuals previously in this blog. The so-called skeptics would probably approve heartily of the latest pronouncement from an evolutionary biologist that use of unproven treatments for the deadly disease Ebola is unethical outside of a prospective randomised controlled trial:

http://scientiasalon.wordpress.com/2014/08/14/on-the-science-and-ethics-of-ebola-treatments/

The same bug-eyed loonies 


that find the notion of a terminal cancer patient getting some hope through trying an innovative treatment quite awful, will probably be horrified at the prospect of someone with Ebola, which in the current outbreak has a mortality of 55%, trying an untested treatment in the hope that it may benefit them. It is an indictment of their inflexible thinking that they cannot see the difference between this situation and experimental treatment of more common but less lethal diseases. 

It's also proof that scientists by and large shouldn't stray into the field of ethics. A bit like another famous evolutionary biologist (and his followers) should keep out of religious debates. 

Neurolaw in the UK

Neurolaw in the UK

Neuroscientific evidence will continue to increase in importance in criminal trials. The biggest danger is the potential failure to properly test such evidence, and it is important that judges and lawyers understand the limitations of much neuroscientific evidence. What educational resources are available in the UK?

The Royal Society's Brainwaves project looked at developments in neuroscience and their implications for society and public policy. One module looked at neuroscience and the law. The medical Royal Colleges and the Royal Society of Medicine hold seminars on medico-legal matters, for example the RSM is holding a series of events on Sleep and the Law (the first meeting is on Sep 30th). A medico-legal seminar was held at Keele in 2013 on automatism which was expressly aimed at both medical experts and lawyers. There are a number of events organized for lawyers on neurolaw in the United States. Most of the universities known for neurolaw are in the USA. 

British universities do offer modules in this area, for example the University of Kent offer a module on "Neuroscience in Law: Forensic, Medical and Ethical Aspects". Much of the expertise in this area is in the field of forensic psychiatry, and indeed there is a dedicated Forensic Psychiatry Chambers, as well as many forensic psychiatrists working in high and medium secure units throughout the country. There are related disciplines such as neuroethics which inform discussion about the use of neuroscience in the law. 

There are a number of academics with a special interest in neurolaw in the UK - Lisa Claydon, Paul Catley, and Robin Mackenzie. There is a European body for neurolaw, the European Association for Neuroscience and Law (EANL). There certainly appears to be much academic activity on the continent. It would be a useful resource for the UK to have an established centre for neurolaw to aid education of the legal profession and the judiciary. Neuroscience has great potential to aid legal decision-making, but there also needs to be appropriate skills in handling expert evidence in neuroscience.  Neurolaw may still be in its infancy, but we need to be proactive rather than reactive. 

The limits of the adversarial system

The limits of the adversarial system

A recent action against barrister Lawrence McNulty emphasized that despite what some lay people might believe, there are limits in the adversarial system to the tactics counsel can employ at trial. In fact, although lawyers are retained by their clients, they are nonetheless "officers to the court". This is why a lawyer cannot argue that if his client is innocent if he knows otherwise. He may argue that the case against him has not been proven beyond a reasonable doubt, but he may not argue for this innocence.

Lawrence McNulty is appealing the decision. The disciplinary tribunal found that he had contravened professional ethics in several ways. He had argued a defence of entrapment without the necessary notice. The allegations of entrapment “were completely unfounded and his conduct had the potential to undermine public confidence in the legal profession and the administration of justice”. Further, he made a "deliberate and misguided attempt to undermine the authority of the judge and to neutralise his summing-up", and had also attacked police witnesses without giving them the opportunity of reply. 

It must be emphasized that such behaviour and resulting disciplinary action is notable for its rarity, and no one has suggested that the barrister in question is not normally conscientious and ethical. Nonetheless, it is an important reminder that the courts are interested in justice, and although the adversarial system may seem like a bun fight to the layperson, there are consequences if counsel stray across certain boundaries when representing their client. 

The Evolution of the Insanity Defence in England and Wales

The Evolution of the Insanity Defence in England and Wales

The insanity defence in English law is typically pleaded in the crown court, where the statutory special verdict applies. This dates back to the Criminal Lunatics Act 1800. Prior to this, only the common law insanity defence applied, which resulted in a plain acquittal (although often civil detention occurred given the profound degree of impairment required to persuade a lay jury of insanity before medical experts were permitted in court, the first case being in 1760). This still applies when the insanity defence is successful in the magistrates court. It results in a verdict of not guilty by reason of insanity, although between 1883 and 1964 the verdict was 'guilty of the act but insane at the time' (introduced by the Trial of Lunatics Act 1883, with the original wording restored by the Criminal Procedure (Insanity) Act 1964). This outcome was unacceptable to monarch and parliament for the man who attempted to assassinate King George III, Hadfield, and so emergency legislation was passed to enable his detention.

Hadfield was a veteran of the First War of the Coalition, and had been part of the bodyguard of the Duke of York at the battle of Lincelles, where he received a serious head wound from a sabre. It was clear that prior to the injury he had been a loyal and brave subject. It was likely that the visible head injury (counsel invited the jury “to inspect the membranes of the brain itself”) and his previous loyal service helped persuade the jury that this behaviour was contrary to his pre-morbid character. This was the first case where the concept of partial insanity was accepted as the basis of an acquittal. Hadfield’s counsel, Erskine, argued that delusion “unaccompanied by frenzy or raving madness [was] the true character of insanity”. Hadfield’s delusion was that he must die to save the world, but he could not die by his own hand. Thus he contrived to be killed in the course of an assassination attempt. 

The statutory special verdict allowed for only one disposal until recently - detention at Her Majesty's Pleasure. Once the death penalty was abolished and the defence of diminished responsibility was introduced for homicide, the insanity defence became less and less attractive given the prospect of indefinite detention. The insanity defence became virtually obsolete. However the Criminal Procedure (Insanity and Fitness to Plead) Act 1991 gave judges the choice of four disposal options, later reduced to these three:

1) A hospital order with or without a restriction order (mandatory for homicide where there is a mental condition)

2) Supervision order

3) Absolute discharge

Mackay found that this legislation resulted in increasing numbers of successful insanity defences. 

So rather than being motivated by compassion, the statutory special verdict was a regressive step. During the 19th century it was widely considered that the insane were still capable of being deterred, and so the detention of the insane had a punitive element to it. Indefinite detention very often did amount to detention for life, and the conditions in the asylums of the time were appalling by modern standards. Prime Minister Gladstone considered the special verdict 

"an inducement...to morbid minds for the commission of crime by an apparent declaration of innocence in the teeth of the facts."

This perception led to the substitution of the original verdict of 'not guilty by reason of insanity' with 'guilty of the act but insane at the time', as noted above.