Automatism — R v Quick

Facts

The defendant was a nurse who was diabetic and was treated with insulin. He assaulted a patient at the hospital where he worked and caused actual bodily harm. He said that he had no recollection of the events and that he had taken insulin but eaten little, and had also drunk some alcohol, which brought on a state of low blood sugar.

History

At trial the judge ruled that his evidence, if accepted, showed a defect of reason from disease of the mind, so that it raised insanity rather than automatism. In consequence he changed his plea to guilty, and he appealed against conviction.

Issue

Whether a defendant whose lack of control was caused by low blood sugar following insulin was suffering from a disease of the mind, so that only the defence of insanity was open, or whether he could rely on automatism.

Held

Appeal allowed and the conviction quashed. His state arose from an external factor, the insulin, and not from a disease of the mind, so the defence of automatism should have been left to the jury.

Ratio

• A malfunctioning of the mind of transitory effect caused by an external factor such as insulin, drugs or a blow is not a disease of the mind and supports automatism, whereas a malfunctioning caused by an internal factor such as the diabetic condition itself would amount to a disease of the mind.

The judgments

Key reasoning

• The legal meaning of disease of the mind turns on the cause of the malfunction, and decisions such as R v Kemp [1957] 1 QB 399 and Bratty v Attorney-General for Northern Ireland [1963] AC 386 treat internal causes as diseases of the mind.
• The diabetic condition of the defendant was not the direct cause of the incident; it was the insulin, a drug administered from outside, that produced the low blood sugar.
• The trial judge should therefore have let the jury consider whether the defendant acted without awareness because of the effects of insulin, and the ruling that the defence was insanity was wrong.

Where it fits in the module

Topic 8 on incapacity and general defences contrasts insanity and automatism, which are linked by the question of whether a defendant who lacks control or awareness is dealt with by acquittal or by a special verdict. This case supplies the main test used to allocate cases between them. The module debate concerns whether the internal and external distinction is rational, since it produces differing outcomes for defendants with similar medical conditions.

Criticisms

• The distinction between internal and external causes produces arbitrary results, because a diabetic whose condition causes unconsciousness by too much sugar is treated as insane whereas one who is affected by too little after insulin is not.
• The law assigns the label of insane to defendants who pose no continuing danger, which is stigmatising and has the effect of discouraging them from raising a defence of lack of capacity.
• The test focuses on the origin of the malfunction rather than on the risk of recurrence, which is the real justification for the special verdict and for commitment.