CERTIFICATES OF INSANITY

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insuring some disreputable individual. On the otherhand, the Council of a medical protection society,if it did not do justice to a member, could be turnedout forthwith. Since an insurance company is notsubject to any such discretion the precise conditionshave to be set forth minutely when the insurancemight fail at a critical point.—ED. L.

CERTIFICATES OF INSANITY.

To the Editor of THE LANCET.

SIR,-It is not quite clear what Dr. H. Rayner 1desires ; he appears to object to the responsibilityattaching to certification, but could this be diminishedor could the duty be performed by non-medicalcitizens ? The risk indeed is small to a man whoa,ppreciat,es what he is doing, and who acts withcommensurate care, while the responsibility forordering detention actually does rest with the legalauthorities. All that is required of the medical" witness " is definite, verified, or referenced evidence sufficient to enable this authority to form his ownopinion. If only vague, " scrappy," technical eividenceis offered, this will throw a greater moral onus uponthe medical -,opinion " that the patient should bedetained." .

The very gravity of the charges that have to be made against a medical man for wrongly certifying I(in order to constitute an actionable complaint) showshow well the profession is protected from frivolousrecriminations. If the practitioner desires furthersecurity, he need not certify ; or he could safeguardhimself to some extent by refusing to accept a fee.Further legal immunity-security for the profession-could probably only be obtained at the expense ofpublic security (from unconscientious certification),and even if we desired and could obtain this it wouldonly aggravate the public suspicion, which is our realgrievance.

It is quite true that the community demands fullprotection from insane conduct and then " salves itsconscience " by reviling and penalising its obedientprotectors, but psychiatry is not the only suffererfrom this. The most it justifies us in demanding isa more definite and explicit statement of the principlesupon which the community sanctions interferencewith personal liberty. It cannot be denied, moreover,that our own advocacy of compulsory detention forcurative purposes as distinct from security has added

to the prevailing uncertainty as to the grounds uponwhich detention is recommended and sanctioned.

Dr. Rayner’s contention that " a non-officialgeneral practitioner is not the servant of the legislature,and should therefore not be required to take anyresponsible part in carrying out its objects," appearsto me inadmissible and dangerous doctrine, as alsodoes his demand that medical certificates of insanityshould be secret and " privileged " documents. Theseform an essential part of the procedure for restrictingthe liberty of a fellow-citizen, and must stand publicscrutiny. British law does not act on secret andnon-responsible evidence.

Corporate action by the profession on the lines headvocates, and at the present moment (with a Govern-ment inquiry pending) appears to me very undesirable,especially action that appears designed to " forcethe hand" of the legislature. The only real andsatisfactory security we can have is the confidence ofthe public. Vindictive and unreasonable action ontheir part is symptomatic of suspicion and a feelingthat safeguards and supervision are insufficient.We have nothing to lose by any measures of securityit may please to take : we have everything to gainby an overhauling of the Lunacy Law with which theprofession has never been content. This overhaulhas been promised, and surely our business is ratherto prepare our case than to prejudice it by partisanaction. I am, Sir, yours faithfully,

Perth, March 15th, 1924. 1. D. SUTTIE, M.B.I. D. SUTTIE, M.B.1 THE LANCET, March 15th, p. 570.

To the Editor of THE LANCET.SIR,-Dr. Rayner’s suggestion for the protection of

medical practitioners through the wiping out of everytrace of the evidence given by them for committal toan asylum would, I fear, be likely to lead to a reactionin the direction of providing more safeguards for theindividual concerned. It would also incidentallyabolish Section 82 of the Lunacy Act.The question of a doctor’s liability in the matter of

signing a certificate did not arise in the recentaction of Harnett v. Bond and Adam. Certifyingdoctors are at the present moment amply protectedby reason of the fact that in the eye of the law it isthe reception order signed by the judicial authority,and not the medical certificate, which is the cause ofthe alleged lunatic’s committal. The certifying doctorescapes liability on the ground that he is only awitness tendering evidence. In common with allother witnesses, the reliability of the doctor’s evidenceought in fairness to be tested through cross-examina-tion by the solicitor or friend of the alleged lunaticin the presence of the magistrate and of the individualhimself. Should the latter desire it, the wholeproceedings could be conducted in privacy. Doctorsneed not consequently be in any dread as to liabilityfor damages arising out of bona fide certification,while their sworn evidence from the witness-box willbe regarded as strictly privileged.

I am, Sir, yours faithfully,S. E. WHITE, M.B., B.Sc.

1’ower Hill, E., March 16th, 1924.S. E. WHITE, M.B., R.Sc.

, To the Editor of THE LANCET., SIR,-I have read Dr. H. Rayner’s letter in your, issue of March 15th, in reply to which I think the

point he raises is covered by the last paragraph ofSection 330, Subsection 1, of the Lunacy Act, 1890.which reads as follows : " He (the doctor signing themedical certificate) shall not be liable to any civil

, or criminal proceedings whether on the ground of’ want of jurisdiction or any other ground if such

person has acted in good faith and with reasonablecare." I am, Sir, yours faithfully,

’

STANLEY A. GILL, M.D., &C.Formby, Lancs, March 17th, 192.

HARNETT v. BOND AND ADAM.

To the Editor of THE LANCET.

SIR,-In your leading article with reference to thiscase in your issue of March 8th, 1924, I note withsatisfaction that you express yourself as " amazed andhorrified " that the jury should have found that Dr.Bond was aware of the plaintiff’s sanity at the timewhen he was taking measures to return him to MallingHouse, and in addition to which I believe he statedin his evidence that he considered him to be ofunsound mind. You also draw attention to the factthat Justice Lush expressed himself surprised on

learning that the patient is not personally made awareof the grounds of his detention, and, if I rememberrightly, conveyed the impression that he consideredthe patient should be presented with a copy of hiscertificate. Personally, I have always treated thesecertificates as confidential documents, and I should beinterested to know whether this is not the way thatthey are looked upon by every Medical Superintendent.and also whether this is not the attitude the MedicalProfession would expect us to adopt? P

I am, Sir, yours faithfully,RICHARD EAGER, O.B.E., M.D.,

Medical Superintendent, Devon MentalMarch 12th, 1924. Hospital, Exminster.

RICHARD EAGER, O.B.E., M.D.,Medical Superintendent, Devon Mental

Hospital, Exminster.

** * To a question asked in the House of Commonslast week " Whether, in view of the verdict inHarnett v. Bond and Adam, the Minister of Healthproposed to suspend Dr. Bond from acting as a LunacyCommissioner pending the decision of the Court ofAppeal," Mr. Wheatley replied in the negative.Mr. Wheatley called attention to the fact that a