Fenwick P
Institute of Psychiatry, De Crespigny Park, London.
Psychol Med Monogr Suppl. 1990;17:1-27. doi: 10.1017/s0264180100000758.
The law on automatism is undergoing change. For some time there has been a conflict between the medical and the legal views. The medical profession believes that the present division between sane and insane automatism makes little medical sense. Insane automatism is due to an internal factor, that is, a disease of the brain, while sane automatism is due to an external factor, such as a blow on the head or an injection of a drug. This leads to the situation where, for example, the hypoglycaemia resulting from injected insulin would be sane automatism, while hypoglycaemia while results from an islet tumour would be insane automatism. This would not matter if the consequences were the same. However, sane automatism leads to an acquittal, whereas insane automatism leads to committal to a secure mental hospital. This article traces the development of the concept of automatism in the 1950s to the present time, and looks at the anomalies in the law as it now stands. It considers the medical conditions of, and the law relating to, epilepsy, alcohol and drug automatism, hypoglycaemic automatisms, transient global amnesia, and hysterical automatisms. Sleep automatisms, and offences committed during a somnambulistic automatism, are also discussed in detail. The article also examines the need of the Courts to be provided with expert evidence and the role that the qualified medical practitioner should take. It clarifies the various points which medical practitioners should consider when assessing whether a defence of automatism is justified on medical grounds, and in seeking to establish such a defence. The present law is unsatisfactory, as it does not allow any discretion in sentencing on the part of the judge once a verdict of not guilty by virtue of insane automatism has been passed. The judge must sentence the defendant to detention in a secure mental hospital. This would certainly be satisfactory where violent crimes have been committed. However, it is inappropriate in many cases where non-violent confusional crimes, such as petty larceny, have been committed. Suggestions are made for desirable changes in the law.
关于自动行为的法律正在发生变化。一段时间以来，医学观点和法律观点之间一直存在冲突。医学界认为，目前对神志正常的自动行为和精神错乱的自动行为的区分在医学上没什么意义。精神错乱的自动行为是由内部因素引起的，即脑部疾病，而神志正常的自动行为是由外部因素引起的，比如头部受到撞击或注射药物。这就导致了这样一种情况，例如，注射胰岛素导致的低血糖属于神志正常的自动行为，而胰岛肿瘤导致的低血糖则属于精神错乱的自动行为。如果后果相同，这倒也无关紧要。然而，神志正常的自动行为会导致无罪释放，而精神错乱的自动行为则会导致被送往安全的精神病院。本文追溯了20世纪50年代至今自动行为概念的发展历程，并审视了现行法律中存在的异常情况。它考虑了癫痫、酒精和药物导致的自动行为、低血糖导致的自动行为、短暂性全面遗忘症以及癔症性自动行为的医学状况和相关法律。还详细讨论了睡眠自动行为以及在梦游性自动行为期间实施的犯罪。本文还探讨了法院获得专家证据的必要性以及合格医生应发挥的作用。它阐明了医生在评估基于医学理由的自动行为抗辩是否合理以及寻求确立这种抗辩时应考虑的各个要点。现行法律并不令人满意，因为一旦作出因精神错乱的自动行为而无罪的裁决，法官在量刑时就没有任何自由裁量权。法官必须判处被告被关押在安全的精神病院。在实施暴力犯罪的情况下，这当然是令人满意的。然而，在许多实施非暴力混乱犯罪（如小偷小摸）的案件中，这是不合适的。文中针对法律的理想变革提出了建议。
