Q. Is the current distinction between sane and insane automatism satisfactory?

What changes, if any,

would you recommend?

A. The contrast between sane and insane automatism in legal situations raises deep problems about the
nature of responsibility, culpability, and the confluence of law and medical expertise. Sane automatism
refers to unconscious behaviors induced by external forces such as a hit to the head or a rapid shock,
whereas insane automatism is caused by internal reasons, often a mental illness. This demarcation tries
to define the amount of culpability and suitable legal results for persons who perform activities without
conscious purpose. The discussion below will look at the present distinctions between sane and insane
automatism, evaluate their applicability in modern legal systems, and consider alternative paths for
change.

Lord Denning described automatism in the matter of Bratty v AG of Northern Ireland (1963) as “No act is
punishable if it is done involuntarily… ‘Automatism’ – means an act which is done by the muscles without
a control by the mind”. Bramwell B noted situations of automatism in which “the defendant would not
act differently even if there were a police man at his elbow”.

The accused is nearly unconscious in the condition of automatism, and his acts are wholly automatic. A
successful defense of automatism leads in an unconditional acquittal. Because this defense resulted in an
unequivocal acquittal, the court has limited the scope and availability of this defense by splitting
automatism into sane and insane automatism (also known as insanity). The insane automatism is based
on the term 'disease of the mind' and is controlled by M'Naghten principles. The difference between the
two versions is a matter of law rather than medical. As a result, if the law acknowledges a medical illness
as a ‘disease of the mind’ the accused is deemed to have insane automatism. This difference has allowed
the courts to limit the extent of automatism.

Though the defense of automatism resulted in an absolute acquittal, it comes with a proviso. Because
the distinction between sane and insane automatism is one of law rather than medicine, the court may
refer to the defendant's medical condition as a "disease of the mind" rather than automatism. This will
result in a special judgement of 'not guilty' rather than an unconditional acquittal, and the accused may
be required to be hospitalized.

The women was strangled to death in the case of Bratty (1963). He invoked the 'automatism' argument
based on evidence that he was suffering from psychomotor epilepsy at the time of the occurrence. The
court judged his condition 'insanity,' and issued a 'special verdict' of not guilty, sending the defendant to
a mental institute permanently. The defendant in Quick (1973) was a diabetic who took insulin but ate
very little food. In addition, he had consumed alcohol. This produced hypoglycemia, which led in angry
outbursts. As a result of the attack, the defendant was charged with assault. The trial judge ruled
Insanity in contrast to defense of automatism raised by the defendant. However, the Court of Appeal
classified the medical condition as "automatism." It was discovered that hypoglycemia is caused by the
use of insulin and cannot be classified as a "mental illness."

What can be concluded from the previous two situations is that if the trigger of the disease is internal,
epilepsy in Bratty, then such a condition will be addressed as 'insanity'. However, if the condition is
activated outside, like by taking insulin in Quick, it will be considered automatism. Though this
distinction is not difficult to grasp, it becomes problematic when seen through the lens of a specific
condition such as diabetes.
Diabetes can result in hypoglycemia (low blood sugar) if a person takes insulin but does not consume the
recommended quantity of meals. It can also cause hyperglycemia (high blood sugar) if a person fails to
take the required dose of insulin. The consequences in both cases are the same, and have been shown to
lead to illegal behaviour. Quick (1973) found that the defendant who suffered from hypoglycemia was
suffering from automatism because hypoglycemia is viewed as an external trigger. In the case of
Hennessy (1989), the defendant who suffered from hyperglycemia was found to be insane because
hyperglycemia is viewed as an internal trigger. As a result, the problem is obvious since the condition,
diabetes, is the same yet produces distinct results.

Because automatism is a rejection of both actus reus and mens rea, it is considered a defence for strict
liability offences such as reckless driving. Based on this, the courts have limited its use since requiring
proof of culpability for strict liability offences would not be contrary to societal standards. The failure of
brakes in the case of Burns v Bidder (1967) resulted in the availability of the defence of automatism. In
the case of Neal v Reynolds (1966), the defence of automatism was not accepted since the victim
abruptly came in front of the defendant's automobile, giving the defendant no time to stop. Both
instances were distinguished by the fact that, in Burns, the defendant was not driving his automobile
owing to brake failure; the car drove itself. In Neal, the defendant was in control of his vehicle, despite
the fact that the victim quickly pulled in front of it. Courts took a strict approach in the cases of Broome v
Perkins (1987) and A-G's Reference (No 2 of 1992). In Broome, the defendant was a diabetic who
suffered from hypoglycemia. The court ruled that believing the automobile could be driven for several
miles without control was reckless. As a result, the defence of automatism for reckless driving was not
permitted. The result in Broomes is rather perplexing because the law clearly defines hypoglycemia as an
exogenous element causing automatism. The above instances demonstrate how the courts have limited
the defence of 'automatism' when dealing with strict responsibility offences. As previously stated, this is
due to 'policy' reasons.

Aside from the eligibility of 'strict responsibility' offences, the defence of 'automatism' is also limited
where the defendant is responsible for self-inducing it. In Bailey (1983), the defendant was charged with
injuring after suffering from a hypoglycemic crisis as a result of failing to eat after taking insulin. The
argument of 'automatism' was rejected since it was shown that diabetic individuals are well aware that
forgetting to eat after taking insulin resulted in hypoglycemia. As a result, the court determined that the
automatism might have been avoided. This judgement contradicts the result in Quick, where the
defendant was likewise diabetic and had neglected to eat after taking insulin, and had also consumed
alcohol. In Lipman (1970), the defence of automatism was denied when the defendant experienced
hallucinations as a result of deliberate drinking. Voluntary drunkenness may be permitted only if the
defendant was unaware that the substance would create a condition of automatism, as in the instance of
Hardie (1985).

When willful drunkenness is involved, the stringent constraints on the law of 'automatism' are
reasonable. A person should not be exempt from culpability because of his own hazardous behavior.
However, it might be claimed that the rule of internal and external triggers is a matter of medicine rather
than law, because automatism cases are solely founded on medical circumstances. In its Discussion
Paper on Insanity and Automatism (23 July 2013), the Law Commission observed, "The principal problem
is that the distinction between 'sane automatism' and 'insane automatism' does not make sense. It
depends on a crude distinction based on whether the cause of loss of control is due to a factor that is ‘external’ or ‘internal’”
(para 5.38). This was shown in the preceding trials, when the same condition, diabetes, resulted in various verdicts.

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