History of Medicine

History of Medicine: How Courtrooms Dealt with the Medical Concepts of Sanity 1866-1918

Before the 1800s, questions of sanity were more likely to be legal questions than medical questions.  But during the 1800s, defining sanity increasingly became the domain of medical professionals.  As a result, lawyers and judges began to use medical concepts of sanity in the courtroom.   For a recent AMS funded studentship, I researched Ontario property law court proceedings between 1866 and 1918 to see how judges engaged with medical concepts of sanity.  In this blog post, I will outline the scope of my project and introduce one of my case studies.

The cases I studied shared a common narrative – an older male adult died, leaving a will that favoured some of his family members and neglected others.  In court, the neglected family members claimed that the will was invalid, arguing that the deceased was incapable of writing that will.  My goal was to understand how the judges of these proceedings used medical concepts of sanity to support their judgements on whether or not the deceased was capable of writing the will in question.  I exclusively studied cases that dealt with the wills of older adults, as older adults have consistently been a unique group in terms of how they have been associated with mental incapacity. Older adults who are legally or medically identified as mentally incapable have often been denied the responsibility of entailing their estates and making other significant decisions.

Medical concepts of sanity were often used in the judgements.  Judges frequently referred to the “sanity” and “capacity” of the deceased as though they were interchangeable terms.  Medical concepts of sanity were used to support both claims that the deceased had the capacity to write his will, and that he did not have the capacity to write his will. At the same time, the legal judgements of these cases were also impacted by factors, like the judges’ biases around aging, gender conformity, and class.  Though it can be difficult to distinguish the influence of medical concepts from the influence of these other factors, it is clear that medical concepts were consistently present in judgements at this time.

The following case study is an example of how medical concepts of sanity and other factors affected a judge’s verdict.  In this case, the will of John was favourable to his son Albert but neglected his other son.  Albert lived in the same town as his father, while the other son (who remains unnamed in the judgement), lived a considerable distance from them.

Over a decade before John’s death, Albert acquired almost all of his father’s property, and in return promised to look after him in a decent way.  Instead, Albert kept John almost entirely in isolation in a small room, in living conditions that the judges described as “uninviting” and “morbid”.  John lived in this way until he developed gangrene in his foot and was admitted to the hospital.  His foot was amputated and six weeks later he died from “diabetic collapse”.  The evidence showed that John’s will was written after the gangrene and diabetes had “become a serious ailment”, but before John was hospitalized for these conditions.  Albert suggested the will be written, and Albert employed the solicitor who had it made.  The will was signed by John in his room, with Albert present.

Albert testified that his father was always rational, strong and healthy, and possessed a will stronger than his own.  However, in a letter John wrote thirteen years before his death, he said that he was lonely, was not well, and felt a “smothering sensation”.  From the judge’s discussion of the evidence, it seems he is confident that John’s miserable experience was consistent for the thirteen years from the day he wrote this letter to the day he passed away.  The judge made it clear that he distrusted Albert, and that he believed Albert took advantage of John’s weak state and forced the execution of a will that was only in Albert’s interest.

Throughout the judge’s verdict, he evoked images of John’s old age and poor health as evidence that he was incapable of writing a will.  The emphasis on John’s gangrene and diabetes is a good example of how physical medical conditions were associated with mental deterioration and incapacity.  However, the judge also wrote at length about the arrogance, poor moral character, and absence of family values reflected in Albert’s behaviour; and it is likely that the judge’s strong disdain for Albert informed the verdict.  Thus, this case effectively demonstrates the conflation of social factors with medical concepts in the judges’ verdicts.

These trials say a lot about the balance of medical and legal forces involved in defining a person’s capacity to write a will.  Notably, medical concepts of sanity permeated early Canadian judgements on the validity of wills.  This project sheds some light on how medical concepts were engrained and reinforced in the courtroom, and how this affected the outcomes of court cases.

The fine, elusive line between being capable or incapable of writing a will has not been resolved in recent decades.  Groups in Ontario and across Canada continue to lobby for comprehensive legal recognition of policies such as assistive decision making.  My study’s look into the courts of an earlier period offers insight into current debates on capacity, as all legal evolutions must negotiate with precedent.

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