Patricia Casey: 'Those left behind after familicide deserve truth, not speculation'
The sad case of the Colls, who lost a whole family, killed at the hands of their husband/father Alan Hawe, has generated huge public interest and sympathy. Although it is two years since the sad events in Co Cavan took place, the failure of the family to obtain information from gardaí surrounding the detail of why it happened and accessing the book of evidence has stimulated debate. Gardaí say this information is privileged and cannot be released.
Several other families are similarly affected. Una Butler, from Cork, lost her children and husband when he crashed the car they were travelling in. She has expressed her concern that the psychiatrist treating her husband for depression should have involved her in his treatment so that tell-tale signs could be disclosed to forestall this sad outcome.
This raises the question of doctor-patient confidentiality. Confidentiality, while crucial, is not absolute. If a doctor believes in good faith that a patient poses a risk to others, then this can and must be disclosed to protect the relevant parties. The Medical Council guidelines and the colleges of psychiatry (Irish, British, Canadian and others) all allow for this. But there must be a named person or persons who are the target.
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Tarasoff warnings, as they are known, stem from a famous California case in 1969 when Tatiana Tarasoff, a young woman, was murdered by her ex-boyfriend who had disclosed his intention to his therapist. Although this was reported to the police, the therapist was found wanting by the courts for not having taken steps to protect the victim.
The principles behind Tarasoff are now applied more generally in medical ethics. Confidentiality can also be broken if a court of law or other government-sanctioned body requests medical records.
The families of these cases are seeking answers that, if found, will help them in their grief. Coping with the inexplicable is near impossible; filling in the pieces of the puzzle through relevant information renders the emotional pain less disabling. Public inquisitiveness is understandable but should not be catered for unless there is a public interest in doing so, as for example if a crime of disturbing proportions may have been committed by the deceased, as has been suggested in the Hawe case.
I listened to politicians on radio and TV, both from the Government benches and the Opposition, claiming they would take action to prevent such terrible events recurring. The reason for my scepticism is I find it impossible to comprehend how a complex and rare problem like familicide can be addressed if we don't understand the underpinning problems. How can action be taken if we don't know what we have to address?
For us to try to respond to such tragedies, we must do three things. First, because of its rarity we must look to the scientific literature to examine what it is saying about the causes of familicide. Second, we must establish the cases in Ireland resemble those described in the global picture. The findings from international studies may not necessarily generalise to Ireland. Third, for the families we must provide the information so necessary for their understanding and healing.
During the debates about familicide in the last few days, the recently commenced Coercive Control Bill (2018) regarding domestic violence was trotted out by commentators and politicians, reflexively and unthinkingly, as one response to such cases. This utterly inane, simplistic response should be derided in the context of our ignorance surrounding familicide tragedies in Ireland. Ideology was replacing fact in the discussion, as it was assumed that domestic violence of a controlling nature was responsible for these cases. We have no such evidence.
The international literature on this topic is very limited. The most comprehensive study to date was published in academic journal 'Trauma, Violence and Abuse' on January 31 last. It examined data from the highest quality studies on this topic. Data from 18 countries and 67 studies was considered but only eight met the quality standard required.
It found that mental illness, financial matters and relationship difficulties were the main factors. Most acts were committed by men in their 40s and 50s. Similar findings were reported in a 2017 study reported in the 'Scandinavian Journal of Public Health'. Unfortunately, this information does not assist in providing a way through this sad social and personal quagmire.
At a local level, in order to achieve our own understanding of these family catastrophes, we must move beyond the inquest, as this is limited in what it can achieve. It can answer the where, how and when questions, but not the why. There has to be some mechanism by which documents can be provided to close family members and if necessary the public can be informed when there is a genuine public interest at issue.
I would suggest that for cases of familicide, a commission of investigation should be established under the 2004 Commission of Investigation Act so families can receive the documents that will chart them out of their despair and the public can receive information if it is deemed to be relevant.
This process would overcome the question of confidentiality and privilege. The Act allows for evidence to be given in private, for witnesses to be called, for documents to be produced. The final report may be published in certain circumstances. This process differs from other inquiry processes in Britain such as the Confidential Enquiry into Maternal Deaths and the National Confidential Inquiry into Homicide and Suicide, since witnesses are not called and data is gathered anonymously.
If we are serious about responding meaningfully to the requests from families such as those of the Colls and Una Butler, then we have to consider how we can maximise the information while maintaining privacy. We should not take reflexive action if we don't know what we have to address - and at present we have only speculation to guide us.