Sir: Not many would disagree with Szmukler's article (Psychiatric Bulletin, January 2000, 24, 6-10) but I have to take issue with his interpretation of the inquiries regarding “the patient as an automaton”. One of the concepts he elaborates in support of his argument that patients have feelings and a mind of their own is to ask us to imagine that an aeroplane with a mind of its own decided not to follow the pilot's landing instructions. But I do not think the analogy is very valid in relation to homicide inquiries. One will surely agree that when a plane crashes, the inquiry will have to look at what part or parts failed and why. If there was wear and tear, why was this not identified and rectified prior to the flight, and more important was this oversight a negligent act? If the plane had a structural defect due to a ‘harsh’ landing the previous day, which was not corrected prior to the next flight, surely some one was culpable and possibly negligent?

Equating a crash enquiry with a homicide inquiry is oversimplifying a very complex and quite understandably an emotional issue. Maybe if we had civil suits of negligence in homicide cases instead of inquiries, we would not feel so aggrieved, as the team would have its chance to defend its practices (which should in any case be within standards of reasonable care adopted by the profession).