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Commentary: UK Perspective on Competency to Stand Trial

Dr. Exworthy is Consultant Forensic Psychiatrist, Redford Lodge Hospital, and Department of Forensic Mental Health Science, Institute of Psychiatry, Denmark Hill, London, United Kingdom. Address correspondence to: Tim Exworthy, FRCPsych, Consultant Forensic Psychiatrist, Redford Lodge Hospital, Edmonton, London N9 9DY, UK. E-mail: t_exworthy{at}hotmail.com

This commentary offers a perspective from another common law jurisdiction, specifically the law in England and Wales, where competency to stand trial on a criminal charge is known as fitness to plead. The commentary begins with a discussion on the principle of proportionality evident in health care decisions by way of comparison with the topic in the criminal arena. Fitness to plead is an historical legal concept and employs an intellectual test that has evolved very little since its appearance in case law. There have been amendments, through statute, to its procedure and outcomes following a determination of being unfit to plead. However, competency to stand trial in England and Wales remains a more marginal issue than in the United States. Recent developments in domestic and European jurisprudence have been related to consideration of the requirements for a fair trial, driven by the demands of the European Convention on Human Rights.