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Mentally vulnerable defendants who struggle to effectively participate in their trial in the magistrates’ courts are not receiving the same protection as those who stand trial in the Crown Court. The Law Commission for England and Wales recognised this lacuna and suggested that the law relating to effective participation should be equally applicable in the magistrates’ courts. On closer examination of the law, the legal aid system and perspectives of legal professionals on the ‘front line’, it is clear that improvements in policy are of greater importance than legal reform and are more likely to meet the needs of these vulnerable individuals. The aim of this paper will be to demonstrate that reform of the law will be insufficient to adequately protect mentally vulnerable defendants in the magistrates’ courts and that changes in policy are needed in place of, or alongside, legal reforms.

This article asks whether the time is right for abolition of the offence/defence of infanticide. To this end, a two-pronged approach is taken, examining infanticide initially as an offence, and then as a defence. In terms of the offence of infanticide, consideration is given both to the concept of the ‘infanticidal mother’ and to the status of infants below the age of 12 months. When considering the defence of infanticide, examination is made of the exclusive nature of the defence and of the scope for an individual to be a ‘partial’ moral agent. The contradictory nature of infanticide, being both inculpatory and exculpatory, suggests the need for a theoretical rationale that justifies disallowing the offence/defence to, inter alia, those women who kill their own children over 12 months and to men who suffer similar ‘environmental’ postnatal depression. It is suggested that women who kill their children while suffering from the ‘after-effects’ of childbirth are either, depending on the severity of mental disorder, fully competent and therefore criminally responsible (although perhaps entitled to a lesser sentence due to a reduction in culpability) or fully incompetent, therefore incurring no criminal responsibility at all. This proposal can be achieved by recognising that there is a place for reduced culpability or a complete absence of responsibility to fall within the current defence of diminished responsibility or within the Law Commission’s recommended alternative to the insanity defence of ‘not criminally responsible by reason of recognised medical condition’.

The Law Commission published Consultation Paper No. 197 in October 2010 on unfitness to plead. This article will focus on the trial of facts hearing and the Law Commission's proposals in this regard. An examination will also be made of the Court of Appeal's judgment in R v MB given since the publication of the Law Commission Consultation Paper. The preferred route chosen by the Law Commission will be advocated, subject to concerns of properly balancing the need to protect both the vulnerable defendant from an unfair hearing and the public from the dangerous individual.

The Law Commission published Consultation Paper No. 197 in October 2010 on unfitness to plead. This article will focus on the relationship between the proposed capacity test and the abolition of the defence of doli incapax for children aged 10 or above.

The Law Commission published Consultation Paper No. 197 in October 2010 on unfitness to plead. Among the many issues to be covered were: an examination of the test for capacity which is narrower than the test for capacity under the Mental Capacity Act 2005; the scope of the trial of facts; and whether accident, mistake or self-defence could be raised as part of the defence in the context of unfitness to plead. This article will examine some of the proposals made in the Law Commission's Consultation Paper with particular focus on the meaning of capacity, along with the scope and limitations of the current law on unfitness to plead.

This article examines the need for a new insanity defence in the light of the inadequacies of the M'Naghten Rules. Consideration is given to some of the theoretical and practical issues which must be addressed in drafting a new insanity defence. Attention is given to American versions of the insanity defence and other proposals for reform. Tentatively, a new form of defence is suggested.

The standard operation for an aortic root dissection is an aortic root replacement with direct re-implantation of the coronary arteries. In some cases, such as acute dissection and redo surgery, this approach can be difŽ cult. The Cabrol technique was developed to overcome this and involves the use of a Dacron interposition graft to connect both coronary oriŽ ces to the aortic graft. This was found to carry the risk of right coronary artery thrombosis. The subsequent modiŽ ed Cabrol’s technique involves the direct re-implantation of the right coronary artery and the re-implantation of the left coronary artery by the utilization of a Dacron graft anastomosed to the left coronary artery ostium. This is then passed posterior to the ascending aortic graft and anastomosed to the right side of the aortic graft. This 74-year-oldmale recently had redo aortic root surgery with a composite carbosealprosthesis.He originally had an aortic valve replacement and presented 19 years later with chronic aortic dissection. In this case, because of the scarring caused by previous surgery, the left coronary artery could not be adequatelymobilized and was attached using the modiŽ ed Cabrol’s technique described. A 6-month postoperative contrast-enhanced computed axial tomography (CAT) scan at the level of the ascending aorta reported a small residual dissection  ap. The large Dacron interposition graft (arrow) lies at the right postero-lateral aspect of the root replacement. The appearances strongly resemble an aortic dissection (Panels A and B). The incidence of aortic dissection after aortic root surgery is 0.7% . CAT scans are highly sensitive and speciŽ c for aortic dissection. The appearance of two lumens separated by an intimal  ap is speciŽ c for aortic dissection, but care must be taken not to misdiagnose an extra-aortic structure as a false lumen. The left innominate vein, the superior vena cava, the left superior intercostal vein, the left superior pulmonary vein and the superior pericardial recesses can mimic a false channel as can adjacent pleural or pericardial thickening and adjacent atelectasis of the lung. This CAT Ž nding highlights a less considered differential diagnosis of an aortic intimal  ap.