Nemo iudex in causa sua

PC Lundbeck

My opinion on the TV3 documentary which aired last night is irrelevant at this stage. There is one issue though which I have had from the start and which came up again last night – the Irish College of Psychiatry’s involvement in my son’s inquest. Professor Patricia Casey, who arrived at the courthouse, uninvited I might add with her legal team in tow, said she was asked by the college to represent it at the inquest. The coroner refused her request to testify, having already had his quota of experts in the form of Professor David Healy and Dr Declan Gilsenan. 

The jury at my son’s inquest found that the drug Citalopram possibly caused his death and thus rejected a suicide verdict. Professor Casey who had involved herself before, during and after Shane’s inquest, directly afterwards spoke to the Irish media stating that there were “aspects of the evidence which the college took issue with”. While undermining the jury’s verdict, she neglected to disclose her links to Lundbeck, the pharmaceutical company who made the implicated drug, Citalopram. I subsequently discovered, through a FOI request, that an internal college e-mail had been forwarded to Lundbeck pharmaceuticals from the Irish College of Psychiatry regarding this statement.

Four years on, Professor Casey used the TV3 documentary as an exercise to finally contradict Professor David Healy, who testified at Shane’s inquest that the drug had caused Shane’s death. Professor Healy, a psychopharmacologist, scientist and psychiatrist is an expert on psychiatric drugs. Professor Patricia Casey, who is a psychiatrist (not a psychopharmacologist or scientist) chose to contradict Professor Healy stating that the drug was not to blame, instead that it was the ‘psychiatric illness’ that he was suffering from. At one stage she contradicted Professor Healy’s description of delirium, stating that a person suffering from delirium could not possibly drive a car and would probably crash. Whether she read all the inquest testimonies is debatable considering there was one description of the drive home stating that Shane drove erratically and even hit the curb at one stage. 

I should probably point out that Professor Casey has corresponded with me before, in the form of a couple of Solicitor’s letters here and here. Shane’s inquest is not the first one involving Lundbeck where Professor Casey had issues. In this inquest of a man aged 62, again with a Lundbeck drug, Professor Casey defended the drug and said – “Scientific research indicates that children under 18 who are prescribed SSRI antidepressants were at increased risk of suicide attempts and suicidal thoughts but people of 30 years and older were not affected similarly”. 

Speaking here for Lundbeck she said “The outcome for those who get treatment is very good. It is also important to be aware too that antidepressants are not addictive”. She said “These medicines also help ‘re-wire’ the brain so that thinking processes work better.” Where is the science behind this re-wiring mechanism?

Being married to a barrister and having co-written a legal-medical book ‘Psychiatry and the law’ in conjunction with Ciaren Craven (part of her legal team at Shane’s inquest) she must be aware of the principle of ‘Perception of Bias’. This is where a decision maker must step down, not just if there is bias but even where a perception of bias may occur. Finín O’Brien – ‘The most obvious source of bias is for the decision-maker to have a financial interest in the matter to be decided.’ So should the expert witness have a similar impartiality?

There are two main rules in the perception of bias principle: Nemo iudex in causa sua; no-one should be a judge in his own cause, and audi alteram partem; hear the other side too.

In 2008 the Law Reform Commission provisionally  recommended that an expert witness should be obliged to disclose the existence of any pre-existing relationship with a party to a case or “any other potential conflict of interest”. Speaking at a person’s inquest, while simultaneously being paid by the pharmaceutical company implicated in the death, is surely a conflict of interest?

Professor Casey is no stranger to controversy as an expert witness. In this case, the High Court quashed a decision of the Irish Medical Council’s ‘Fitness to Practise Committee’ for rejecting its own expert and instead going with the opinion of Professor Casey – who had instigated the case in the first instance. The High Court quashed findings of professional misconduct against the doctor on the ground that he had not been afforded fair procedure.

In my opinion, the objectivity and impartiality of Professor Casey as an expert witness is questionable, so I’ll take her opinion that my son was suffering with a psychiatric illness with the respect it deserves. On the other hand Professor Healy’s expert report can be viewed here.



10 thoughts on “Nemo iudex in causa sua”

  1. There are two main rules in the perception of bias principle: Nemo iudex in causa sua; no-one should be a judge in his own cause, and audi alteram partem; hear the other side too.

    Maybe you should take your own advice on board .
    . Interesting that the only comment you have to make about the whole documentary is in relation to Patricia Casey.
    Once again the Creane family carried themselves with respect and dignity and are absolutely after nearly 5 years within their rights to look for Balance.


    1. Hi Joan,
      I’m not sure that I understand what I have said to offend you here. I have made no comment on the documentary yet you find that an issue? If asked, I would totally agree that the Creane family have a right to look for balance; where have I said otherwise? All concerned acted in a respectful and dignified manner.
      I have an issue with Patricia Casey attending my son’s inquest and undermining the jurys’ verdict and the expert testimony. I have been fairly consistent there I think.


      1. You must be even more upset over the whole documentary which rubbished the inquest, roundly condemned it for lack of balance and used it as an example of inquest inadequacies meriting major reform. And VB described the late late show explanation offered by RTE as being “obscene”


  2. I suppose I’d be upset if I thought that the inquest procedure in Shane’s case was defective; for me it wasn’t. I have no issue with the inquest apart from Prof Casey trying to undermine the jury, Coroner and expert witness. If the findings warned people that when taking any medication you need to be fully informed, then that’s okay with me and I think it did.
    As for the Late Late Show, we were told from the very start that the other family was asked to take part on that night or any other night. That is something for the other parties to clarify.


    1. The irony is, the opinion of Patricia Casey would not have provided ‘balance’ as Patricia Casey is not an expert in pharmacology, nor is she wholly independent and without bias. On the other hand, Dr David Healy is an expert on these types of cases, particularly where SSRI’s have been implicated in causing certain types of side effects. It seems to me that Patricia Casey would not have provided balance, because not only was she on a mission to deny the side effects of SSRI’s drugs, and also to protect the ideology of Irish psychiatry, but as she has proven, time and time again, she allows her own prejudices and biases to cloud her judgement and opinion. In the abortion debate, she was more or less laughed out of the country,the same happened in the recent gay marriage/adoption debate. She has absolutely no credibility.


  3. Silvia. The inquest was conducted in accordance with the law. The fact an application to the High Court to have it overturned failed is evidence of that. Shane’s inquest was an enquiry into what caused his death. Seb’s inquest was an enquiry into what caused his. Leonie was did not seek to influence Seb’s inquest recognising her opportunity to get answers was at her own child’s inquest, not someone else’s. By contrast a number of people sought to influence the Coroner in Shane’s inquest. Each family involved in this tragedy had the opportunity to have their child’s inquest focus on the questions they needed answered and there was no need for them to do so through the inquest of the other person’s child. The only imbalance was one that impacted Leonie – that she did not meet with Seb’s coroner and seek to influence the outcome of his inquest, a choice she made out of respect for the Creane family and the Court process. You and others appear unaware that the changes to inquest process that the Creane’s are seeking are already part of the Coroner’s Bill 2007, legislation drafted two years before the deaths of Shane and Seb.


  4. The major flaw in the TV3 documentary was that, in an attempt to achieve “balance”, so much credence was given to the views of Professor Patricia Casey that, by the time post-programme discussion was ended, they had become the authorised version.
    Professor David Healy is widely acknowledged as one of the world’s leading experts in the properties of psychiatric medication. Professor Casey, on the other hand, is not.
    Leaving completely to one side her long-standing links to Lundbeck, Professor Casey’s views are not accepted by the majority of her profession, let alone those who formulate official policies in countries like the UK and the USA.
    Let’s take, for example, Professor Casey’s statement that: “Scientific research indicates that children under 18 who are prescribed SSRI antidepressants were at increased risk of suicide attempts and suicidal thoughts but people of 30 years and older were not affected similarly.”
    Research in the UK has shown that, out of a database of almost 2000 antidepressant-related “suicides” over the past decade, 78% of the victims were in fact over 30, with the median age being 43.
    Professor Casey’s “diagnosis” of Shane was both tasteless and unprofessional, contrived to attempt to justify her assertion that the toxic level of Citalopram in Shane’s system played no part in the tragedy. This aspect of the documentary is covered in more detail in my article at “AntiDepAware”.
    In the end, we have to accept that the world is round. It doesn’t become flat just because one member of the Flat Earth Society tells you otherwise, no matter how loudly they may shout.


  5. Hi Leone.I am new to all this so forgive me if I say the wrong thing. I too live in Ireland and was prescribed Cipramil for no apparent reason by a doctor in Galway. Unless you count unemployment a good enough reason? This drug made me want to kill myself from very early on. Luckily my own doctor in Dublin had seen this reaction before and made the connection, stopping this drug immediately. I actually saw that tv3 programme. It was a tragic tale and heartbreaking for both young men and their families. You are doing a wonderful job of warning the public about prescription drugs. Before the tv3 programme it had never occured to me that prescribed drugs could be dangerous, as we always trust that the doc knows best don’t we? So sorry that you lost your son in this way. Keep up the good work though and thanks. Seán


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