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Infanticide, Filicide, and Cot Death

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Infanticide, Filicide, and Cot Death Arch Dis Child: first published as 10.1136/adc.60.6.505 on 1 June 1985. Downloaded from Archives of Disease in Childhood, 1985, 60, 505-507 Annotations Infanticide, filicide, and cot death The 'suppression' of unwanted babies seems to have in England and Wales are under the age of 16-81% been commonplace in antiquity. Early travellers to of them being killed by their parents; and children in New Zealand, while remarking on how fond the their first year are at a greater risk of being the Maoris were of their children and how well they victims of proved homicide than at any other age.3 looked after them, noted that infanticide was openly Most studies relating to filicide have been under- practised. The most favoured methods were squeez- taken by psychiatrists working with people who have ing the nose between the fingers, pressing the been convicted of killing their children. d'Orban,4 fontanel, or putting a wet cloth over the baby's reporting on 89 women charged with killing or head-practises that time perhaps had shown would attempting to kill their own children, put the causal enable a child to die without a struggle.' In some groups in descending order of frequency as: (1) Aborigine communities in Australia it was not battering, (2) mental illness in the mother, (3) possible for women to bring up more than one baby, neonaticide, that is the killing of a baby within 24 and it was the duty of the maternal grandmother to hours of birth, (4) retaliating mothers, (5) unwanted ensure that the weakest of twins did not survive. children, (6) mercy killing. Today, if an Aborigine woman has twins and one is Cases of filicide fall into two groups-newborn kept in hospital requiring resuscitation, local and later. The first present with a younger aged paediatricians inform me when it goes home it is group of parents. These -deaths are frequently likely, in some areas, to shortly present as a cot registered under the heading of 'inattention at death. Currently in China, where the state is trying birth'-women who claim not to have known they to limit families to one child, there has been an were pregnant, and classically the baby born into the increase in the incidence of cot deaths in girls-girls lavatory pan. Unless there has been gross violence are being suppressed. to the child or the child has been suffocated by a It has been estimated that in western Europe one cloth being thrust into its mouth, these deaths are third of all infants were suppressed at the beginning rarely the subject of further proceedings by the http://adc.bmj.com/ of the last century.2 It was no chance happening that police. It is in the death of the older baby that the Napoleon set up large orphanages in France at that relation to cot death becomes important. time to save infants who would form the backbone of the future armies of France. In this country the Pathology of filicide act of 1933 recognised that a mother who kills her child before the age of 1 year will not be convicted of There are four main groups of causes of death: (1) 'murder', but of 'infanticide'. Infanticide has now a accidents; (2) poisonings, which may or may not be on October 2, 2021 by guest. Protected copyright. legal meaning and is associated with death under 1 accidents; (3) non-accidental injury; and (4) 'gentle year of age at the hands of the mother, but also in battering'-a term which is self evident, as victims general it means the killing of an infant by anyone. do not show the evidence of violence characteristic The term 'filicide' covers the topic we are discussing, of group (3). It is this last group that merits which is child homicide by either parent. We need to discussion in relation to cot death. In detective think of filicide in relation to the current social fiction the forensic pathologist is able to say with attitude to killing babies. The killing of a baby in certainty whether or not a person has died from utero up to at least 20 weeks' gestation can be asphyxia-in fact this is by no means the case. The carried out for social reasons. The question of classically accepted stigmata petechiae are known to whether or not doctors may expedite death in a have very complicated patterns of causology. We viable or live born child was not solved by the have all seen children who have been accidentally Leonard Arthur case, but it is noteworthy that no suffocated by plastic bags over their faces and who further paediatricians have been brought to trial on have shown none of the classic stigmata of suffoca- this front. Have doctors more responsibility to tion or asphyxia. Furthermore, the presence of individual children than parents have? We are living infection or a minor disease does not help in in a period of moving social attitudes to procreation. eliminating filicide. If parents are at the end of their A quarter of all victims of legally proved homicide tether psychologically, a mild illness in the child 505 Arch Dis Child: first published as 10.1136/adc.60.6.505 on 1 June 1985. Downloaded from 506 Emery makes him more irritable and therefore more likely infant death syndrome, which is an unexplained to produce a final, emotional, parental crisis. natural cause of death. The introduction of the Evidence relating to filicide has to come from diagnosis SIDS did not alter the steady rise in the much more than conventional histopathology, it diagnosed infanticide rate in the United States.6 requires a polyfactoral approach to the death. The diagnosis of SIDS greatly helped many Perhaps the most important factor at necropsy is an parents, but it has had an unfortunate effect upon assessment of the biochemical state of the child such the research into the causology of these babies' as was carried out in the recent multicentre study for deaths. It is too easy to find nothing at necropsy, the Department of Health and Social Security and a situation has been created whereby people (DHSS),s together with a psychosocial study of the who have very little knowledge of paediatric pathol- family and its background. The latter is not easy. ogy are justified in propounding theories of caus- Once a child has been given the label of 'cot death' ology and carrying out very extensive investigations or 'sudden infant death syndrome' (SIDS), and most along these lines. Being a condition of unknown pathologists are prepared to do this on naked eye aetiology, nobody is to blame or need do anything necropsy, the parents are given the literature on active about it except to comfort the parents-and SIDS and immediately told that their child has died many are active here. Against this background the from natural causes for which they were not to suggestion that some of these babies' deaths are due blame. This affects the parameters of any subse- to filicide becomes unacceptable. quent discussion of the death. If a mother or father says that they killed the child How common is rilicide among cot deaths? it in no way proves that they did so (I have had far more mothers tell me that they have killed their While some centres examine some aspects of nec- child than I believe have actually done so), people ropsy in greater detail (for example virology in make confessions because they feel guilty, not Melbourne), the general depth of investigation into because of what they did. Furthermore, if a confes- cot deaths in Sheffield is not exceeded anywhere in sion of smothering is obtained by the police it is easy the world, and the Sheffield necropsy findings have for a defending lawyer to claim that the confession largely been substantiated by the DHSS multicentre was obtained under duress-and is not a bereaved study. Since that study the local investigation of cot parent always under duress?-and so is inadmissible deaths has been extended to include a psychosocial as court evidence. Thus the confessional statement study of the family, and it is this further information has limited value. This was brought home to me very in collaboration with that of the necropsy pathology clearly several years ago when my forensic pathol- that led us to believe that in Sheffield, filicide is the http://adc.bmj.com/ ogist colleague and I believed that a certain young probable mechanism in death in approximately one mother had smothered two of her children: she had in 10 of the unexplained, unexpected deaths.' It is also confessed to this to the police. When brought to important here to use the term filicide rather than trial, however, the confession was withdrawn as not infanticide because, in our opinion, all these deaths admissible in evidence and we were forced to agree are not due to actions on the part of the mother that the features we described at necropsy existed in alone. How do our findings fit in with earlier as in cot and of elswhere? We the published reports findings deaths. The findings those other people are on October 2, 2021 by guest. Protected copyright. case was dismissed. Such is the current dilemma. not aware of any other community group of deaths, including the DHSS multicentre study, that has been Diagnosis of SIDS studied in this way. I have recently studied a group of cot deaths in another country with a very If we consider the situation of children found experienced paediatric pathologist.
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