Kota Kinabalu: A consultant forensic psychiatrist on Wednesday maintained that the manner of death of Zara Qairina Mahathir was most consistent with suicide.
The recalled deponent, Dr Chua Sze Hung, stood by his conclusion but stressed that the final determination on the manner of death was the prerogative of the Coroner’s Court.
Dr Chua was answering questions from Conducting Officer Nahra Dollah before Coroner Amir Shah Amir Hassan.
Nahra: Having regard to consultant psychiatrist Dr Simon Wong (deponent 75)’s methodology — interviewing only the parents, his admitted limitations on retrospective assessment, his reliance on affectionate audio and video recordings, and his conclusion about the genuineness of the mother’s love — do you maintain your professional opinion that the deceased’s manner of death is most consistent with suicide?Dr Chua: Clinical psychiatric assessment is not meant to be done retrospectively or to determine the manner of death. I stand by my conclusion that the manner of death is most consistent with suicide. I humbly submit that it is the prerogative of the court to determine the manner of death. My opinion remains an expert opinion based on the balance of probabilities.
Nahra: Dr Wong testified that, on the balance of probabilities, the events of July 15 were “clinically significant” because they were “not isolated events” but occurred “on top of already ongoing cumulative stresses”.
You concluded that the “stressful interrogation and the isolation” that morning or night was the direct factor, with other factors being predisposing or indirect. Are Dr Wong’s “clinically significant” and your “direct factor” consistent with each other?Dr Chua: I am not exactly sure what Dr Wong meant by clinically significant, but it is possible that what he meant was clinically significant distress. I believe this part of Dr Wong’s conclusion and my identification of a direct factor are consistent with each other.
Nahra: Dr Wong testified that his report was “not intended to determine the exact cause of death” and that he stood “within my area of expertise... as a clinician”. You, by contrast, concluded that “suicide is most probable”.
In your opinion, can a report that deliberately refrains from addressing the manner of death be considered less assistance to the court than a psychological autopsy?Dr Chua: Dr Wong has approached the case, from what I believe, from a clinical psychiatric assessment or formulation angle, which was never designed or intended clinically to determine the manner of death. In contrast, a psychological autopsy is a tool specifically designed to determine the manner of death.
In my opinion, a psychological autopsy would be more relevant in assisting the court in its inquiry into the manner of death.
Dr Chua agreed with Dr Wong’s testimony that self-harm is not equivalent to suicide, and that suicide generally requires self-inflicted agency, a precise intention to die and a fatal method or plan.
Nahra: Dr Wong testified that self-harm is not equivalent to suicide, and that suicide requires: (i) self-inflicted agency; (ii) a precise intention to die; and (iii) a fatal method or plan.
As a general proposition, do you agree with that three-part distinction?Dr Chua: Yes, I agree.
Nahra: Dr Wong agreed that “on the balance of probabilities, the events of July 15 were clinically significant”. Does Dr Wong’s own concession support your finding that the interrogation at A-3-6 was the direct triggering factor?Dr Chua: I believe so.
The inquest continues.
