A review of patient-level factors related to the assessment of fitness to stand trial

  • Teodora Prpa School of Law, University of Western Ontario
  • Heather Marie Moulden McMaster University & St. Joseph's Healthcare Hamilton
  • Liane Taylor St. Joseph's Healthcare Hamilton
  • Gary Andrew Chaimowitz McMaster University & St. Joseph's Healthcare Hamilton


Under Canadian law, when the issue of fitness to stand trial is raised, a medical professional completes an assessment and provides an opinion of fitness.The Criminal Codedoes not mandate a specific form of fitness assessment, and in the last fifty years, a number of unstructured and structured measures have been created for clinicians’ use. In the last three decades, a multitude of studies have been conducted in the assessment of fitness to stand trial in an attempt to provide a clearer picture of which patient-level factors influence a clinician’s finding of fitness. Previous conclusions on the influence of demographic, psychiatric, criminal, and psycholegal factors have ranged heavily, and research on fitness determinations in Canada is minimal. The purpose of this review is to consolidate the numerous studies to provide an understanding of where future research should be focused so that reliable and valid fitness determinations can be made. Future research should focus on mirroring the unstructured assessments used by clinicians in their studies and then measuring the influence of patient-level factors. Most notably, research should focus on psycholegal factors and their influence on the determination of fitness under the applicable legal standards for fitness across the world.