Leo Sher, M.D.

Forensic psychiatric evaluations fundamentally differ from routine provision of clinical care, despite significant overlap in how they are performed (1-9). The opinion generated by the interview could be helpful, harmful, or neutral to the person being evaluated. These points distinguish a clinical psychiatric interview from a forensic evaluation.

A proposal has been made for an ethical framework of forensic psychiatry, which considered that its practice was acceptable if it fulfilled two criteria: truth-telling (honesty) and respect for persons, which means respect for the right of the people evaluated by a forensic psychiatrist to be informed of the implications of the assessment before entering into the process (3).

The American Medical Association (8) the American Psychiatric Association (9) and the American Academy of Psychiatry and the Law (2) issue ethics and practice guidelines and promote professional development. The American Academy of Psychiatry and the Law (2) suggests the following principles of ethical behavior of a forensic psychiatrist:

•    Confidentiality (“Respect for the individual’s right of privacy and the maintenance of confidentiality should be major concerns when performing forensic evaluations. Psychiatrists should maintain confidentiality to the extent possible, given the legal context”)
•    Consent (“At the outset of a face-to-face evaluation, notice should be given to the evaluee of the nature and purpose of the evaluation and the limits of its confidentiality. The informed consent of the person undergoing the forensic evaluation should be obtained when necessary and feasible”)
•    Honesty and Striving for Objectivity (“When psychiatrists function as experts within the legal process, they should adhere to the principle of honesty and should strive for objectivity… Being retained by one side in a civil or criminal matter exposes psychiatrists to the potential for unintended bias and the danger of distortion of their opinion.”)
•    Qualifications (“Expertise in the practice of forensic psychiatry should be claimed only in areas of actual knowledge, skills, training, and experience. When providing expert opinion, reports, and testimony, psychiatrists should present their qualifications accurately and precisely”)

As a collaborator of the judicial system, forensic psychiatry has a significant risk of being perverted by the dominant social ideology. It is therefore important to stay within the value system of medicine, although this may involve conflicts with prevailing social values.

References

1.    Appelbaum PS, Gutheil TG. Clinical Handbook of Psychiatry and the Law. 4th ed., Philadelphia: Lippincott Williams & Wilkins, 2007.
2.    American Academy of Psychiatry and the Law. Ethics Guidelines for the Practice of Forensic Psychiatry. Adopted May, 2005. http://www.aapl.org/ethics.htm  Accessed: July 30, 2014.
3.    Appelbaum PS. A theory of ethics for forensic psychiatry. J Am Acad Psychiatry Law 1997;25:233–247.
4.    Calcedo-Barba A. Objectivity and ethics in forensic psychiatry. Curr Opin Psychiatry 2010;23(5):447-52.
5.    Stone AA. The ethical boundaries of forensic psychiatry: a view from the ivory tower. Bull Am Acad Psychiatry Law 1984;12:209–219.
6.    Candilis PJ, Martinez R, Dording C. Principles and narrative in forensic psychiatry: toward a robust view of professional role. J Am Acad Psychiatry Law 2001;29:167–173.
7.    Norko MA. Commentary: compassion at the core of forensic ethics. J Am Acad Psychiatry Law 2005;33:386–389.
8.    American Medical Association: Principles of Medical Ethics. Available at http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/principles-medical-ethics.page? Accessed: July 24, 2014.
9.    American Psychiatric Association: The Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry. 2010 edition. American Psychiatric Association, Arlington VA, 2010.