Handbook of Forensic Psychiatric Practice in Capital Cases
Expertise
A key domain of clinical ethics lies in the duty to acquire and maintain medical expertise. However, in relation to expert witness work, this includes a duty not just to maintain clinical competence, but a duty to acquire and maintain specific medico-legal competence; that is, competence at the interface between psychiatry and law (see Chapter 2). And such a duty is clearly greatly emphasised in the context of capital legal proceedings, where the consequences of less than fully competent practice can be both ‘ultimately severe’ and irreversible, in terms of ‘doing harm’. Remaining within the limits of your expertise is paramount, and this may require you to refuse involvement in a case. Undertaking to be an expert witness in a case, even for the defence, can be far more harmful in its implications for both the defendant and for justice than refusing to do so if you are not adequately competent to do so.
Ethical codes
Ethical codes can offer a template or aid to the process of reasoning required to reach an ethical decision. However, they are frequently written in such broad terms as often to be less than fully helpful within the circumstances of an individual case and dilemma. Such codes are also not substitutes for good ethical reasoning.
Each professional will have a set of ethical codes that they are bound to consider. Te World Psychiatric Association (WPA), the American Psychiatric Association (APA) and the General Medical Council (GMC) all publish ethical codes. Similar codes exist for psychologists. Te American Academy of Psychiatry and the Law publishes ethical guidance for the practice of forensic psychiatry.
Some overall ‘national’ codes concerned with the practice of forensic psychiatry include within them codes directed specifically at medical involvement in capital proceedings.
Values, bias and objectivity
Tere should be no personal interest in any case. It is, however, very difficult to detach yourself completely from your personal values and beliefs, and perhaps particularly so in capital cases.
Acknowledgment of your personal values and beliefs is to be encouraged, in that good ethical reasoning should include insight into the personal values you inevitably bring to such reasoning. Pretending that you are ‘unbiased’ is ethically more dangerous than acknowledging your likely sources of bias, and attempting to be as honest as you can, alongside such ‘insight’ into ‘your ethical self ’.
Objectivity is an impossible goal; however, the attempt to achieve objectivity, and the pursuit of honesty, are crucially important goals within good clinical ethical practice. And again, clarity in defining the ethical question at hand, and in defining and acknowledging a given form or reflective process, will offer the best protection against the ‘unseen’ operation of personal bias.
More simply, consider the following factors: 114
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