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Ethical Issues in Forensic Psychiatry in Capital Cases


Tat is, where it is legally required that a convict be ‘medically certified’ as fit for execution, such doctors would refuse to certify any convict, on the basis that this would facilitate the causation of ‘ultimate harm’.


Where there is legally a presumption of fitness, however, harm caused by a doctor can only be, as in regard to sentencing or mercy hearings, by way of finding no relevant disorder


Treatment to restore competence to be executed


Te treatment of a mentally disordered prisoner solely for the purpose of restoring their competence to be executed is considered by almost all medical bodies to be unethical.


However, where a convict is in extreme mental distress, arising from a treatable mental condition, there may be thought also to be an ethical imperative to treat the condition.


Where such treatment is likely to restore competence for execution, an ‘almost impossible’ ethical dilemma is posed, in terms of balancing harms.


If the convict remains competent to consent to, or refuse treatment, then he should make the decision. However, mental disorder which has removed competence to be executed will most likely also have removed competence to consent to treatment, and so involvement of the convict’s lawyer in the decision is required. Tis may appear to offer ‘resolution’ of the doctor’s ethical dilemma. However, such apparent resolution is illusory, since, even if the advocate offers an opinion, it is still the doctor who ultimately has to decide ‘whether to treat’.


Conclusion


Medical involvement in legal proceedings related to imposition of the death penalty is both profoundly ethically problematic and open to the strongest of emotion and opinion. It is an ethical cauldron. And this emphasises the importance of calm, considered, insightful and reasoned deliberation and reflection. It is hoped that this chapter will offer some assistance to clinicians faced with death penalty cases towards achieving such deliberation and reflection, in the knowledge that therein lies the best route to confidence that ethical process has been pursued as well as it can be.


Te authors would welcome contact from colleagues about specific clinical and clinico-legal ethical dilemmas they have encountered, in the hope that open dialogue will serve to enhance ethical practice in this very difficult field.


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