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Handbook of Forensic Psychiatric Practice in Capital Cases


knowledge of the potential consequences of not taking part in an assessment, in terms of not having access to a potential mental condition defence or mitigation factors in sentencing. Terefore, the process is less collaborative.


Te doctor conducting a forensic assessment must walk a difficult and narrow ethical line, using clinical techniques for example, empathy to put the defendant at his ease and to elicit a truthful and honest account, yet being mindful that their primary duty is to others, and not the defendant.


Tere is also a risk of ‘doing harm’ to a defendant assessed, for example, where data is elicited which implies not mitigation but aggravation of culpability, as it will be perceived by the court, thereby contradicting one of the main principles of medical ethics of ‘non-maleficence’ (see Chapter 15) .


Some forensic psychiatrists perceive no ethical difficulty in assessing a defendant for legal purposes, even where it is clear that the effect may well be ‘to do harm’. Tey do so by resorting to their duty in ‘justice’ (a medical and general principle which can be in competition with that of ‘beneficence’ or ‘non-maleficence’) and by way of describing assessment for legal purposes as being not ‘medical practice’ at all but, rather ‘being a forensicist’, akin to a forensic scientist. However, although this is a ‘nice distinction’ in theory, in practice it is spurious. Even if, quite properly, the doctor makes plain to the defendant at the outset his non-medical that is, ‘forensicist’ role, s/he then adopts and applies medical techniques, and this includes techniques of empathy and other techniques which are clearly medical and which aim to extract information from the defendant. Hence, s/he is quite clearly ‘being a doctor’. And, even if s/he thinks s/he is not, the defendant will soon forget the initial warning about role and quickly ‘experience’ the alleged forensicist as a doctor.


Te lack of any real escape from ‘being a doctor’ in carrying out assessments for court most acutely focuses the medical mind ethically in capital cases where the doctor is asked to assess by the prosecution. Some doctors find this to be ‘a harm too far’ and will only accept instruction in capital cases from the defence, although this position emphasises the importance of being aware of the potential impact on assessment of one’s own ‘values set’, in terms of the potential for bias, and of acting ‘honestly’ (see Chapter 15).


Even where a doctor is instructed by the defence, if s/he is not adequately competent to conduct the assessment, then s/he can clearly ‘do harm’ by way of not, for example, eliciting medical information which would likely assist the defendant legally. And that is quite obviously ethically wholly unacceptable.


Before accepting instructions


If approached to conduct a forensic assessment, the first question to be asked is whether the proposed assessment is within your field of expertise; or whether, even if it ‘just is’, whether it would be more so within the expertise of a different doctor. Alternatively, whether, in addition to your own assessment, that of another expert is also required (for example, where there is the possibility of brain damage it may be necessary that a neuropsychiatrist and/or a neuropsychologist be instructed alongside a forensic psychiatrist). To reach a view on this a detailed letter of instruction is required. Even before this, there is often much to be gained from an informal discussion with a defendant’s legal advisors,


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