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Ethical Issues in Forensic Psychiatry in Capital Cases


• Have you considered your own values and beliefs, and then whether your opinion is unduly influenced by these?


• Have you given thought to alternative opinions and why you do not favour them, and might the reason lie in your own personal values?


• Is there any element of you giving an opinion based upon a personal or professional ‘hobby horse’? Relationship with the defendant


A defendant is not a ‘patient’, and both the doctor and defendant should be fully aware of this from the outset.


However, ‘telling’ a defendant that your role is not that of a doctor assessing and treating a patient, though crucial and necessary, may well not – indeed likely will not – result in persistence of understanding of the distinction on the part of the defendant – or even the doctor sometimes – as the assessment proceeds. Tis is because the doctor necessarily applies medical techniques to the assessment, some of which involve techniques of communication which simply make it feel to the defendant that you are ‘being a doctor’ (see also below in relation to the notion of being a ‘forensicist’). However, this likely lack of appreciation of the unusual relationship must be at least acknowledged and kept ‘in mind’ as much as is possible.


Informed consent


Te clinician should make available to the defendant they are assessing all information that might affect their decision on whether to co-operate with the assessment. Tis should include the nature and purpose of the assessment and your instructions, your duty to the court, and the limits of confidentiality. It is also important to make it clear that the purpose of the assessment is not to offer treatment, although you might recommend treatment in some cases. And there is clearly an even greater need for a defendant to be fully informed of all of the foregoing prior to an assessment in a capital case.


Clinician or forensicist


A major ethical debate has been pursued, particularly in the United States for at least two decades, concerning the role of doctors in criminal proceedings, including capital proceedings, specifically in terms of whether they set aside their medical identity – and ethical principles associated with that identity – when they assess a defendant. Tat is, whether the medical ethical duty of ‘non-maleficence’ simply does not apply to a doctor assessing a defendant, because, in that context, the doctor’s sole duty is to ‘justice’, and to the court.


In validating this ethical approach, it is suggested that the doctor assessing a defendant is not ‘being a doctor’; rather s/he is being ‘a ‘forensicist’, somewhat akin to being a forensic scientist.


However, forensic scientists do not deal directly with individuals to whom they might owe a duty, other than one of honesty; and they certainly do not, in other circumstances, ‘treat’ individuals. And herein lies a potential, perhaps crucial, flaw in the forensicist ‘alibi’, in that, in utilising medical techniques, a doctor necessarily utilises techniques of communication which make it nigh on impossible to maintain in the


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