Ethics and Forensic Psychiatry BY STEPHEN P. HERMAN, MD, FAPA, FAACAP
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orensic psychiatry is often misunderstood by other mental health professionals, attorneys, and members of the general public. It may be surprising to learn that this unique sub-specialty has its own ethical standards. First, what do we mean by “ethics?” Derived from the Greek ethos meaning, “accustomed place” or habit, ethos is the root of the word ethikos, meaning “moral” or “showing moral character.” Aristotle wrote extensively on ethos, as did later philosophers, who noted its appearance in theatre, literature and art. While they still debate today over fine points, we use “ethical” today to mean adhering to the basic values of a person, profession, business, etc. “Medical ethics” is a term first used by an English physician, Thomas Percival, who wrote a pamphlet about it in 1794. However, the subject was written about in the West, by Hippocrates (the well-known Hippocratic Oath), early Christians, and Catholic scholars such as Thomas Aquinas, Jews, including Maimonides and Muslim philosophers, including Ishaq ibn Ali al-Ruhawi, author of Conduct of a Physician. The first code of medical ethics of the American Medical Association was adopted in 1847. Today, the term is ubiquitous in every aspect of medicine.
Ethical standards apply to psychiatry and forensic psychiatry. After 1980, when the AMA updated its Principles of Medical Ethics, the American Psychiatric Association published The Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry. The latest revision was in 2013. In its 35 pages, the Annotations contains eight parts covering every aspect of psychiatric research and practice, from forensic issues: “When the psychiatrist is ordered by the court to reveal the confidences entrusted to him/her by patients, he or she may comply or he/ she may ethically hold the right to dissent within the framework of the law. When the psychiatrist is in doubt, the right of the patient to confidentiality and, by extension, to unimpaired treatment should be given priority. The psychiatrist should reserve the right to raise the question of adequate need for disclosure. In the event that the necessity for legal disclosure is demonstrated by the court, the psychiatrist may request the right to disclosure of only that information which is relevant to the legal question at hand;” mcmsonline.com/round-up
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