Psychiatric ethics in the courtroom

P S Appelbaum
1984 The Bulletin of the American Academy of Psychiatry and the Law  
In his provocative article, "The Ethical Boundaries of Forensic Psychiatry," Alan A. Stone, MD challenges those of us whose work brings us in contact with the courts to define a set of principles by which our behavior might be guided. Delineating the proper role of psychiatry in the courtroom is, of course, not a problem limited to those who consider themselves "forensic psychiatrists." My experience suggests that most psychiatrists in institutional practice (and that includes private
more » ... , as well as community mental health centers and state hospitals) are frequently called on for courtroom testimony; I suspect that a survey of our colleagues in private practice would show that a surprising number of them come into contact with the courts as well. Despite the discomfort court appearances arouse in many psychiatrists, there is little reason to believe this contact will diminish. Societal demands for psychiatric testimony in tort actions, child custody cases, and criminal cases, not to mention more exotic fonns of litigation, show no sign of abating. Sometimes psychiatrists enter these cases voluntarily, but their testimony is often coerced, the result of a court's subpoena. Even were forensic psychiatry to disappear as a subspecialty, therefore, the problems associated with psychiatric testimony and the need for ethical guidelines in the courtroom would remain. Thus, the problems identified by Dr. Stone are issues that should concern all psychiatrists. The visibility of psychiatric testimony and the often angry responses it draws from the public (witness the brouhaha that followed the Hinckley trial) should serve to reinforce that concern. Dr. Stone describes my approach to these matters as follows: "Dr. Paul Appelbaum has suggested the standard of truth should govern the forensic psychiatrist.. .. I assume that Paul Appelbaum's standard of truth is not the same as the one I raised at the beginning ... the truth in an absolute sense .... What Dr. Appelbaum means, I think, is closer to honesty; the forensic psychiatrist must honestly believe what he says and should not allow his views to be distorted."• Let me refme that a bit further. The primary task of the psychiatrist in the courtroom, I believe, is to present the truth, insofar as that goal can be approached, from both a subjective and an objective point of view. I will consider the implications of this principle, but I must first note that other commentators have addressed psychiatric ethics in the courtroom in similar terms. Elements of my approach can be found in the writings of forensic psychia-
pmid:6478064 fatcat:mytsb6ozebdg5h7xkzpwg4srk4