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Ethical Issues in Forensic Psychiatry: Minimizing Harm



Ethical Issues in Forensic Psychiatry: Minimizing Harm

Robert L. Sadoff

ISBN: 978-1-119-95735-5 June 2011 256 Pages

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Ethical medical practice and treatment in psychiatry are based on the concept of first do no harm. However, this cannot, and does not, apply to forensic cases where there is no doctor–patient relationship and the forensic psychiatrist may indeed cause harm to the examinee. In this book, Robert Sadoff analyzes the ethical issues affecting forensic psychiatric practice, especially those promulgated by the American Academy of Psychiatry and the Law. Within those guidelines, he looks at individual bias, vulnerability of the examinee, and potential harm to the mental health professional.  The book discusses each of the procedures of the forensic expert separately with respect to minimizing harm. It has been written with an international audience in mind and features chapters reviewing the European and UK perspectives, by Emanuele Valenti and John Baird, respectively.

Robert Sadoff addresses the long-term harm that can be either avoided or minimized through careful planning and application of ethical principles. He is not advocating that the harm can be totally eliminated, because that is impossible in the adversarial system in which forensic psychiatrists work. However, there are means by which harm may be minimized if care is taken during the assessment, the report writing, and the testimony phase of the proceedings. The book develops the scope of forensic psychiatry from the standpoint of administrative, civil and criminal cases. It presents the practical issues involved in conducting forensic psychiatric assessments under various conditions plus special considerations, such as bias, minimizing harm, developing a therapeutic approach, and elaborating on various vulnerable individuals who are frequently examined in forensic cases. These include juveniles, mentally retarded, autistic, sexual assault victims, the elderly, the organically damaged, the psychotic, and mentally disabled prisoners. Immigrants are covered in a chapter by Solange Margery Bertoglia. The ethical issues in conducting forensic psychiatric examinations and presenting psychiatric testimony in court are examined and discussed. Cases illustrating the difficulties involved punctuate the presentation. The book closes with a fascinating account of the legal perspective by Donna Vanderpool.

In summary, this book illustrates the ethical and practical issues that affect forensic psychiatric practice. The question is not what we do, but how we do it, and which standards, ethical guidelines and personal values contribute to the total picture. Despite the fact that we cannot always adhere to the doctrine of "primum non nocere," we can minimize the harm caused inherently by the adversarial system in which we participate.

Praise for Ethical Issues in Forensic Psychiatry

"One of the founding giants of the forensic psychiatric field has written here far more than a "mere" ethics textbook. Instead, this compendium serves multiple purposes: it is a valuable primer on forensic techniques of examination and testimony, a model of best forensic practices, and an instruction on the most appropriately civilized way in which to conduct oneself as a forensic psychiatrist.

The success of these multiple accomplishments clearly derives from characteristics of the author. In both sage advice to practitioners and in many revealing case examples, Dr. Sadoff displays the tact, good manners and sensitivity of a consummate gentleman – a term not always associated with the hurly-burly of courtroom work. The book's primary focus on avoiding harm to all the parties involved in the work places it on the moral high ground of the legal system in which participating clinicians must find a place."
Thomas G. Gutheil, MD, Professor of Psychiatry and Co-Founder, Program in Psychiatry and the Law, Beth Israel Deaconess Medical Center, Harvard Medical School

About the Authors.




List of Contributors.

Part One Ethics in Forensic Psychiatry.

1 Ethical Issues in Forensic Psychiatry in the United States (Robert L. Sadoff).

2 Minimizing Harm: A Perspective from Forensic Psychiatry in the United Kingdom (John A. Baird).

3 Mental Health and Human Rights in Forensic Psychiatry in the European Union (Emanuele Valenti and Luis Fernando Barrios Flores).

Part Two The Practice of Forensic Psychiatry.

4 The Forensic Psychiatric Examination (Robert L. Sadoff).

5 The Forensic Psychiatric Report (Robert L. Sadoff).

6 Expert Psychiatric Testimony (Robert L. Sadoff).

Part Three Vulnerable Populations in the Justice System.

7 Children and Adolescents (Robert L. Sadoff).

8 The Elderly, the Mentally Retarded, and the Severely Mentally Disabled (Robert L. Sadoff).

9 Victims and Predators of Sexual Violence (Robert L. Sadoff).

10 Immigrants: A Vulnerable Population (Solange Margery Bertoglia).

11 Prisoners and Death Row Inmates (Robert L. Sadoff).

12 Forensic Psychiatric Experts: Risks and Liability (Robert L. Sadoff).

13 Risks of Harm to the Forensic Expert: the Legal Perspective (Donna L. Vanderpool).


"Sadoff's book is a vital contribution to the psychiatric literature, as it fills a need unaddressed by more theoretically oriented works. Anyone interested in mental health or medical ethics will find this text worthwhile, especially as it contains an introduction for lay readers explaining basic forensic roles and functions.The book is most valuable, however, to forensic mental health practioners, who will benefit from its practical instruction aimed at minimizing harm." (Journal of Clinical Psychiatry, December 2012)

"Sadoff has crafted an admirable mix of facts and anecdotes, presented in a manner
that could help undergraduates get a taste for the realities of forensic practice, help graduate
students connect the theoretical with the practical, and even provide veteran practitioners
with helpful reminders and provocative food for thought." (PsycCRITIQUES, 23 November 2011)

"It will serve as a useful resource and is a welcome addition to my library." (Doody's, 11 November 2011)

"While Ethical Issues in Forensic Psychiatry appears to be targeted at the forensic psychiatrist, as emphasised in the title, I believe that it can be valuable reading for all forensic mental health professionals. . . Ethical Issues in Forensic Psychiatry makes practical ethics easy reading. . . This book is an invaluable guide to ethical practice." (Journal of Mental Health, 1 October 2011)