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Ethics and Forensic Psychiatry: Translating Principles Into Practice

Dr. Appelbaum is the Elizabeth K. Dollard Professor of Psychiatry, Medicine, and Law, and Director, Division of Psychiatry, Law and Ethics, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY. An earlier version of this paper was presented at the 38th Annual Meeting of the American Academy of Psychiatry and the Law, Miami Beach, FL, October 19, 2007. Address correspondence to Paul S. Appelbaum, MD, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 122, New York, NY 10032. E-mail: psa21{at}columbia.edu

Twenty-five years ago, Alan Stone expressed his skepticism that forensic psychiatry could be practiced ethically. His remarks have proven a useful goad to the field, focusing attention on the importance of an ethics framework for forensic practice. But Stone remains dubious that any system of ethics—including the "Standard Position" on which he focuses his critique—could be of much value in practice. In contrast, I suggest that Stone's pessimism is not well founded. Immanent in forensic practice itself is a reasonable set of ethics principles, based on truth-telling and respect for persons. Psychiatrists can offer reliable and valid testimony, while resisting seduction into an advocacy role. Indeed, with new structured approaches to assessment, the potential utility of forensic testimony is probably greater than ever. Though problematic behavior still exists, forensic psychiatry offers the factual background and interpretive context to allow legal decision-makers to make better choices than they otherwise would.

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