Forensic psychiatry, one subspecialty with two ethics? A systematic review

Area of Science:

• Forensic Psychiatry
• Medical Ethics
• Legal Medicine

Background:

• Forensic psychiatry applies psychiatric expertise to legal matters.
• The involvement of a third party necessitates adapting traditional ethical principles.
• Ethical considerations are paramount due to the unique patient-doctor dynamic in forensic settings.

Purpose of the Study:

• To explore the ethical principles governing forensic psychiatry.
• To analyze the evolution and application of these principles over time.
• To compare ethical frameworks in correctional and legal forensic psychiatry.

Main Methods:

• A chronological literature review from 1950 to 2015.
• Analysis of 47 articles, two book chapters, and professional guidelines.
• Comparative analysis of ethical tenets in different forensic subspecialties.

Main Results:

• Ethical principles in correctional and legal forensic psychiatry show congruence in concept but divergence in implementation.
• Correctional forensic psychiatry aligns with deontological ethics (justice, beneficence, autonomy).
• Legal forensic psychiatry leans towards consequentialist ethics (professionalism, objectivity, informed consent).

Conclusions:

• Both correctional and legal forensic psychiatry share the principle of non-maleficence, prohibiting involvement in inhumane treatment or capital punishment.
• Ethical frameworks require adaptation based on the specific legal context.
• Consistent application of ethical principles ensures patient welfare and professional integrity.