Ethics, Empathy, and Detached Concern in Forensic Psychiatry

Clinical medical ethics are ruled by the principles of beneficence and non-maleficence. In forensic psychiatry, however, the duty to serve as an agent of the justice system overrules these principles; thus, examination subjects may indeed experience harms incurred by the psychiatrist's testimony. Alan Stone argued more than 30 years ago that the participation of psychiatrists in legal proceedings runs two essential and opposing risks: skewing justice to serve patients and deceiving patients to serve justice. In this article, we review the major lines of response and critique stemming from Stone's article. We focus on the use of empathy in examination and evaluation, a topic central to the ongoing discussion and debate. We then describe detached concern, a concept with a long history in medical education but new to discussions of ethics and empathy in forensic psychiatry. We conclude by proposing this concept as a useful addition to thought, discussion, and, above all, practice. We argue specifically that detached concern can help practitioners, seasoned and novice alike, to avail the benefits and manage the ethics risks of using empathy in evaluations.