Practical ethical problems of the forensic psychiatrist in dealing with attorneys.

Alan A. Stone, MD has delineated clearly the areas of ethical conflict for the forensic psychiatrist. He focuses primarily on issues of criminal law and psychiatry and the forensic psychiatrist as double agent. However, he also alludes to the four issues concerning ethical boundaries of forensic psychiatry. His first concern is whether psychiatry has anything true to say that the courts should listen to. His next three concerns relate to the role of the forensic psychiatrist in either twisting the rules of justice and fairness to help the patient or the opposite risk that the patient will be deceived by the forensic psychiatrist in order to serve justice and fairness. Finally, he is concerned that the forensic psychiatrist will prostitute the profession of psychiatry as he or she enters the adversarial system and is assaulted by it. I agree with Stone that these are appropriate concerns and potential risks faced by the forensic psychiatrist. I am grateful to Professor Stone (as should all forensic psychiatrists be grateful) for his scholarly approach to our dilemmas and for alerting us to the potential hazards of our sub speciality. This article will focus on the ethical concerns of the forensic psychiatrist working with attorneys in various phases of both criminal and civil law. Dr. Stone seems concerned about the potential seduction of the forensic psychiatrist by the power of the adversarial system. Perhaps of greater concern than seduction is the potential intimidation of the forensic psychiatrist by the attorney requesting his/her services. The canons of ethics for attorneys demand a vigorous approach to representation of the best interest of the client. In pursuing ethical goals with his or her client, the attorney may make demands on the forensic psychiatrist that are either inappropriate or potentially unethical from the medical-psychiatric position. Potential ethical conflicts may arise in these areas: 1. The nature of the case and the psychiatrist's professional expertise. 2. The nature of the case and the psychiatrist's personal biases. 3. The nature of the case and the psychiatrist's prior record of contact with the patient, client, or other attorneys involved in the case. 4. Issues of confidentiality of information. 5. Issues involving preparation of reports and testimony at depositions and trials. 6. Issues involving fees for professional services rendered.