Ethical dilemmas in forensic psychiatry: two illustrative cases

Sen, Piyal; Gordon, Harvey; Adshead, Gwen; Irons, Ashley

doi:10.1136/jme.2006.017806

Cited by 36 publications

(26 citation statements)

References 13 publications

(8 reference statements)

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“…The institutional environment is also characterized by high level of security where patients are often cared for over long periods of time (Hörberg et al, 2012 ). Sen, Gordon, Adshead, and Irons ( 2007 ) highlight ethical dilemmas in forensic psychiatry such as the immoderate use of segregation, the use of mechanical restraints, and physical treatment without consent.…”

mentioning

confidence: 99%

Caring potentials in the shadows of power, correction, and discipline—Forensic psychiatric care in the light of the work of Michel Foucault

Hörberg

Dahlberg

2015

International Journal of Qualitative Studies on Health and Well

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The aim of this article is to shed light on contemporary forensic psychiatric care through a philosophical examination of the empirical results from two lifeworld phenomenological studies from the perspective of patients and carers, by using the French philosopher Michel Foucault's historical–philosophical work. Both empirical studies were conducted in a forensic psychiatric setting. The essential results of the two empirical studies were reexamined in a phenomenological meaning analysis to form a new general structure in accordance with the methodological principles of Reflective Lifeworld Research. This general structure shows how the caring on the forensic psychiatric wards appears to be contradictory, in that it is characterized by an unreflective (non-)caring attitude and contributes to an inconsistent and insecure existence. The caring appears to have a corrective approach and thus lacks a clear caring structure, a basic caring approach that patients in forensic psychiatric services have a great need of. To gain a greater understanding of forensic psychiatric caring, the new empirical results were further examined in the light of Foucault's historical–philosophical work. The philosophical examination is presented in terms of the three meaning constituents: Caring as correction and discipline, The existence of power, and Structures and culture in care. The philosophical examination illustrates new meaning nuances of the corrective and disciplinary nature of forensic psychiatric care, its power, and how this is materialized in caring, and what this does to the patients. The examination reveals embedded difficulties in forensic psychiatric care and highlights a need to revisit the aim of such care.

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confidence: 99%

Caring potentials in the shadows of power, correction, and discipline—Forensic psychiatric care in the light of the work of Michel Foucault

Hörberg

Dahlberg

2015

International Journal of Qualitative Studies on Health and Well

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“…According to Sen, Gordon, Adshead et al, the difficulty in implementing the « four principles plus scope » in a forensic context, results from the obligation to consider a third party, represented by the society in general [ 10 ]. In the rise of ethical conflicts in forensic psychiatry, it is the principle of justice that prevails, contrary to the principle of autonomy that is less relevant in this particular field of psychiatry.…”

Section: Resultsmentioning

confidence: 99%

“…These authors insist on the fact that none of the four principles aforementioned should have priority over one another, and that their use in daily practice should depend on the particular case considered. The principist approach of Beauchamp and Childress, largely recognized and accepted worldwide, represents a platform for common reflection on clinical ethics [ 10 ]. However, the consequentialist approach is often mentioned as a means to solve ethical conflicting situations, and in which the principist approach is not satisfactory.…”

Section: Introductionmentioning

confidence: 99%

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

Niveau

Welle

2018

BMC Med Ethics

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BackgroundForensic psychiatry is a particular subspecialty within psychiatry, dedicated in applying psychiatric knowledge and psychiatric training for particular legal purposes. Given that within the scope of forensic psychiatry, a third party usually intervenes in the patient-doctor relationship, an amendment of the traditional ethical principles seems justified.ResultsThus, 47 articles, two book chapters and the guidelines produced by the World Psychiatric Association, the American Association of Psychiatry and the Law, as well as by the Royal Australian and New Zealand College of psychiatrists, were analyzed. The review revealed that the ethics of correctional forensic psychiatry and those of legal forensic psychiatry do not markedly differ from each other, but they are incongruent in terms of implementation.MethodsIn an effort to better understand which ethical principles apply to forensic psychiatry, a chronological review of the literature published from 1950 to 2015 was carried out.ConclusionThe ethics of correctional forensic psychiatry are primarily deontological. The principle of justice translates into the principle of health care equivalence, the principle of beneficence into providing the best possible care to patients, and the principle of respect of autonomy into ensuring confidentiality and informed consent. The ethics of legal forensic psychiatry are rather consequentialist. In this latter setting, the principle of justice is mainly characterized by professionalism, the principle of beneficence by objectivity and impartiality, and the principle of respect of autonomy by informed consent. However, these two distinct fields of forensic psychiatry share in common the principle of non maleficence, defined as the non collaboration of the psychiatrist in any activity leading to inhuman and degrading treatment or to the death penalty.

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“…FPC staff have to simultaneously manage caring for patients while maintaining control [ 1 , 11 – 18 ]. These studies highlight the complexity in forensic psychiatric caring related to the dilemma of providing custodial care, that is, providing care in a custodial manner.…”

Section: Introductionmentioning

confidence: 99%

Engaging with Families Is a Challenge: Beliefs among Healthcare Professionals in Forensic Psychiatric Care

Hörberg

Benzein

Erlingsson

et al. 2015

Nursing Research and Practice

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Being healthcare professionals in the complex field of forensic psychiatry care (FPC) seems particularly challenging. Historically, families have almost been invisible in FPC. The aim of this study was to uncover beliefs among healthcare professionals concerning families of patients admitted for FPC. Using a hermeneutical approach inspired by Gadamer's philosophy, group interviews with healthcare professionals in four Swedish forensic psychiatric clinics were analyzed. Analysis resulted in seven key beliefs. There were three beliefs about families: family belongingness is a resource for the patient; most families are broken and not possible to trust; and most families get in the way of the patient's care. Four beliefs concerned encounters with families: it is important to achieve a balance and control over the family; it is essential to set aside one's own values and morals; family-oriented work is an impossible mission; and family oriented work requires welcoming the families. Despite ethical dilemmas of working with families in FPC, healthcare professionals showed a willingness and desire to work in a more family-oriented manner. More knowledge, understanding, and caring tools are needed in order to meet the needs of the family as well as support the family's resources.

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Ethical dilemmas in forensic psychiatry: two illustrative cases

Cited by 36 publications

References 13 publications

Caring potentials in the shadows of power, correction, and discipline—Forensic psychiatric care in the light of the work of Michel Foucault

Caring potentials in the shadows of power, correction, and discipline—Forensic psychiatric care in the light of the work of Michel Foucault

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

Engaging with Families Is a Challenge: Beliefs among Healthcare Professionals in Forensic Psychiatric Care

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