Worldwide, a wider understanding of the relationship between mental states and crime has led to an increased utilisation of forensic experts in courts of law at different levels of legal action. Psychiatrists and other mental health specialists are often required to conduct assessments in criminal cases with a view to determine the presence of mental or emotional problems in such cases. These types of assessments are needed in multiple situations, ranging from examinations to specify the impact of injuries, level of risk posed by the perpetrator, to evaluations of personality and the capacity, to psychological autopsies in order to assess testamentary capacity in suicidal cases or sudden death and of late evaluations to profile and study behaviour of terrorists.
The double revolving door phenomenon, whereby criminals circulate between courts and prisons, has made ordinary public deeply suffer from the delays in sentencing the criminals to punishment. By virtue of their involvement in legal matters, forensic psychiatrists would participate in the drafting and application of legislation, especially on the issues of involuntary commitment, that in many countries is based on determination of dangerousness as opposed to just need for treatment, of management of mentally ill offenders and of legal protections for incompetent persons. Given that one major area of their expertise is the assessment of violence and the possibility of future violent behaviour, forensic psychiatrists are usually called upon to make decisions on risk posed by violent civilly committed patients.
Forensic medicine is becoming more and more important for participation in the criminal justice system in Pakistan. Forensic psychiatry is an important part of crime and criminology but is being thoroughly neglected in Pakistan due to the limited knowledge about the subject and dearth of the specialists in this field. We cannot ignore the mental status of a person in relation to commission of a crime, as it is the case in all spheres of life. So introducing a forensic psychiatrist and his specific expertise in forensic examinations may play key roles in crime investigations. The law can judge the merit of a case on the basis of how far the circumstances might influence to commit a crime but the investigation of crime has to be a compulsorily teamwork consisting of man of forensic psychiatry or at least forensic medicine expert and the other investigating agencies.
As clinicians, psychiatrists are unequivocally dedicated to relieving the suffering of those who are afflicted with mental disorders. However, findings from a recent cross sectional survey shows that 36 percent of literate public in Pakistan found it difficult to draw a distinction between psychiatrists and psychologists making it extremely distinct possibility that educated public are aware about the forensic psychiatrist professional acting in an evaluative role. Before I examine the ethical issues raised by psychiatric involvement in the investigation process, it is important that I do not reject the view that a forensic psychiatrist, who undertakes an evaluation, is to be considered as an advocate of justice who is not bound by conventional ethical duties to the individual whom he or she assesses. It contends that the forensic psychiatrist has an important role to play in presenting evidence and examining the subject that may result in conviction or the mitigation of the sentence that may be imposed on a person who is charged with a crime. The facts of the case become clearer when the criminal behaviour is analysed and psychiatrists opinions are expressed about which part of the behaviour was to be considered rational or irrational.
It is unquestionably true that forensic psychiatry has reached its coming of age and is now respected as one of the major subspecialties of psychiatry. However, some controversies still remain that challenge the value system underlying this subspecialty and question the way it is practised. Actually, it has even been questioned whether the value system of forensic psychiatry to some extent contradicts that of psychiatry or medicine. The problem is how we can reconcile forensic practice in situations like the five-year-old girl’s rape case in Lahore with the traditional values of the police investigation practice and controversial criminal and civil justice system in Pakistan. Psychiatrists operate outside the medical framework when they enter the forensic realm, and the ethical principles by which their behaviour is justified are simply not the same. The principles of beneficence and non-maleficence lose their primacy to the principle of truth and objectivity in the forensic setting. Probably forensic psychiatrists would lose their main ‘medical essence’ if they just regarded objectivity as the supreme value. Therefore, respect for persons should be regarded as a second moral rule. This is an extension of the informed consent doctrine to the practice of forensic psychiatry. The criminal justice system of Pakistan should be aware of the implications of the forensic assessment and the prosecution may use the information he is providing to be examined. It must be very clear that there is no obligation of confidentiality.
Thus, two main values should guide our criminal investigation practice: objectivity and credibility. But, can we consider that enough? Probably not. That would leave the law quite far from the core justice. Is it possible for us to still feel we are members of the international fraternity of justice in providing an answer to this question? According to the arbitrators we have our own historical narrative and an internal set of duties, values and ideals, essential for delivering criminal justice responsibilities. The historical narrative anchors the criminal justice system in values that resist the vagaries of social and situational forces. A narrow view can be held of criminal prosecution as an integral part of the court, but a broader view of professional integrity demands fact-based values to influence the justice role.
Forensic psychiatry is far more than collaborating as an expert witness in a trial. This specialty provides a body of knowledge and a methodology that helps to illuminate areas of practice where different value systems face each other. Forensic psychiatry is the branch of psychiatry that deals with issues arising in the interface between psychiatry and the law, and with the flow of mentally disordered offenders along a continuum of social systems. Modern forensic psychiatry has benefited from four key developments: the evolution in the understanding and appreciation of the relationship between mental illness and criminality; the evolution of the legal tests to define legal insanity; the new methodologies for the treatment of mental conditions providing alternatives to custodial care; and the changes in attitudes and perceptions of mental illness among the public. Forensic psychiatry deals with issues at the interface of penal or criminal law as well as with matters arising in evaluations on civil law cases and in the development and application of methods that help in understanding of the criminal behaviour.
The growth of forensic psychiatry may be due to changes in the law and to a more liberal acceptance of psychiatric explanations of behaviour, but a more immediate reason is the large number of emotional and behaviour problems seen in our society now. Failures of the general mental health problem may, therefore, be at the root of the growing importance of forensic psychiatry. Because of its dual role in medicine and in law, the practice of forensic psychiatry is fraught with ethical dilemmas worldwide. A forensic psychiatrist is, first of all, a clinician with theoretical and practical knowledge of general psychiatry and forensic psychiatry, and experience in making rational decisions from a clearly stated scientific base. In law, forensic psychiatrists must know the legal definitions, the legal policies and procedures, the legal precedents relating to the question or case at hand.
(To be continued)
The writer is a member of the Diplomate American Board of Medical Psychotherapists Dip.Soc Studies, Member Int’l Association of Forensic Criminologists, Associate Professor Psychiatry and Consultant Forensic Psychiatrist at the Huntercombe Group United Kingdom. He can be reached at [email protected]