Duty to the Patient or Society: Reflections on the Psychiatrist’s Dilemma

Abstract

My discussion of the essays by Professor Winslade and Professors Culver and Gert will obviously be influenced by my background as a clinical psychiatrist and a teacher of clinical psychiatry. Undoubtedly it will also be influenced by my European background and awareness of cross-cultural studies in the area of legal psychiatry. Finally, in the last three or four years, having served on a number of committees, I have been directly involved in the formulation of legislation in the area of civil commitment, competency to stand trial, and the insanity defense. This involvement in public policy issues clearly has afforded me the opportunity to learn how lawmakers perceive society’s needs and psychiatrists’ expertise. This does not necessarily run true to either our professional goals or our self-image. In a federal union, with fifty different jurisdictions writing statutes, fifty different state supreme courts interpreting the constitutionality thereof, and a federal judiciary often -overriding on appeal to state decisions, it is clear that policy is far from monolithic. Given the heterogeneity of American society, its different ethnic and religious mixtures, the issue of morality in public life and policy transcends philosophical debate and becomes quite often political instead. In turn many political problems become invested with ideological slogans.KeywordsMental IllnessSupreme Court DecisionCivil CommitmentUnited States SupremePublic Policy IssueThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.