Ethical cases

Abstract This chapter covers twenty-four ethical cases with accompanying reflection questions to guide the forensic psychiatrist through difficult ethical issues. It begins with the right or duty to disclose defence reports in a criminal law context, and the right or duty to breach confidence in a civil law context. The duty to supervise a patient in the community is covered, alongside what information to share with patients. Treating the psychiatrist and therapist as an expert witness in criminal trials and civil litigation are both explained, alongside the role professional versus expert witnesses, and professional versus contractual duty and medically relevant but legally inadmissible information. The role of personal values in expert decision-making is discussed, and how to navigate uncertainty about your opinion and resisting legal pressure is explained. Disputes within forensic mental health teams and presenting evidence to a tribunal is related, and what to do when there is a clash between clinician and organisational values is explained. The role of personal values in risk-formulation, monitoring ‘treatment’, assisting police and the prosecution of a patient, measuring ‘good-enough’ treatment outcomes for patient progression, and assisting the detection, prevention, or prosecution of a serious crime are all covered. Professional boundary violations and workplace discrimination, how to weigh the benefits of treatment against detrimental side-effects, and finally what to do when all options present ethical issues are included.