> For the complete documentation index, see [llms.txt](https://thisispiggy.gitbook.io/my-wiki/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://thisispiggy.gitbook.io/my-wiki/02-step-2/psych/legal-psychiatry.md).

# Legal Psychiatry

## Decision

Decision-making ability must be assessed for a patient to be able to give informed consent. Decision-making ability typically requires that a patient understand the information, be aware of the alternatives and consequences, then effectively communicate their decision.

Note: Patients with mental disorders (e.g. schizophrenia, bipolar disorder, etc.) should be **assumed to have decision-making ability** unless actively displaying psychiatric dysfunction! A schizophrenic well-controlled on medication can give informed consent until assessed otherwise.

Competence is a **legal** term typically assessed by a judge. It refers to a patient's ability to enter legal contracts, and its lack thereof questions the validity of such contracts.

Capacity is assessed in a clinical setting (a common psych consult). It refers to a patient's ability to make informed **medical** decisions.

Competence and capacity are **situation-dependent**. Depending on the gravity of decisions and their consequences, the same patient may or may not have decision-making capacity.

This is exemplified by a suicidal patient being able to sign themselves into a hospital (a low-risk, low-consequence scenario), but not to sign themselves out (high-risk).

Minors follow parental input/consent unless they are emancipated by one of the following scenarios:

* **Financial independence**
* **Military service**
* **Marriage**
* **Have children**

## Legal

**Legal insanity** applies to a patient's inability to understand and be responsible of a crime they committed due to mental illness. It absolves the patient, to varying degrees, of criminal responsibility for a crime. It is not usually successful (about a **2.5% success rate**).

**The duty to protect principle** (also known as the Tarasoff case) refers to a principle of forensic psychiatry that states that **medical professionals can break patient confidentiality to protect involved parties from harm from dangerous patients**.

Depending on state-specific laws, this principle may be mandatory, permissive (confidentiality breaching is permissible but not negligent if foregone), or a law regarding the principle may not exist at all.