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.