Ethical Obligations of the Evaluator-Client Relationship in Forensic Psychiatry

Forensic psychiatry is a subspecialty in which the physician provides consultation in a legal context. The psychiatrist conducts a forensic evaluation with a narrow focus for a psycholegal question, which could include a client’s competency to stand trial, or their mental state at the time of an offense.
The psychiatrist establishes an evaluator-client relationship, which differs from the traditional physician-patient relationship of a treating psychiatrist. The evaluator-client relationship does not involve a therapeutic alliance; rather, there is limited contact with the client, an impartial stance, and an evaluative style. This relationship alters the duties of a physician to their patient, as they relate to informed consent, confidentiality, fiduciary responsibility, and other ethical principles.
This presentation will explore the unique nature of the evaluator-client relationship. It will characterize the ethical obligations of forensic psychiatrists and how these obligations change along with the shift from a hospital or clinic setting to a courtroom. Several duties of psychiatrists will be considered, including duty to the client, duty to patients, duty to non-patients, and to society. The potential for bias will also be explored, and ways to mitigate its effects. Finally, this presentation will comment on whether an evaluator-client relationship should be classified as a physician-patient relationship.
Considering the importance of inclusive public discourse, this presentation will explore the value of empowering physicians to give unbiased testimony in the courtroom. Strategies to limit the negative effects of bias in expert testimony will be discussed.

J. Wesley Boyd – Professor, Center for Medical Ethics and Health Policy, Baylor College of Medicine