Ethical Issues of Long-Term Forensic Psychiatric Care

Forensic Summary by Kiana DelGrosso

In the Ethics, Medicine and Public Health volume 2 journal, Dr. Völlm, Bartlett, and McDonald introduces the difference between psychiatry and forensic psychiatry and how ethical standards are more complex in forensic psychiatry in their article Ethical Issues of Long Term Forensic Psychiatric Care. Their duty is centered on the two reasons why these patients have to be secured and even detained in care centers: care and treatment of the patient and preventing harm to the public. Because forensic psychiatrics must not only focus on their patient’s well-being, their ethical standards can become torn between their obligation to the patient as well as their obligation to the public. The authors’ main dilemma about long-stay forensic psychiatric care can be addressed. There was a study included in the article that showed how vastly different general psychiatric long-term care was from forensic psychiatric long-term care. This difference in long-term care hinged on the fact that patients in forensic psychiatric care were only released once they had shown progress in their treatment and they were no longer a threat/risk. The authors then branch into the varying legislations that are present in different European countries.

When conducting their own study, they used focus groups that were made up of researchers related to forensic psychiatry so that they could create a discussion on this topic of long-term care. They also collected information form three sites that specialized in long-term care in order to collect a range of comments on the subject. When analyzing these conversations, they took care to focus on any ethical issues that had arisen or any information pertaining to ethical standing. From conversations with the focus groups alone, they had found five main ethical issues that had arose: system failure, avoidance of warehousing, the importance of hope, denial, and long-stay units and quality of life. Dialogue on these five issues had been included in their article however they did mention that this did not analyze any patient opinions or responses which could provide more insight. Dr. Völlm, Bartlett, and McDonald concluded that their overall findings showed that the expectations of forensic psychiatrists and their staff cause tensions and dilemmas that can cause ethical problems to arise especially in long-term care cases.

Völlm, P. Bartlett, R. McDonald, Ethical issues of long-term forensic psychiatric care, Ethics, Medicine and Public Health, Volume 2, Issue 1, January–March 2016, Pages 36-44, ISSN 2352-5525, http://dx.doi.org/10.1016/j.jemep.2016.01.005.

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