Psychiatry and the Law: Moral Ambiguities

Story by: Sean Kook

Visuals by: Noah Weinberg

Date: 7/21/21

The rule of thumb that doctors must unconditionally abide by, the general public assumes, is the nondisclosure of confidential information enclosed by a patient to a doctor. Though state by state, the doctor patient confidentiality agreement prevents professionals from divulging sensitive information outside of the meeting room. In states where this promise is not binded, for instance Alaska, patients can summon a lawyer, who is legally forbidden from revealing material against the client’s wish, in order to maintain the premises of a nondisclosure environment. However, certain circumstances can cause this promise to become fragile, as can be the nature of the relationship between a psychiatrist and a person seeking desperate psychological guidance. In one example, if a patient who is an excessive drug user refuses to listen to a professional’s recommendations, the psychiatrist then might consult this dilemma with a fellow coworker or advise that he or she see another doctor. In another example, if a psychotic man confides to his doctor that he might kill his ex-girlfriend tonight, the doctor may be morally compelled to disclose this forewarning to the police. From an interaction in which a doctor is presented with information that foreshadows impending danger or harm on another person, or say a lawyer who receives confession of guilt from their client, the confidentiality contract can not always be kept for the good sake of safeguarding the whole of society, physically and psychologically. As established, there is a line, though perfectly obscure, that distinguishes the role of a psychiatrist from being a professional expert from a good-natured citizen.

On the whole, however, psychiatrists do not find themselves in a position of having to grapple with such moral confrontations; rather, their most prevalent function in the judiciary is to provide expert testimonies on character witnesses by conducting psychiatric evaluations. Now this question must be examined: to what extent should character witnesses be permitted in a courtroom and how much weight should the jury assign on psychiatric testimonies? Through the modern scope of looking at the process by which a court reaches its verdict, it is generally accepted that a defendant who is also a victim of a grave psychological illness such as schizophrenia is a drowning duck in a courtroom without the vouch of an expert psychiatrist. To raise perhaps the most well known case of this instance, observe the failure of the 1959 Kansas State Court in giving the death penalty to Perry Smith and Dick Hitchcock, two wayward freelancers who murdered a family of five with the blinding hope of finding their retirement money, an assurance instilled by a prison acquiantance. Although psychiatric testimonies in court at the time of the trial was inadmissible due to the ancient M’naughten rule, professional studies performed after the date of the defendants’ death revealed the astounding role of schizophrenia at the time of their murder. The two defendants’ early background of parental neglect, societal seclusion, and accustomed violence provided strong evidence of developing schizophrenia later in their lives. During this reaction, which is often triggered by an object or movement similar to that of their traumatic past, they lose complete control of their behavior and experience a lapse from reality. It is hard to assume, therefore, that today’s court would choose to sentence Smith and Hitchcock to capital punishment rather than assign them to a rehabilitation center for criminals or other more fitting alternatives. Spotlighted by author Truman Capote through his book In Cold Blood, the murder case of Smith and Hitchcock set a public standard to permit psychiatric evaluations in courtrooms under the circumstances that the defendant has a history of involuntarily losing control of themselves and their actions.

This is certainly not to say that psychiatric testimonies should have its place everywhere, even in the modern periphery of the judiciary. In the particular case of the Jeffrey MacDonlad murder of 1979, for instance, the court did not permit psychiatric interventions, though they were provided outside of the courtroom. Justifiably accused of murdering his wife and two kids, MacDonald was affronted with undeniable forensic evidence of murder, for example the finding of his blood at the crime scene. Subsequently, the judge could not see fit the effort to convince the jury of MacDonald’s innocence by including psychiatric testimonies that stated it was inconceivable that he could be the kind of man who would kill someone. Furthermore, evaluations from different experts reached varying conclusions, further weakening the defense’s proposition to admit the role of psychiatrists into the courtroom. Later on, the 4th Circuit of Appeals and the Supreme Court also upheld this decision to exclude psychiatric testimonies reasoning that, as the prosecutor puts it eloquently, “if we can prove that he did it, then we don’t need to prove that he is the kind of guy who could’ve done it.”

The moral standard of judicial procedures, whether from the public’s perspective or the legal, is transforming by the probing of every unusual case that challenges our ethical reasoning. The role of psychiatry is expanding profusely, but, as with the MacDonald case, there must be improved discernment of instances when psychiatry should not interfere with legal proceedings. The mission of the American criminal system is to retribute just punishment after a careful inspection of the relevant context and evidence, and as the nation forges onward with the best intention in mind, it must attempt to adhere to this principle with closer regards to humanity.


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Capote, Truman. In Cold Blood: A True Account of a Multiple Murder and Its Consequences. New York: Random House, 1965.