The ethical dilemmas of forensic psychiatry: a utilitarian approach.

The problem of defining a set of ethical principles that will guide mental health practitioners in their interactions with patients is not limited to forensic psychiatry. All aspects of psychiatric practice have ethical implications, and these are particularly complex when the psychiatrist's allegiances are not directed entirely toward the patient. Any psychiatric function that obligates the psychiatrist to evaluate patients for purposes that serve the interests of social or private agencies may support actions on the part of agencies that patients perceive as harmful. There are obvious ethical problems for members of a healing profession who participate in activities that may harm their patients. The problems are similar whether that harm is created by courtroom testimony or by virtue of the psychiatrist submitting a written or oral report to an agency. The first part of this article is an effort to define general principles that might assist psychiatrists in assessing the ethical dimensions of all types of forensic and social functions. In elaborating on these principles, I emphasize that process of procedural aspects of our social and forensic functions must be given special attention in dealing with ethical conflicts. Once defined and discussed, these principles will then be considered as they apply to one of psychiatry's most important social and forensic roles, the involuntary commitment of dangerous patients.