Research ethics and forensic psychiatry: a comment on Regehr and others.

The CPA po si tion pa per, edi to rial, and 2 re view ar ti cles on evidence-based psy-chia try in the June 2001 is sue of The Ca-na dian Jour nal of Psy chia try are most timely, thought-provoking, and ex ceed-ingly well done. I con gratu late Lesage and oth ers for their par ticu larly lively and pene trat ing analy sis. Of cen tral im por tance is the dis cus sion of the sev eral dif fer ent ori en ta tions (medi cal, eco nomic, bu reau cratic, and po liti cal) that must be in te grated if the prac tice of evidence-based psy chia try is to thrive. In this con nec tion, I sug gest that 2 ad di tional per spec tives might be added: the ori en ta tion of the prac ti tio ner and the ori en ta tion of the sci en tific in ves ti ga tor. Prac ti tio ners are not ori ented to ward trying to es tab lish gen eral truths and prob-abili ties but, rather, to draw ing on the store of already-established truths and prob abili ties to help in di vid ual pa tients. They seek to in te grate this sci en tific in-for ma tion with other avail able re sources to treat as ef fec tively as pos si ble the par-ticu lar in di vidu als in their care. A sci en-tific in ves ti ga tor, on the other hand, is not con cerned with the care of in di vid ual pa tients but with in creas ing the store of sci en tific truths and prob abili ties and thus in creas ing the bene fits avail able to the many peo ple who are or may be come men tally ill. This dif fer ence in ori en ta tion in volves dif fer ences in per cep tions, hab its of thought, and val ues that are of ten not fully rec og nized by ei ther prac ti tio ners or in ves ti ga tors—much less by the other par tici pants in the de vel op ment and opera tion of the health serv ices. Par ticu-larly in psy chia try, the mean ing of the ory and evi dence is apt to be viewed …