Legal and Ethical Issues
Kimberley Clow
kclow2@uwo.ca
http://instruct.uwo.ca/psychology/155b/
Outline
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Legal Issues
 Criminal Commitment
 Tests of Mental State
 Civil Commitment
 Rights of Patients
Ethical Issues
 Privacy
 Confidentiality
 Limitations
 Dual Relationships
Criminal Commitment

Being incarcerated for
committing a crime
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We have free will
Responsible for our choices
Suffer the consequences of our
actions
Issues arise when individuals
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Aren’t aware of the consequences to
their actions
Are not freely choosing to perform
certain actions
Mental State of Defendant

Insanity Defence
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M’Naughten Rule
Durham Rule
Irresistible Impulse Test
American Law Institute Rule
Competency to Stand Trial
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Factual understanding?
Rational understanding?
Able to consult with counsel?
Little Known Facts

The Insanity Defence is used < 1%
Most often rejected
 Judges reject the plea about 50%
 Juries reject the plea 85%
 When plea is successful
 <15% are murder charges

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“Not guilty by reason of insanity”
Do NOT go free!
 Confined to mental hospital

The Defense is Misperceived
Reforms

Since the Hinckley case …
Rather than prove a defendant’s sanity, must
now convince judge or jury that clients are
insane
 Restrict use of defense

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Connecticut doubled the average term spent in
institutions
Idaho, Montana, & Utah abolished the defense!
“Guilty but Mentally Ill” Plea has emerged
Civil Commitment

But you can be committed to an institution
against your will even if you didn’t commit
a crime or do anything wrong
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Criteria for Civil Commitment
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Person presents clear and imminent danger to self or
others
Inability to care for self
Inability to make responsible decisions
Procedure

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Petition court for examination
Formal hearing is held
Rights of Treatment

The Right to Treatment
The Least Restrictive Alternative to Treatment
 The Right to a Humane Environment
 Protection and Advocacy for Mentally Ill
Individuals

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The Right to Refuse Treatment
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Must have informed consent before conducting
treatment
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Especially risky or intrusive treatments
Cannot force people to take antipsychotic medication in
order to be competent to stand trial
Ethics

What are the potential issues?
Do no harm
 Do not exploit
 Practice only within your competence
 Treat people with respect and dignity
 Protect confidentiality
 Obtain informed consent first
 Practice within the framework of social equity
and justice

Other Ethical Issues

Privacy
Limiting other’s access to information
 Assuring freedom from intrusions
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Confidentiality
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Refers to legal rules and ethics that protect
individual from unauthorised disclosure of this
information
Privilege

An exception to the general rule that the public has a
right to relevant evidence in a court proceeding
Limits on Confidentiality
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Confidentiality, however, is not a RIGHT

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We strive to provide confidentiality, because it
is important, but there are a number of
situations that can arise where confidentiality is
broken
Limits on Confidentiality
Mandatory Reporting
 Duty to Warn
 Duty to Protect
 Legal System Exceptions
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How to Act?
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Consider the following:
Describe parameters of situation
 Define the potential issues involved
 Consult any existing guidelines
 Evaluate the rights, responsibilities, and welfare
of all affected parties
 Generate alternatives for each issue
 Calculate consequences of all alternatives
 Based on evidence, not just conjecture!
 Choose the lesser of the evils
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Dual Relationships
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Dual Relationships
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When the therapist is in another, significantly
different relationship with one of his or her
clients
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social, financial, professional, sexual
Problems with Dual Relationships
Conflict of interest
 Power differential
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Sexual relationships are NOT permitted!!!
Therapist Sex Differences
Behaviour
Sex
Difference
Hugging a client
F>M
Having client use your first name
F>M
Say to client, "I’m sexually attracted to you"
M>F
Treating homosexuality as pathological
M>F
Engaging in sexual fantasy about client
M>F
Directly soliciting person to be client
M>F