Ethical Issues In Clinical Forensic Psychiatry

Preface......Page 5
Contents......Page 7
Part I: Clinical Forensic Psychiatry......Page 8
1.1	 Forensic Psychiatry in the UK......Page 9
1.1.1.1	 Police and Court Diversion......Page 13
1.1.1.2	 Prisons and Young Offender Institutions......Page 14
1.1.2.1	 Inpatient Care......Page 15
1.1.2.2	 Outpatient Care......Page 17
1.2	 Forensic Psychiatry in Europe Outside the UK......Page 18
1.2.1.2	 Inpatient Care......Page 19
1.2.3.1	 Sweden: Legal Framework and Inpatient Care......Page 20
1.3.2	 Inpatient and Outpatient Care......Page 21
1.4.1	 Japan......Page 22
1.5	 Forensic Psychiatry in America......Page 23
1.6	 Status of Psychiatric Services and Forensic Psychiatry Services in the Middle East......Page 25
1.6.1.1	 Culture of Psychiatry and the Stigma in Iraq......Page 26
1.6.1.2	 Mental Health Workforce in Iraq......Page 27
1.6.2.1	 Inpatient and Outpatient Services......Page 28
1.6.3.1	 Specialist Psychiatric Facilities......Page 29
1.7	 Conclusion......Page 30
References......Page 31
2.1.1	 What Are Ethics?......Page 34
2.1.2	 Recent History......Page 35
2.1.3	 Generic Ethical Issues......Page 37
2.1.4	 Conclusion......Page 38
2.2.1	 Deprivation of Liberty......Page 39
2.2.2	 Confidentiality......Page 41
2.2.3	 Ethical Dilemmas Arising from the Unique Relationship Between Patient and Clinicians in Forensic Psychiatry Settings......Page 44
2.2.4	 Forensic Research......Page 45
References......Page 46
Part II: Ethical Issues in the Treatment and Management of Sex Offenders......Page 49
3: Introduction......Page 50
References......Page 52
4.1	 Background......Page 53
4.1.1	 Effectiveness of Existing Treatments......Page 57
4.2.1	 Males......Page 59
4.2.2	 Females......Page 60
4.2.3	 Why Consider Medications for Sex Offenders?......Page 61
4.3.1	 Who Should Be Considered for Medications?......Page 62
Selective Serotonin Reuptake Inhibitors (SSRIs; Fluoxetine, Sertraline)......Page 63
4.3.2.2	 Anti-hormonal Substances......Page 64
MPA......Page 65
GnRH Analogues (Triptorelin, Leuprorelin, Goserelin)......Page 66
4.4	 Use of Surgical and Chemical Castration in Legal Settings......Page 67
4.5	 Use of Medication to Manage Sexual Arousal in Forensic Psychiatry......Page 69
4.5.1	 Medical Responsibility and Legal Obligations......Page 71
4.5.2	 Free Will or Coercion?......Page 73
4.5.3	 Other Complexities......Page 75
4.6	 Juvenile Sex Offenders......Page 76
4.7	 Female Sex Offenders......Page 77
4.8	 Transgender Sex Offenders......Page 79
4.9	 Conclusion......Page 80
References......Page 81
5.1	 How the Polygraph Works......Page 86
5.2	 PCSOT......Page 89
5.3	 Ethical Issues and Conclusion......Page 93
References......Page 94
Part III: Ethical Issues in the Assessment, Treatment and Management of Violent Offenders and Sex Offenders in Clinical Settings......Page 98
6.1	 Introduction......Page 99
6.3	 Use of High-Dose Antipsychotics and Polypharmacy in the Management of Severely Disturbed Offenders......Page 101
6.4	 What Ethical Issues Are Raised by the Use of High-Dose Antipsychotic Medication?......Page 104
6.5.1	 Autonomy......Page 106
6.5.2	 Beneficence......Page 107
6.6	 Issues with Principlism......Page 108
6.7	 Informed Consent, Capacity and the Forensic Arena......Page 109
6.8	 Conclusion......Page 111
References......Page 113
7.1	 Introduction......Page 115
7.2	 Recent History and the Rise in Use of Surveillance in Criminal Justice Settings......Page 117
7.2.1	 Use within the Criminal Justice System......Page 119
7.2.2	 Limitations of Use......Page 120
7.3	 Extrapolation of Surveillance to Clinical Settings......Page 122
7.4	 Ethical Considerations......Page 125
7.5	 Societal Considerations......Page 128
7.6	 Cost Considerations......Page 131
7.7	 Conclusion......Page 132
References......Page 133
8.1	 Ethical Issues in the Assessment and Management of Transgender Forensic Psychiatry Populations......Page 135
8.2.1	 Introduction......Page 140
8.2.2	 Ability to Learn......Page 141
8.2.3	 Sexual Consent/Understanding Sexual Relationships......Page 143
8.2.4	 Safeguarding......Page 144
8.2.5	 Medication and Consent......Page 145
8.2.6	 Forensic Services and Integration......Page 146
8.2.7	 Advance Directives......Page 147
8.2.8	 Conclusion......Page 148
References......Page 149
Index......Page 150