Ethical issues in child and adolescent forensic psychiatry: a review

Ethical challenges in child and adolescent forensic psychiatry arise, on the one hand, from the dilemmas commonly faced in forensic psychiatry with adult patients, such as the dual role of the forensic psychiatrist, questions of criminal responsibility, autonomy and competence and involuntary treatment, and, on the other, from the immaturity and dependent position of the minor. Child and adolescent forensic psychiatry deals with minors involved in crime, not only as offenders, but also as victims. In this review, we attempt to describe ethical challenges in child and adolescent psychiatry using as a frame of reference the principles of biomedical ethics according to Beauchamp and Childress.     

英美两国对精神病人刑事责任能力评判的演变

司法精神病学是法学的一个分支学科,其诞生和演变与法学的主旋律始终保持一致。精神障碍者刑事责任能力问题是司法精神病学的主要构成部分,英国1843年的麦克·纳顿条例是专门就精神障碍者刑事责任能力问题的法律规定,它对英美法系和大陆法系国家的相关立法都产生了巨大深远的影响。美国最近20多年处理违法精神病人的法律改革对现代诸国的司法精神病学完善具有相当大的影响力,所以研究英美两个国家这一方面的司法精神病学的历史和现状对推动我国司法精神病学的进步意义重大。     

法医精神病鉴定内容架构及评定要点解析

法医精神病鉴定在刑事、民事和行政三大诉讼领域中,以鉴定意见的证据形式发挥着重要作用。然而,与其重要性不相匹配的是,法医精神病鉴定学科发展尚不完善、专业发育尚不成熟,尚不能满足社会和民众的期盼和要求,甚至引发负面评价。为进一步促进法医精神病鉴定规范化、标准化建设。以法医精神病鉴定人的视角,结合法医精神病鉴定的内容架构,重点阐述法医精神病鉴定主要项目及其作用、评定要点,尤其聚焦刑事责任能力评定,阐明当前存在分歧和困难;简要介绍法医精神病鉴定人执业要求、法医精神病鉴定质量控制;以及简述法医精神病鉴定与临床精神医学实践的区别与联系。     

Ethical analysis of a curious event of a forensic case becoming an involuntarily hospitalized psychiatric patient

It is not uncommon in forensic psychiatry that the duty to care for the patient conflicts with the responsibility to the court, or the duty to protect the public from harm from the potentially dangerous patient-offender. This paper exemplifies the scenario of what happens when the line between forensic and clinical psychiatry is crossed and whether crossing that boundary can be justified. Ethical discussion also embodies and clarifies the issues of unjustified violation of the patients’ autonomy and an undue infringement on their right to liberty on the arbitrary basis of existing or perceived mental illness. The paper provides an in-depth analysis of the issues of physicians’ conflicting duties, vulnerability of patient-offenders, and their human rights in the light of court orders and involuntary hospitalizations.

I argue that in order to promote ethical decision-making we must establish clear rules and guidelines for psychiatric practice, separate conflicting roles, and provide sufficient training of health-care professionals regarding topics of human rights and legislation governing clinical and forensic psychiatric practice. Empowering patients and enhancing their rights to autonomy and liberty can also be potent tools of promotion and protection of their human rights and prevention of ethical breaches in practice.     

Criminals or Patients? Towards a Tragic Conception of Moral and Legal Responsibility

There is a gap between, on the one hand, the tragic character of human action and, on the other hand, our moral and legal conceptions of responsibility that focus on individual agency and absolute guilt. Drawing on Kierkegaard’s understanding of tragic action and engaging with contemporary discourse on moral luck, poetic justice, and relational responsibility, this paper argues for a reform of our legal practices based on a less ‘harsh’ (Kierkegaard) conception of moral and legal responsibility and directed more at empathic understanding based on the emotional and imaginative appreciation of personal narratives. This may help our societies and communities to better cope with unacceptable deeds by individuals who are neither criminals nor patients, to make room for praise as well as blame and punishment, and to set up practices and institutions that do not rely on a conception of responsibility that is hard to bear for all of us.     

Emergent authority and expert knowledge: Psychiatry and criminal responsibility in the UK

In the UK context, the rise of the discipline and practice of forensic psychiatry is intimately connected with the concurrent development of principles and practices relating to criminal responsibility. In this article, we seek to chart the relationship between psychiatry and the principles and practices of criminal responsibility in the UK over the early modern, modern and late modern periods. With a focus on claims about authority and expert knowledge around criminal responsibility, we suggest that these claims have been in a state of perpetual negotiation and that, as a result, claims to authority over and knowledge about criminal non-responsibility on the part of psychiatrists and psychiatry are most accurately understood as emergent and contingent. The apparent formalism of legal discourse has tended to conceal the extent to which legal policy has been preoccupied with maintaining the primacy of lay judgments in criminal processes of evaluation and adjudication. While this policy has been somewhat successful in the context of the trial – particularly the murder trial – it has been undermined by administrative procedures surrounding the trial, including those that substitute treatment for punishment without, or in spite of, a formal determination of criminal responsibility.     

Forensic psychiatry in China

This article reviews the legal basis for the development of forensic psychiatry in China, the organization of clinical assessments, and training of forensic psychiatrists. Regulations for the management of patients in Ankang hospitals and the role of forensic psychiatrists within the Criminal Justice system are described. The primary role of forensic psychiatrists is to provide expert opinions on competence to stand trial and criminal responsibility in criminal cases. They are increasingly involved in civil court proceedings and tribunals at the request of a range of official agencies. The clinical cases assessed by Chinese forensic psychiatrists are very similar to those of their counterparts in Western countries, but the organizational and legal framework for these assessments reflects a very different system that has evolved independently.     

刑事诉讼中法医精神病鉴定争议的反思与理论诠释

法医精神病鉴定在一些重大刑事案件中持续成为舆论关注的焦点。不论法医精神病鉴定启动与否均会陷入被质疑的困境。这既存在制度安排的问题,也存在鉴定本身的问题,还存在凭直觉判断的问题,更存在理论误导的问题。这些问题叠加在一起衍生了较为复杂的中国性问题。这一复杂问题的解决,需要合理配置启动法医精神病鉴定程序的权力(利),科学对待法医精神病鉴定本质,尊重法医精神病鉴定的医学认定,正确使用法医精神病鉴定意见中的刑事责任能力判断,在正当程序中维护法医精神病鉴定的科学性。对于非制度问题需要正确的理论诠释,避免因实践难题与理论缺陷交织触发一些不具有实质意义的纷争和枉顾科学的呼吁。     

再议毒品所致精神障碍者的刑事责任能力评定

我国法律并未直接规定毒品所致精神障碍者的刑事责任问题,国内法学界和司法精神病学界对此问题仍分歧众多。争论的焦点主要集中在吸毒者陷于辨认或控制能力丧失状态下实施危害行为时该如何评定其刑事责任能力上。从法律的角度来探讨毒品所致精神障碍者的刑事责任能力评定。主张目前实践中司法鉴定人员结合吸毒者的心理态度来评定其刑事责任能力缺乏法律依据,也不适宜对案件的处理,因此不宜由司法鉴定人员以精神病学的角度来认定毒品所致精神障碍者的刑事责任能力。     

New perspectives in the legal psychiatry of cocaine-related crimes.

The legal criteria for the insanity defense as it applies to cocaine-related crimes remains elusive because of cocaine's unique spectrum of effects on human thought and action. This paper discusses the literature relevant to cocaine and forensic psychiatry/psychology, and summarizes the results of a survey of forensic psychiatrists on the topic of drug-induced psychosis. A conceptual framework is posited for the expert witness to distinguish the separable effects of cocaine on human behavior and to clarify their relationship to criminal responsibility.     

The forensic evaluation and treatment of children: ethics and values

This article will review the history of ethics and values in the forensic evaluations and treatment of children. Topics to be discussed include paternalism, advocacy, parental responsibility, and legal doctrine of parens patriae. Various aspects of the treatment of children, including medications, behavior modification, and psychotherapy, are also examined for ethical considerations. Agency consultation in conflicts of ethics that are associated with public laws are also addressed. The ethical implications of the use of children in any research as research subjects is also addressed.     

错鉴损害的民事责任

司法鉴定结论不可能拥有绝对的准确率,一旦出现错鉴,必须要对因此带来的损害后果承担相应的法律责任。错鉴民事责任在形式上与违约责任、侵权责任和专家责任竞合。不论选择哪一种处理路径都存在着利弊的权衡,都需要对现有法律作适当的调整。需要确定错鉴责任承担主体,并对利害关系人和归责原则作出相应规定,对责任主体的过错程度作出评判。     

Justice as solidarity: A study of the political socialization of adolescents from East and West Germany within the theoretical framework of Durkheim's sociology of morality

The contemporary transformations in western societies confront us with a problem already stated by Durkheim a century ago: What enables members of society to practice social solidarity while becoming increasingly more individualistic? This question is analyzed in view of the political socialization of adolescents and its developmental implications. In line with the Durkheimian tradition in developmental psychology established by Piaget and elaborated by Kohlberg, it is claimed that the development of moral autonomy gives rise to a justice-related sense of responsibility that may foster bonds of solidarity within society. This developmental model was tested against the impact of socialization variables in a sample of East and West Germany adolescents, aged 15 and 18 (N=348). Analyses of the data revealed a substantial relationship between the development of moral autonomy and the readiness to take responsibility for others in response to justice concerns. The impact of the development of moral autonomy on the formation of a justice-related sense of responsibility depended only minimally on background indicators of political socialization in adolescence (e.g., East or West German origin, the socioeconomic status of parents). In the context of current social conditions a developmental approach to political socialization appears crucial to explain the emergence of justice concerns giving rise to solidarity.     

精神病人刑事责任能力相关问题研究

受“有病无罪”观念的错误影响,长期以来法学领域很少开展对精神病人“犯罪”的研究,致使形成“精神病学鉴定专家裁判精神病人是否犯罪”的态势,忽视了对社会公共安全的保护。笔者简明扼要地介绍了美国司法精神病学近几十年的变迁,以此为参照,发表了对精神病人犯罪研究的一些看法。     

Doing justice to justice

Adshead's recognition that only when taken together can the many different conceptions of justice accommodate what is called for in the particularly demanding setting of forensic mental health care, is to be applauded. Each must be honoured and built into the systems of assessment and treatment that are the tasks of the forensic psychiatrist, she demonstrates. Adshead's far‐reaching revisions could resolve much that is troubling about the present practice of forensic psychiatry. Yet how much these revisions can overcome the moral dilemmas associated with dual roles in forensic psychiatry, is not so clear.     

论董事对公司债权人负责的法理正当性——从法人组织体说的局限性及其超越之路径展开

董事为什么对公司的债权人承担民事责任是一项必须在法人本质论学说下进行学术探索的工作,而当下的法人组织体说无法为该论题提供正当性依据。在区分作为制度分析与建构支架的理论逻辑基础的法人本质与作为本体论意义上的法人本质这个前提下,董事对公司债权人负责的命题不能从其他法人本质论的学说获取立论根据,只能算作法律的特殊规定。为了阐明该特殊规定的法理正当性,有必要超越法人组织体说的局限性,探求法人本质论层面之外的论证根据。从经济分析的方法来看,该特殊规定表现了帕累托改进效应,其说服力因之得以增强,可作为董事对公司债权人负责的法理正当性来源。     

The forensic psychiatrist of the future

The rate of change in scientific knowledge and the growing psychiatric sophistication of attorneys and courts have made it increasingly difficult for forensic psychiatrists to retain proficiency in the full spectrum of potential professional activities. As the consumers of forensic services become more sophisticated, forensic psychiatrists have an increasing need to become scientifically informed and a decreasing need to become legally informed. Traditional training in forensic psychiatry, which emphasizes clinical, legal, and institutional knowledge and experience, gives short shift to behavioral science and other technical knowledge that can enhance the validity of forensic assessments and their value to the legal system and society. Forensic psychiatrists can best respond to these changes and maximize the value of their assessments by narrowing their focus to some subset of the four branches of the discipline: criminal behavior, mental disability, forensic child psychiatry, and legal aspects of psychiatric practice. Maximal proficiency in each of these four branches requires a greater depth of knowledge and experience than was once sufficient among those who practiced in all four areas. Fellowship training programs and professional organizations should lead forensic psychiatry into the twenty-first century by organizing their efforts along these four parallel tracks.     

略论“鉴定留置”——由邓玉姣案说起

邓玉娇故意伤害案中的司法精神医学鉴定的过程,非常典型地暴露出了我国司法精神医学鉴定中有关＂鉴定留置＂制度缺位的严重问题。精神病鉴定虽然是一个医学问题,但它更是一个法律问题,我国对司法精神病鉴定制度的规定存在严重的缺失,对精神病鉴定等一系列问题的立法必须提升到我国立法的议事日程上来。对此,我们应当借鉴国外成熟经验,首先,应认识到对犯罪嫌疑人精神病鉴定是需要干涉公民人身自由的强制处分行为,并明确限定鉴定留置的范围。其次,对于鉴定留置的适用条件,在决定适用此措施之前必须听取鉴定人、辩护人意见,同时,鉴定留置措施只能适用于具有重大犯罪嫌疑的被指控人。再次,应明确规定对犯罪嫌疑人精神病鉴定的期间,在对犯罪嫌疑人精神病鉴定的期间不计羁押期限的基础上,明确犯罪嫌疑人精神病鉴定的时间,应当能够折抵刑期。     

公司非破产清算民事责任研究

公司非破产终止后,如何切实保护债权人的合法利益,确定公司债务承担的主体,又不违背有限责任原则,这是当前清算案件中较为困惑的问题之一。我国现行公司法律制度对此规定得较抽象、欠完善,操作性不够,可诉性不强,确有必要统一新的判定基准。通过对理论与实务的简要分析,可以考虑确立强制清算制度、确立清算责任主体的法律概念、确立公司清算民事责任承担的归责原则。这样,在公司法理论上,一定程度地削减了法律漏洞,完善了相关的制度;在实务效果上,既能增强义务人依法经营的责任意识,又能切实维护债权人的合法权益,还能有效推进我国现代企业制度的法制建设,这种思维角度值得关注。