Abstract
Psychiatric practice involves an implied contract in which each party fulfills a specialized role and incurs corresponding duties and obligations to be discharged as best able. Patients incur duties at three levels. First are specific duties that arise from patients’ specialized role in their own health care: (1) to provide accurate and complete information, and (2) to cooperate with treatment within the bounds of informed consent. Second are general duties that apply to all citizens, but are especially relevant within the mental health context: (1) to respect the physical integrity of self, others, and property, and (2) to obey the law. The controversial “duty to protect” is at a third level, a transcendent duty that is specific to the context at hand, but in principle can apply to more than one party. Advantages of enforcing patients’ duties include better care by treating professionals, optimum level of functioning of patients, and improved systems-wide morale and safety. Breach of patients’ duty has many potential consequences in the forensic sphere: termination of care, malpractice defense, criminal prosecution, and tort liability. Complicating factors include the degree and effect of patients’ psychiatric impairment, patients’ legal status, and the role played by psychotherapeutic transference.
Footnotes
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Dr. Beahrs is associate professor of psychiatry, The Oregon Health Sciences University and Portland VA Medical Center. This article was presented as part of a panel, “Treatment Versus Protection: Roles and Responsibilities,” at the Nineteenth Annual Meeting of the American Academy of Psychiatry and the Law, San Francisco, October 20, 1988. The views presented in this article are the author’s own and do not represent those of the Veterans Administration
- Copyright © 1990, The American Academy of Psychiatry and the Law
