Ethics in Forensic Psychiatry: Principles, Dilemmas, and Human Rights

Ethics and its Relationship with Forensic Psychiatry

Regarding essential ethical principles in psychiatric evaluation, there is agreement among leading authors that the expert’s primary commitment is to the judicial system [3]. The principles of truthfulness (commitment to the truth) and respect for persons must be strictly observed [1].

Miranda de Sá LS, et al [4] add the following principles to be followed in psychiatric evaluation [4]:

Confidentiality: In medical examinations, unlike clinical practice, the expert must inform the examinee that standard confidentiality does not apply, as information will be reported to the competent authority. However, in psychiatric research, confidentiality must be preserved at all stages.

Fidelity: The physician must prioritize the interests of society, then their own, and finally those of the examinee. The expert acts as an assistant to justice.

Impartiality and justice: Requires emotional neutrality, without moral judgments or preconceived opinions about the case.

In Brazil, a distinction is made between the forensic psychiatrist acting as an expert, who responds to judicial demands, and the technical assistant, who is linked to one of the parties. According to the Code of Civil Procedure (art. 466), technical assistants are trusted by the party and are not subject to impediments or suspicions [5].

Both roles must be guided by honesty and truthfulness. However, impartiality is a fundamental characteristic of the expert’s role and is not required of the technical assistant due to their connection with one of the parties [6].

Forensic psychiatry presents ethical specificities that substantially differentiate it from traditional clinical practice. This is because the forensic psychiatrist operates in a context where there is no classical doctor-patient relationship, but rather a relationship mediated by legal and judicial demands. In this scenario, the professional often faces conflicts between fundamental ethical values, especially between beneficence and justice [7].

While traditional medicine prioritizes the patient’s well- being as its main goal, in forensic psychiatry the central objective tends to be contributing to justice. In this sense, Appelbaum proposes that the fundamental ethical principles of this field are truthfulness and respect for persons, emphasizing that commitment to truth plays a central role in expert practice [8]. This shift implies that the forensic psychiatrist does not primarily act as a therapeutic agent but as a technical assistant to the judicial system.

Furthermore, recent systematic reviews indicate that forensic psychiatry can be understood through two distinct ethical models: a clinical (correctional) model and a legal (forensic) model. In the clinical model, traditional bioethical principles—beneficence, autonomy, and non-maleficence- remain relevant, especially in providing care to individuals deprived of liberty. In the legal model, these principles are reinterpreted: beneficence becomes objectivity, justice becomes professionalism, and autonomy becomes the guarantee of informed consent [9].

This ethical dualism reveals a structural tension in the field. On one hand, there is the obligation to promote the well-being of the evaluated individual; on the other, there is the duty to contribute to judicial decisions that may result in restrictions of freedom or other adverse consequences. This tension is particularly evident in contexts such as involuntary hospitalization, criminal responsibility evaluations, and assessments of individuals considered dangerous.

Another relevant aspect concerns practice in prison settings. In these environments, the principle of equivalence of care stands out, establishing that individuals deprived of liberty should receive healthcare equivalent to that available to the general population. However, this principle often conflicts with structural limitations and institutional security demands [9].

Additionally, the issue of autonomy becomes particularly complex in forensic psychiatry. Many evaluated individuals present mental disorders that may impair their decision- making capacity, raising questions about the validity of informed consent. In such cases, the psychiatrist must carefully assess decision-making competence, balancing respect for autonomy with the need to protect against harm [10].

Research in forensic psychiatry also presents specific ethical challenges, especially when involving vulnerable populations, such as prisoners or institutionalized individuals. Studies indicate that these groups are at greater risk of coercion, explicit or implicit, requiring additional rigor in obtaining consent and protecting participants [3]. In this context, research ethics must ensure that participation is truly voluntary and that potential benefits justify any risks involved.

Another important point concerns harm prevention. The principle of non-maleficence, although universal in medical practice, takes on specific contours in forensic psychiatry, including the prohibition of participation in practices that may result in degrading treatment, torture, or the death penalty. This reinforces the psychiatrist’s commitment to fundamental human rights, even within diverse legal systems [9].