Legal Issues in Psychiatric Practice

In medical practice, conflicts arise when patients refuse treatment, when patients are considered dangerous to themselves or others, or when bad outcomes occur. The course of action for the psychiatrist in any of these situations is guided by clinical judgment and skill, knowledge, training, and professional guidelines. Ultimately, however, the resolution of these conflicts may be governed by civil and criminal law. Psychiatrists may be called upon to assist legal decision makers in determinations of mental health related impairment and occupational disability, with questions of competency to make medical or other decisions, and with issues surrounding accountability or culpability for behavior. Although special expertise in issues related to the psychiatric-legal interface is the purview of forensic psychiatrists, the practice of all psychiatrists is subject to legal regulation and all psychiatrists will participate in proceedings or procedures at the medico-legal interface. This chapter outlines legal issues-both civil and criminal-with which psychiatrists should be comfortable and familiar in order to deliver appropriate care.