There is a natural conflict of interest that occurs when a psychiatrist who is providing treatment to a patient agrees to perform an evaluation or render an opinion about something of a legal nature regarding the same patient.
In treating patients in the community, I’ve turned down requests from attorneys on several occasions when they wanted me to provide expert opinions about my own patients. I simply did not feel comfortable doing so as I believed that it was going to interfere with my treatment relationship with them.
This viewpoint is endorsed by the American Academy of Psychiatry and the Law in their Ethics Guidelines for the Practice of Forensic Psychiatry (PDF).
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In the U.S., correctional facilities are required by law to provide inmates with access to medical care. As health care costs have spiraled out of control everywhere, jails and prisons have attempted to develop innovative ways of reducing this hefty financial burden while simultaneously meeting their legal obligation to provide care.
One approach that has gained significant popularity in recent years is to require inmates to pay a small fee, usually less than $10, to gain access to medical care in certain situations. There are arguments both for and against these co-pays. I’ll list just the main points.
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Assume for a minute that you do not have an underlying psychiatric or neurologic condition. You’re healthy. If you could take a pill that would significantly improve your memory, help you to concentrate through great distractions, keep you full of energy even though you’ve slept little, help you to be more social, or keep you from worrying much, would you take it?
That’s really the issue at stake with the concept of cosmetic psychiatry. Is it okay for psychiatry to evolve beyond simply treating disease and relieving suffering to the point where the goal is also enhancement of “normal” functioning?
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