The ethics of forensic psychiatry: moving beyond principles to a relational ethics approach

Abstract

Forensic psychiatry has been described as a ‘moral minefield’. The competing obligations at the interface of the justice and healthcare systems raise questions about the very viability of an ethical framework for guiding practice. The explicit need for security and detention, and the implicit ‘untrustworthiness’ of forensic patients shape practitioners' everyday reality. Suspicion colors client–practitioner relationship and fundamental care concepts, such as patient advocacy, take on different nuances in this milieu. Despite the complex ethical demands of this unique practice area, it has received little attention within mainstream bioethics. There is, however, a growing imperative to find a theory of ethics for the specialty. In this article, the ethics of forensic psychiatry is examined, and it is argued that relational ethics is a fitting framework for forensic practice and, further, that forensic settings are the very place to test the validity of such an ethic.