Psychiatry & Law In the Department of Psychiatry

Welcome to Psychiatry and Law

Training in Psychiatry and Law is integral to residency education in the Adult Division of the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Each resident develops a working knowledge of the legal regulation of psychiatric practice and the competency to perform a criminal forensic assessment. Our forensic supervisors are Drs. Harvey Dondershine, John Greene, James Missett, and George Wilkinson.

California physicians required to notify their patients that they are licensed by the Medical Board of California.

Effective June 27, 2010, physicians practicing in California must inform their patients that they are licensed by the Medical Board of California, and include the Board's contact information. The information must read as follows: NOTICE TO CONSUMERS - Medical doctors are licensed and regulated by the Medical Board of California. This requirement is the result of Title 16, California Code of Regulations section 1355.4, as mandated by Business and Professions Code section 138. The purpose of this new regulation is to inform consumers where to go for information or with a complaint about California medical doctors. See Board Notice for full details

Indiana v. Edwards, 128 S. Ct. 2379 (2008): Competency to Stand Trial and the Pro Se Defendant’s Right of Self-Representation

This is a case of interest to the forensic as well as to the clinical psychiatrist and psychologist.  For the forensic expert, it defines a new issue: when is a mentally ill defendant who is competent to stand trial (Dusky) and competent to waive right to counsel and plead guilty (Godinez) not competent to represent himself (appear without counsel) at trial.   For the non forensic clinician, it is a reminder that competency is far from a unitary concept.  Indeed, there are many specific competencies.

A finding of i ncompetence limits a person’s right to make a decision.  It requires a determination that a person (1) has a mental deficit (a functional incapacity) steming from a mental illness and (2) a link between the deficit found and the decision made.  To opine, the clinician needs to understand not only the nature of the decision but the mental skills needed to make that decision.  Only then can the clinician do an examination crafted to address the relevant issues. Most cases do not involve global incompetence for all decisions but narrow questions of incompetence to make very specific types of decisions; e.g. make a will, practice a profession, sign a contract, give informed consent for medical care, refuse antipsychotic medications, etc.

ADA Amendment Act of 2008

On September 25, the ADA Amendment Act of 2008 became the law of the land.  The underlying act is, “HR 3195: An act to restore the intent and protections of the Americans with Disabilities Act of 1990.”  Depending on EEOC and appellate courts, this act clarifies impairment, disability and major life activities. The act will likely benefit qualified individuals with a disability and restore “the intent and protections” of the 1990 Act.  

Advance Directive – Don’t leave home without one!

Respect for the autonomy of personal decision making is among the highest of ethical standards in medicine.  The doctrine of informed consent is its shield. An advance directive is an exercise in “prospective” autonomy that continues effective after the author of the directive becomes incompetent.  For a review of the legal principles involved, see the 2001 California Supreme Court case Conservatorship of Wendland.

Sex Offenders and Insanity

Sex Offenders and Insanity: Examination of 42 individuals found not guilty by reason of insanity. (J Am Acad Psychiatry Law 35:4:444-450, 2007)

Psychiatric Malpractice

A discussion of liability issues involving prescribing, suicide assessment, informed consent, and duty to protect under Tarasoff. (Psychiatric Times, April 15, 2007)

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