Forensic Psychiatry

Informed consent (IC) is a medicolegal term describing the documented conversation between a patient and their physician wherein the physician discloses all relevant and necessary information to a patient who is competent to make an informed and voluntary decision regarding their care. Competency, disclosure, and voluntariness are the key elements upon which IC is based. The patient's well-being and autonomy are the 2 key fundamental moral values that are preserved by IC. Medical care decisions requiring IC range from the choice to undergo a defined medical or surgical treatment to participation in a research study. The IC represents shared decision-making between the patient and their caregiver and is thus mandatory for both clinical care and enrollment in research studies. Informed consent is usually documented in a signed written form.

Decision-making capacity and legal competence are terms often used interchangeably in a hospital setting to describe an individual's ability to make consequential decisions regarding themselves, as a manifestation of their autonomy. More specifically, however, capacity describes a patient’s ability to make autonomous decisions regarding their care, as determined by a physician, whereas competence is a legal term that describes a person’s ability to participate in legal processes, as determined by a judge.

Confidentiality is a set of rules that dictates the protection of health information shared by a patient with a physician. In general, this information should only be used to dictate medical decision-making steps and can only be disclosed to a 3rd party with the patient’s express consent. While there are some specific situations where patient-doctor confidentiality may be broken (e.g., when the patient is at risk for self-harm), these situations are considered exceptions and clinicians ought to make sure that confidentiality is not unnecessarily jeopardized.

Medical malpractice is a civil wrong describing a physician’s dereliction of duty directly leading to damage to a patient under the physician's care. Although medical malpractice is not a crime, a tort claim (or civil wrong) can be made in a court of law when a patient suffers a poor outcome. Malpractice lawsuits can generally be avoided with excellent communication, demonstration of empathy, good medical practice, a good doctor-patient relationship, not cutting corners, and thorough documentation.