Legal Aspects of Psychiatry

Interestingly, the domain of psychiatry includes a lot of legal medicine and ethics. On consult service, we are sometimes asked to assess a patient's capacity, whether they have the ability to make an informed consent decision. Ironically, psychiatry has the fewest procedures so we rarely consent patients ourselves (electroconvulsive therapy is one exception). But we are considered knowledgeable of a patient's ability to consent because we spend a fair amount of time assessing cognitive capacities.

Psychiatry can also place legal holds on patients (along with general physicians, law enforcement officers, and others). That is, we can detain a patient against their will if they meet certain criteria such as being a danger to self, danger to others, or gravely disabled due to mental illness. These "5150s" are an interesting example of how individual rights are subsumed by paternalism (preventing suicide, grave disability) and societal safety. While many people can initiate the 5150, usually only psychiatrists really pursue the longer term holds such as the 5250 or putting a patient on a conservatorship.

Because of this intersection between medicine and law, psychiatrists are often involved in hearings that take place in the hospital by the bedside. They act as expert witnesses to argue whether someone should be held against their will or given medications involuntarily. To me, this is a fascinating aspect of medicine I hadn't thought about before.