Legal duties of psychiatric patients.
J. O. Beahrs,
Bull. Amer. Acad. Psychiatry & the Law
18(2): 189-202, 1990.
Psychiatric practice involves an implied contract in which each party fulfills a specialized role and
incurs corresponding duties and obligations to be discharged as best able. Patients incur duties at
three levels. First are specific duties that arise from patients' specialized role in their own health care:
(1) to provide accurate and complete information, and (2) to cooperate with treatment within the
bounds of informed consent. Second are general duties that apply to all citizens, but are especially
relevant within the mental health context: (1) to respect the physical integrity of self, others, and
property, and (2) to obey the law. The controversial "duty to protect" is at a third level, a
transcendent duty that is specific to the context at hand, but in principle can apply to more than one
party. Advantages of enforcing patients' duties include better care by treating professionals, optimum
level of functioning of patients, and improved systems-wide morale and safety. Breach of patients'
duty has many potential consequences in the forensic sphere: termination of care, malpractice
defense, criminal prosecution, and tort liability. Complicating factors include the degree and effect
of patients' psychiatric impairment, patients' legal status, and the role played by psychotherapeutic
transference. [References: 85]