Ethics in child and adolescent forensic psychiatry.

Ethical concerns are ever present in the practice of all branches of psychiatry. They are likely to be more acute and commonplace in the practice of child and adolescent psychiatry because of the complication introduced by the immaturity of the patient. Children, depending on their age and developmental stage, may be incapable of giving meaningful consent, and situations in which breaking confidentiality must be considered arise more often. The field of forensic psychiatry is fundamentally different from clinical psychiatry because of the universal involvement of third parties and because interactions with evaluees do not occur within the context of a doctor patient relationship. Arguably, these conditions compel the forensic psychiatrist to function as a double agent. According to Appelbaum, an influential psychiatric ethicist, forensic practice calls for a different set of ethical guidelines that, while humane, do not either imply or derive from the existence of a doctor patient relationship. Others argue that a mix of forensic and clinical ethics is more appropriate. New developments in psychiatry, including the use of the Internet for E-mail and telepsychiatry, require continuing vigilance by the profession so that ethical standards can evolve to cover new circumstances at the frontiers of psychiatric practice.