Goldstein R L
Legal and Ethical Issues in the Practice of Psychiatry Program, College of Physicians and Surgeons of Columbia University.
Bull Am Acad Psychiatry Law. 1989;17(3):269-81.
In the wake of Hinckley, widespread public dissatisfaction with the role of psychiatrists in insanity defense litigation prompted Congress in 1984 to amend the Federal Rules of Evidence to prohibit psychiatric testimony on the ultimate legal issue of whether or not a defendant is insane. APA's Statement on the Insanity Defense served as the ably articulated premise for this evidentiary amendment. APA argued that in going beyond their psychiatric expertise by answering ultimate issue questions as to whether defendants are legally insane, experts are likely to confuse the jury and undermine public confidence in psychiatry. APA also asserted that there was an impermissible logical leap between scientific psychiatric inquiry and moral-legal conclusions on the ultimate issue of insanity. This article reviews the origins, history, and vicissitudes of the Ultimate Issue Rule and analyzes the Statement on the Insanity Defense from both a legal and psychiatric perspective on the issue of whether psychiatrists should answer the ultimate question in insanity cases. The analysis suggests that APA's conclusions are not supported on scientific or evidentiary grounds, but may be warranted as a policy consideration to safeguard the public image of psychiatry.
欣克利事件之后，公众对精神病医生在精神错乱辩护诉讼中所起作用普遍不满，这促使国会在1984年修订了《联邦证据规则》，禁止就被告是否精神错乱这一最终法律问题提供精神病学证词。美国精神病学协会关于精神错乱辩护的声明成为了这一证据修正案的有力阐述前提。美国精神病学协会认为，专家通过回答关于被告是否在法律上精神错乱的最终问题，超越了他们的精神病学专业知识范围，很可能会使陪审团感到困惑，并削弱公众对精神病学的信心。美国精神病学协会还声称，在科学的精神病学调查与关于精神错乱最终问题的道德法律结论之间存在不可接受的逻辑跳跃。本文回顾了最终问题规则的起源、历史和变迁，并从法律和精神病学角度分析了关于精神错乱辩护的声明，探讨精神病医生是否应在精神错乱案件中回答最终问题。分析表明，美国精神病学协会的结论在科学或证据方面并无依据，但作为维护精神病学公众形象的政策考量，或许有其合理性。
