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Psychiatric Decision Making in a Legal Context

Paul S. Appelbaum, MD; Robert M. Hamm, PhD

Arch Gen Psychiatry. 1982;39(4):447-451.

Abstract
• In seeking to commit patients, psychiatrists have often been accused of pursuing ends other than those prescribed by the law, but empiric data have been lacking on those factors that influence commitment decisions. In this study 34 clinicians, most of whom were psychiatrists, responded to 65 requests by voluntary patients for discharge from the hospital. The legal criteria governing commitment were found to be significantly related to the decision. Those nonlegal criteria that seemed most consistently to play a significant role in the decision seemed closely related to one of the legal criteria. The clinicians' affective responses to their patients and the patients' personality traits did not play a significant role in the decision. These findings suggest that this group of clinicians was acting in substantial accordance with the dangerousness requirements of the commitment law.

Author Affiliations
From the Department of Psychiatry, Program in Law and Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine (Dr Appelbaum), and the Division of Primary Care and Family Medicine, Harvard Medical School, Boston (Dr Hamm).

Footnotes
Accepted for publication June 9, 1981.

Reprint requests to Western Psychiatric Institute and Clinic, 3811 O'Hara St, Pittsburgh, PA 15261 (Dr Appelbaum).

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