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Psychiatric Discretion and the Law

Harold I. Schwartz, MD; Paul S. Appelbaum, MD; Richard D. Kaplan, MD

Arch Gen Psychiatry. 1984;41(8):811-815.

Abstract
• Judicial decisions and statutory reforms point to a return to psychiatric discretion when clinical needs and patients' rights must be balanced. In seeking to commit patients, psychiatrists have been accused of contravening the legal rights of their patients by applying criteria other than those prescribed by law. This study examined the factors involved in the psychiatrists' decisions to seek commitment or to release 90 voluntarily hospitalized patients; we found psychiatrists' decisions to be appropriately correlated to legal criteria and legally relevant clinical and psychosocial factors. Interpersonal variables did not play a material role in the decision. Independent assessment of the patients' clinical status were consistent with clinicians' judgments of dangerousness. These findings indicate that this group of psychiatrists, faced with the decision to seek commitment, based their judgments on clinically relevant data rather than interpersonal factors and conformed to the dangerousness requirements of the commitment law.

Author Affiliations
From the Department of Psychiatry, Payne Whitney Clinic, New York Hospital-Cornell Medical Center, New York (Drs Schwartz and Kaplan), and the Western Psychiatric Institute and Clinic, University of Pittsburgh Schools of Medicine and Law (Dr Appelbaum).

Footnotes
Accepted for publication Nov 9, 1983.

Reprint requests to 449 E 68th St, New York, NY 10021 (Dr Schwartz) until July 1; after July 1 to Department of Psychiatry, Beth Israel Medical Center, 10 Nathan D. Perlman Pl, New York, NY 10003 (Dr Schwartz).

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