Forensic psychiatry, one subspecialty with two ethics? A systematic review.

BACKGROUND: Forensic psychiatry is a particular subspecialty within psychiatry, dedicated in applying psychiatric knowledge and psychiatric training for particular legal purposes. Given that within the scope of forensic psychiatry, a third party usually intervenes in the patient-doctor relationship, an amendment of the traditional ethical principles seems justified. RESULTS: Thus, 47 articles, two book chapters and the guidelines produced by the World Psychiatric Association, the American Association of Psychiatry and the Law, as well as by the Royal Australian and New Zealand College of psychiatrists, were analyzed. The review revealed that the ethics of correctional forensic psychiatry and those of legal forensic psychiatry do not markedly differ from each other, but they are incongruent in terms of implementation. METHODS: In an effort to better understand which ethical principles apply to forensic psychiatry, a chronological review of the literature published from 1950 to 2015 was carried out. CONCLUSION: The ethics of correctional forensic psychiatry are primarily deontological. The principle of justice translates into the principle of health care equivalence, the principle of beneficence into providing the best possible care to patients, and the principle of respect of autonomy into ensuring confidentiality and informed consent. The ethics of legal forensic psychiatry are rather consequentialist. In this latter setting, the principle of justice is mainly characterized by professionalism, the principle of beneficence by objectivity and impartiality, and the principle of respect of autonomy by informed consent. However, these two distinct fields of forensic psychiatry share in common the principle of non maleficence, defined as the non collaboration of the psychiatrist in any activity leading to inhuman and degrading treatment or to the death penalty.

A call to improve the validity of criterion-based content analysis (CBCA): Results from a field-based study including 60 children's statements of sexual abuse.

The growing awareness of sexually-abused children has led to a major shift: previously considered untrustworthy, children are now regarded as competent in providing medico-legal evidence. Professionals undertaking the challenging task of assessing the child's credibility need to rely upon approved evaluation methods. The Criteria-Based Content Analysis is a tool developed to assess the truthfulness of a child's verbal statement. This field-based study explores its validity and its limitations. Three independent experts rated the verbatim statements of 60 real-life alleged victims of sexual abuse. The CBCA scoring and final assessment of credibility were linked to the outcomes: confirmed or unconfirmed allegation of sexual abuse. Inter-rater reliability coefficient was 0.74. The average overall accuracy rate corresponding to confirmed and unconfirmed cases was 75%. Among the confirmed allegations, the accuracy rate reached 90%, whereas the probability of discriminating the true negative cases within the unconfirmed cases was lower than chance level. Of all the 19 criteria, items 6 "Reproduction of conversation" and 12 "Accounts of subjective mental state" were the strongest predictors of genuine accounts. A significant association between age and CBCA scores was noted, the effect of age on CBCA scores was strongest in the unconfirmed cases. Although some may argue that the validity of the CBCA is reasonably acceptable, results from this field study are less convincing. Increasing the diagnostic accuracy of the CBCA by adding new criteria, so as to raise the percentage of correct classifications in the confirmed accounts as well as in the unconfirmed accounts, would represent a major improvement.

Colorectal Cancer Screening in Switzerland: Cross-Sectional Trends (2007-2012) in Socioeconomic Disparities.

BACKGROUND: Despite universal health care coverage, disparities in colorectal cancer (CRC) screening by income in Switzerland have been reported. However, it is not known if these disparities have changed over time. This study examines the association between socioeconomic position and CRC screening in Switzerland between 2007 and 2012. METHODS: Data from the 2007 (n = 5,946) and 2012 (n = 7,224) population-based Swiss Health Interview Survey data (SHIS) were used to evaluate the association between monthly household income, education, and employment with CRC screening, defined as endoscopy in the past 10 years or fecal occult blood test (FOBT) in the past 2 years. Multivariable Poisson regression was used to estimate prevalence ratios (PR) and 95% Confidence Intervals (CI) adjusting for demographics, health status, and health utilization. RESULTS: CRC screening increased from 18.9% in 2007 to 22.2% in 2012 (padjusted: = 0.036). During the corresponding time period, endoscopy increased (8.2% vs. 15.0%, padjusted:<0.001) and FOBT decreased (13.0% vs. 9.8%, padjusted:0.002). CRC screening prevalence was greater in the highest income (>$6,000) vs. lowest income (≤$2,000) group in 2007 (24.5% vs. 10.5%, PR:1.37, 95%CI: 0.96-1.96) and in 2012 (28.6% vs. 16.0%, PR:1.45, 95%CI: 1.09-1.92); this disparity did not significantly change over time. CONCLUSIONS: While CRC screening prevalence in Switzerland increased from 2007 to 2012, CRC screening coverage remains low and disparities in CRC screening by income persisted over time. These findings highlight the need for increased access to CRC screening as well as enhanced awareness of the benefits of CRC screening in the Swiss population, particularly among low-income residents.