司法精神醫學的展望

Forensic Psychiatry - An Overview

在維護精神病患之權益與保障社會免於危險精神病患之危害間，存在了相當大的矛盾與衝突。司法精神醫學所致力的就是要解決因精神障礙而導致的種種社會與法律問題，其中精神鑑定更是精神醫學臨床上的重要工作項目之一。本文首先簡介義大利、法國、德國等歐洲大陸國家，英美系統，以及日本及我國的司法精神醫學的歷史及現況，敘述傳統的概念與精神鑑定的實況。由於法界與精神醫學界對於司法精神醫學都有相當多的疑點，本文中特別提出：(1)法界與醫界的交點，(2)鑑定無訴訟能力或無責任能力？(3)司法鑑定與行政鑑定，及(4)病患的預後與復健等四課題來加以討論。近年來由於醫病關係及醫療中法律成份增加的關係，法律與醫學自然有需要去探索彼此間的關聯，法律與精神醫學間彼此互相交流的領域也自然而然擴大了，尤其是在美國已發展出所謂的法制精神醫學。為了預防精神病犯再三地發生犯罪行為，設立追蹤監視治療體系是極為重要的事。repeated offenses by psychiatric patients, establishment of a mandatory follow-up community treatment system is highly recommended.

Fair treatment of mentally ill defendants and protection of society from dangerous mental patients are controversial issues. The current legal and medical responses to the needs of these individuals and their victims are inadequate. Forensic psychiatry has aimed at solving various social and legal problems created by such mentally ill offenders, or insane, in legal terms, by providing ethical, high quality insanity evaluations that comprehensively address the clinical issues of criminal responsibility. In the first part of this selective review of forensic psychiatry, a brief sketch of the development of law and psychiatry in Italy, France, Germany, England, America, Japan, and Taiwan is given. Taiwan has followed German-Japanese theories and traditions in this field for nearly five decades. The forensic psychiatrist must critically evaluate insanity cases with contradictory or inconsistent findings before drawing any diagnostic or forensic conclusions. However, there remain several complicated issues: 1.Markedly discrepant usage of technical terms between the legal and forensic psychiatric frameworks. 2.The findings of 'unfit to plead' in the UK, and 'incompetent to stand trial' in the USA, are not allowed in Japan and Taiwan. Thus, defendants in Taiwan and Japan are unable to obtain insanity evaluation before indictment, making the course of proceedings much more complicated. 3.Marked discrepancies between the insanity evaluation of criminal law and civil commitment assessment of mental health law. 4.The lack of adequate postrelease planning and follow-up for most mentally ill offenders. Our contemporaries have experienced a great deal impact of law and medicine, and physician-patient relationship, malpractice, informed consent, and related issues have been extensively discussed in the public. Law and psychiatry is not an exception, and in the United States, a new field of legal psychiatry has been developed. In order to prevent repeated offenses by psychiatric patients, establishment of a mandatory follow-up community treatment system is highly recommended.