刑事司法精神鑑定之挑戰與期待

Forensic Psychiatric Examination for Criminal Cases: Challenges and Hopes

司法精神醫學（Forensic psychiatry）在20世紀後期正式成為特殊的精神醫學次專科。隨著我國最近十餘年來數起重大刑案發生，涉及被告之司法精神鑑定屢屢成為社會與媒體矚目焦點，亦有許多對於刑事司法精神鑑定之檢討聲浪，因此，筆者藉本文探討並釐清刑事司法鑑定可能遭遇到之重大問題與挑戰，並提出未來可能之一般因應方案。
於介紹司法精神醫學與司法精神鑑定之概念後，本文首先描述刑事司法鑑定與本論文核心挑戰議題有關項目內容與其重點。在第參節，本文概述刑事司法精神鑑定程序，涵蓋刑事司法鑑定模式、刑事司法精神鑑定之特殊倫理考量，收集物證、人證之範圍與方式、以及撰寫鑑定報告時應注意之事項。於第肆節，本文將提出幾個刑事司法鑑定遭遇之重要倫理法律問題及科學性問題（包括理論與實務操作部份）；尤其是關於科學證據之運用（心理衡鑑、藥物輔助會談、神經科學證據等）、詐病評估、教化可能性評估、創傷後壓力症及刑事司法鑑定品質之問題等，皆會提出探討。在第伍節，本文將對於未來刑事司法精神鑑定提出展望與建議，即使無法完全解決第肆節所遭遇之問題，然而以循序漸進之修正方式，以實用主義之精神運用刑事司法精神鑑定，仍可某程度達到提升刑事司法公平正義之目的。

Forensic psychiatry became a subspecialty in psychiatry in the last half of the twentieth century. In recent ten more years in Taiwan, more and more major criminal cases drew the attention of the public. Forensic psychiatric examinations on the defendants of these cases often emerged as the target of social and media commentaries that requested for the reform of criminal forensic psychiatric examinations. Therefore, we explore and clarify the important problems and challenges encountered when conducting such examinations, and then propose general measures to deal with these issues in the future.
After introducing the concepts of forensic psychiatry and forensic psychiatric examination, section two describes various categories of criminal forensic psychiatric examinations and their main contents that are most related to the core challenging issues in the paper. They include criminal responsibility, competency to stand trial, competency to be executed, corrigibility, and post-traumatic stress disorder. Section three covers the general procedure of conducting the examinations, including the modes of examinations, specific ethical considerations, scopes and methods of evidence collections and witness interviews, and the guide and caveat when writing examination reports. Section four addresses important ethical and scientific issues in conducting the examinations, including the theoretical and practical parts. Specifically highlighted are those related to quality of reports, psychological examinations, drug-assisted interviews, neuroscience evidence, malingering, corrigibility, and post-traumatic stress disorder. The paper concludes at section five by depicting the ways that could address the above challenges. It is important to further the professionalization of forensic psychiatry in Taiwan through fellowship training, specialty licensure, and academic research. Transdisciplinary and international collaboration is much needed to enhance medical-legal communication and quality of forensic psychiatric examinations and related studies. Realistically speaking, all the issues pinpointed above could not be solved right away. It is hoped that through incremental and pragmatic refinement of criminal forensic psychiatric examinations, the policy goals of criminal justice could be fulfilled better than ever.