Am J Psychiatry 1992; 149:596-605
Copyright © 1992 by American Psychiatric Association
The debate on treating individuals incompetent for execution
K Heilbrun, ML Radelet and J Dvoskin
Forensic Service, Florida State Hospital, Chattahoochee.
The question of whether to provide mental health treatment to prisoners
under death sentence who have been judged incompetent for execution
presents a powerful ethical dilemma for mental health professionals.
Arguments that favor or oppose the provision of treatment are discussed in
the context of the nature of the disorder to be treated, the type of
treatment to be provided, the goals of treatment, and the relevant legal
standard for determining competency for execution. Arguments against
treating the incompetent include 1) the need to avoid harming those who are
treated, 2) the risk that disclosures in therapy will be used for
assessment purposes, 3) the need for paternalism when sufficient harm is
necessary, 4) the adverse impact on the clinician, 5) the potential
undermining of patient and public perceptions of mental health
professionals, and 6) the poor allocation of limited resources. Arguments
for treating the incompetent include 1) respect for the wishes of the
prisoner, 2) the need to clarify the values underlying the refusal to
treat, 3) the low risk of harm from some forms of treatment, and 4) the
adverse impact on the milieu stemming from failure to treat. The authors
conclude that treating incompetent prisoners may not violate ethical
standards under some circumstances, and that some forms of treatment will
require the informed consent of the prisoner.
