By Alberto M. Goldwaser, MD
The tale of the “Three Little Pigs” is used to illustrate
how psychiatrists use and misuse evidence. This paper refers to the different
approaches of building a case the proverbial Brick House through a forensic
psychiatric study. The object is to assist the jurist by presenting a
picture of the case, and then intelligently persuade.
To know psychiatry well, is but one, albeit important, element of being
an expert (psychiatric) witness. Disconnected from other factors, it may
play a very limited and not helpful role in the establishment of a legal
decision. The expert ought to know what science is, and what it is not,
as well as how to apply it to specific clinical matters under legal scrutiny.
It is essential to be familiar with the rules of evidence allowing or
proscribing his/her participation in the fact finding process. Lastly,
it is vital to clearly differentiate between the forensic and the treating
roles and responsibilities of a doctor.
To be prepared and convey “science” in the expert opinion,
one should have taken the preparatory steps. First, one should know the
boundaries imposed by each professional’s hat: treating psychiatrist
and forensic psychiatrist.
The clinical (treating) psychiatrist relies heavily on the patient’s
self report of symptoms – what the patient feels, or claims to feel.
As the patient’s helper, the clinician accepts such descriptions
as existing, and proceeds with the treatment, which consists first on
learning more about the condition that brings the patient to the office,
and then eliminating those symptoms and perhaps even their cause.
As a clinician, the mental health professional is a believer of his/her
patient’s clinical descriptions with the overriding goal of diagnosis
and treating an illness, advocating, a priori in the patient’s affliction.
There is a pro-patient stance and the utmost adherence to the confidentiality
standard. Such adherence to the doctor/patient relationship does not exist
in a forensic setting. This allows the forensic doctor an objectivity
that is raised to levels commonly not expected from the treating doctor.
All this applies to the study of direct (the individual itself) and indirect
(collateral) sources of information.
There is also the assumption of worthiness and trust to and from the patient.
The doctor uses medical notions and techniques designed for the treatment
of such ailment.
The treating doctor runs a risk, in a court, when explaining the origin
of the symptoms described by the individual based on the dare of an occurrence.
It appears that the clinician is placing those complaints in a time context
based on a leap of faith, (expected only of the “treating”
expert, not of the “forensic” one). Nonetheless, such connection
may not be there.
In the forensic role, the psychiatrist’s neutrality and objectivity
is vital for him/her to be acceptable link in the fact finding process,
expected to be adhered to in the professional attitude and relationship
with the examinee.
Expert witnesses are admitted to testify in courts only because they have
knowledge that is beyond that of the average juror. They should also be
able to teach (digest) clinical concepts into impressions designed for
those not versed to get the picture.
Supreme Court decision on admissibility of expert testimony are meant
to maximize scientific assistance in understanding obscure areas, which
are the focus of the legal inquiry, while eradicating or minimizing speculation
partisanship and bias.
The expert testimony should be based on scientific principles or techniques,
in order to exclude testimony based on unreliable principles. These rules
of evidence evolved from Frye v. United States [293 F. 1013; 34 A.L.R.
145 (D.C. Cir., 1923)] the general acceptance rule, to Daubert v. Merrell
Dow Pharmaceuticals, Inc. [509 U.S. 579 (1993), and KumhoTire Co. Ltd,
v. Carmichael, [526 U.S. 137 (1999)], relevance analysis.
The general acceptance rule states a scientific principle is admissible
only after it gained general acceptance in the field in which it belongs.
The relevance analysis was adopted by the United States Supreme court
for the Federal courts, rejecting Frye. Many States courts are now switching
from Frye to Daubert, based upon the Federal Rule of Evidence 702. On
the surface it appears to be more permissive. It provides trial judges
with an important tool for preventing the introduction of conjecture and
junk science under the guise of expert testimony.
The Federal Rule of Evidence 702 changed the Frye test. It states, “[i]f
scientific, technical, or other specialized knowledge will assist the
trier of fact to understand the evidence or to determine a fact in issue,
a witness is qualified as an expert…may testify thereto in the form
of an opinion or otherwise.” The Daubert Court read Rule 702 to
require that an expert’s testimony must amount to “scientific
knowledge” in order to be admissible.
The Daubert decision asserts that judges must base admissibility decisions
on the reliability of scientific principles, i.e. Has it been tested?
Does it yield accurate results? Are there standards governing the use
of such principles (i.e. clear diagnostic criteria)? What is the ratio
between subjective/objective analysis? Were they the focus of analysis,
and publications? Are the scientific/clinical principles generally accepted
by experts in the field? (included in the Frye rule). The judge conducts
a searching inquiry into the reliability of scientific principles.
The 1999 Supreme Court decision Kumho Tire extended Daubert to non-scientific
experts, giving the court more discretion to evaluate experts testimony,
and adding that Daubert applies not only to scientific knowledge, but
also to “technical” and “other specialized” knowledge.
Professionals draw from many sources of information to reach conclusion
about a case. When it comes to expert testimony in court, the law allows
professionals to base their testimony on the same sources of information
they rely on their normal day-to-day clinical practice outside the courtroom.
The expert’s training is paramount here. For example, the focus
of the practice for a marriage and family therapist is typically on relationship
problems between married persons and children, rather than the diagnosis
of mental illness. They may bring to court “expert” testimony
that involves more advocacy than expertise.
The expert witness ought to help the attorney convince the judges that
the scientific and clinical principles underlying the testimony are sufficiently
reliable. Daubert says that expert testimony must amount to scientific
knowledge in order to be admissible. “Scientific” implies
grounding in the methods and procedures of science (from the Latin science
having knowledge), and “Knowledge” means more than subjective
belief or unsupported speculation.
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