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Extract from the article from "The Bergen Barrister" Summer 2003
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 Kumho Tire 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.
By: Alberto
M. Goldwaser, M.D., D.F.A.P.A. , FORENSIC PSYCHIATRIC ASSOCIATES. Email:
agoldwaser@med.nyu.edu. Website:
http://www.forensic-psych-assoc.com.
Reprinted with permission.
