Clear evidence is needed that without further treatment or medication the person would become even more disabled and/or their condition worsen considerably.
Substantial probability is needed that without appropriate treatment the person’s condition would so deteriorate that they’d suffer severe psychological or physical harm that would result in an inability to function independently outside of an institution.
Ending One’s Life
People have debated the right (or otherwise) to end one’s own life since the time of the ancient Greeks, but in the last few years the possibility of medically assisted suicide and euthanasia raises many questions that require assessments residing at the heart of forensic psychology. These assessments can relate to an individual’s active requests for end-of-life procedures, passive refusals to have life-sustaining treatment or actions by relatives to terminate life-support systems. In all cases, the central issue is the competence of an individual to make such a significant decision.
Assessments of competence need to go beyond the natural logic or rationality of any termination request. They have to incorporate an understanding of the individual and the context of the person’s request, by asking questions such as:
Are there any indications of mental illness or other psychological disorders that would cloud judgement?
Does depression influence judgement and, for instance, minimise the prospect for recovery?
How does the decision accord with previous expressed preferences and attitudes?
If the person has changed his views from previously held ones, what gave rise to that change and how plausible is it?
Is there any indication of pressure from others or desire to respond to the concern of others?
Are there any impairments in the person’s ability to communicate or express a viewpoint so that decisions can be delayed until the person can express a view?
Assessing the Impact of Child Abuse
As legal processes around the world accept more readily the prevalence of child abuse when reported by adults about their earlier experiences, a particularly demanding requirement emerges: to determine the extent of damage the victim suffered, even though the abuse may have happened 30 years previously or longer. Such assessments are carried out to establish compensation as well as any therapeutic interventions.
As well as detecting any malingering or symptom exaggeration by the victim (something I consider for offenders in Chapter 10), a mixture of other matters need to be examined:
Comparison with other related youngsters who weren’t abused.
Similarities and differences in the victim before and after the alleged abuse.