P0120 - The concept of judgment in medico-legal context

Abstract

Assessment of judgment in mentally ill patients has a central role in court appointed evaluation, especially when criminal responsibly is in debate.

Psychiatry and law view judgment differently. The law system aims to reach clear conclusions of right or wrong, guilty versus non-guilty. This leads to restriction of judgment concept, converting it to the investigation of social knowledge.

In psychiatry, judgment is not a bipolar issue, but a wider and more complex concept, involving analytic thinking, social- ethical action tendencies and insight. In clinical practice these components are inter-related and dynamically effect each other. Impairment of judgment can be expressed by insult of each of these mental groups.

Method:

Clinical vignettes illustrate the dynamic inter-relation between the different components of judgment and the importance of judgment evaluation in criminal law.

Results:

Clinical material confirmed our basic hypothesis, that judgment can be considered as preserved when all three components are intact or when only one is impaired, though not sufficient to effect the other two. When two components are impaired, it inevitably leads to insult of the third component and to judgment impairment as a whole, resulting in criminal irresponsibility. In cases of severely ill mental patients, where all three components of judgment are impaired, the individual lacks criminal responsibility even when no clear connection between psychotic production and behavior can be proved.

Conclusions:

Judgment concept and its components will enable mutual understanding and construct a common basis of working alliance and common knowledge for both medical and law people.