Ethical and Legal Issues

Yagi Studio/Taxi Japan/Getty Images. Photo for illustrative purposes only; any individual depicted is a model.

It’s the early evening rush hour in New York City in January 1998. People are waiting in a subway station for a train to take them home, to meet friends, or to go out to dinner. Kendra Webdale, a 32-year-old woman, is among the people waiting at the platform. Andrew Goldstein, a 29-year-old man, comes up from behind her and pushes her in front of an oncoming train as it enters the station. He murdered her, as many witnesses later testified. This might seem an open-and-shut criminal case, but it’s not. Goldstein had a 10-year history of mental illness, had been in and out of psychiatric units and hospitals, and had been diagnosed with paranoid schizophrenia.

Andrew Goldstein (left) killed Kendra Webdale (right) by pushing her off a subway station platform into an oncoming train. Goldstein had a history of mental illness and had been diagnosed with paranoid schizophrenia. How do we determine whether he should be treated as a person suffering from a disease or as a cold-blooded murderer?

AP Photo/Marty Lederhandler
Kevin M. Polowy/Associated Press

If Goldstein wasn’t in his “right mind” when he pushed Webdale, should he face a trial? And if found guilty, should he go to jail, or perhaps be executed? Or should he be judged and treated as someone who is mentally ill—and if so, why? If the mentally ill commit criminal acts, should they be dealt with differently than people who are not mentally ill? Moreover, what if Goldstein had been seeing a psychotherapist and had mentioned that he might do something like this—should the therapist have reported his statement to the police? Mental health clinicians are bound by a code of ethics and by state and federal laws. What are the relevant ethical guidelines and laws that affect how mental health clinicians treat their patients? These are the types of questions that address the relationships among the law, ethics, and the reality of mental illness and its treatment.

In this chapter, we examine the legal and ethical issues that can affect mental health professionals and their patients, paying particular attention to criminal actions by people who are mentally ill—the circumstances under which they are considered insane, what happens to them when they are dangerous to themselves or others, and whether and when they receive treatment.