ABSTRACT
Prearraignment forensic evaluations are forensic psychiatric evaluations performed on a suspect soon after his or her arrest. In the guise of ethics, the committee members who originated this code have imposed apparently personal and political views on all members of respective professional organizations in order to circumvent rulings of the judiciary, including the U.S. Supreme Court. The prohibition against prearraignment evaluations represents a misapplication of physician-as-healer-based medical ethics--in which the core principle is the physician's beneficence to the patient--to the forensic arena, where no physician-patient relationship exists and healing is not the purpose. The ethical code prohibiting prearraignment evaluations reflects misguided paternalism and political bias, as well as being in direct conflict with current law. Whether or not prearraignment evaluations should be permitted is primarily a Fifth and Sixth Constitutional Amendment issue more than a traditional medical-ethical one. Ethics and the law, when both are examined carefully, suggest prearraignment evaluations are proper when performed responsibly.
Subject(s)
Ethics, Medical , Health Policy/legislation & jurisprudence , Insanity Defense , Mental Competency/legislation & jurisprudence , Mental Disorders/diagnosis , Adult , Commitment of Mentally Ill/legislation & jurisprudence , Female , Humans , Informed Consent/legislation & jurisprudence , Mental Disorders/psychology , Patient Care Team/legislation & jurisprudence , Politics , United StatesABSTRACT
In a double-blind, randomized, placebo-controlled trial, we studied 40 cigarette smokers to determine the effects of one week of transdermal clonidine hydrochloride (Catapres-TTS No. 2) treatment on the withdrawal symptoms associated with smoking cessation. Subjects were instructed to maintain their usual cigarette intake during days 1 through 3 and cease smoking for days 4 through 6. All of the withdrawal symptoms measured (craving, irritability, anxiety, restlessness, difficulty concentrating, and hunger) significantly increased during the three days of smoking cessation in the placebo group. There was a 4.3-fold increase in craving, a 3.8-fold increase in irritability, a 3.7-fold increase in anxiety, and a 3.3-fold increase in restlessness in the placebo group compared with the transdermal clonidine group during the three days of smoking cessation. Impairment of concentration and hunger were not significantly diminished by transdermal clonidine treatment during smoking cessation. In addition, a trend was present in the transdermal clonidine group to spontaneously decrease the number of cigarettes smoked per day during the smoking period. Side effects were generally mild. We conclude that transdermal clonidine treatment ameliorates some of the short-term withdrawal symptoms, especially craving, associated with smoking cessation.
