Professional, Ethical, and Legal Issues: Consent, Confidentiality, Competence, and Forensic Roles
Core concepts to master
Ethical practice is governed by informed consent, confidentiality and its limits, competence, multiple relationships, and boundaries of role. Informed consent requires capacity, disclosure, voluntariness, and understanding - and must be tailored to cognitive impairment. Confidentiality yields to legal mandates (duty to protect, abuse reporting, court order) and must be explained in advance.
Competence has two senses: the clinician's scope of competence and the patient's decision-making capacity. Forensic roles demand special care: the forensic examiner serves the court, not the patient; must clarify the referral source; must avoid dual roles (treating clinician vs. expert); and must maintain impartiality and validity testing.
Traps
Confusing clinical and forensic roles. Assuming a patient's agreement equals informed consent when capacity is impaired. Promising absolute confidentiality. Practicing outside competence. Letting a retaining attorney shape findings.
Rule of thumb
Ask who is the client and what is the purpose? In forensic work, the court is the client; in treatment, the patient is. Never blend the two without explicit disclosure and justification.
Worked example: Asked by an attorney to "assess my client's memory to support his claim," the neuropsychologist clarifies that the examiner's duty is impartial evaluation for the court, obtains informed consent explaining limits of confidentiality, and administers validity measures.