Editor:
The editors of the Journal and Dr. Gutheil deserve our gratitude
for publishing an article that details some common pitfalls in the forensic
evaluation of testamentary capacity. [1] It is worth
noting that such pitfalls can be magnified by those hidden dangers common
in both diagnostic reasoning and opinion formulation. [2]
For example, there is the common human tendency to have first impressions
become last impressions. This has been described as the heuristic of "anchoring." Since
treating physicians focus on relief of suffering, they may anchor on
an initial formulation of impairment level which, although helpful for
treatment purposes, is misleading for forensic purposes. Even when a
treating clinician is subsequently presented with the criteria for evaluation
of testamentary capacity, it is more difficult to apply these criteria
in an open-minded fashion without anchoring on the prior evaluation of
impairment for specific treatment purposes. These considerations make
it all the more crucial that the forensic evaluation be conducted separately
from any clinical evaluation. [3] This separation is
necessary to avoid any potential, if inadvertent, conflicts of interest
whose influence, with all good intentions, cannot be easily prevented
or undone. [4]
Harold J. Bursztajn, MD
Associate Clinical Professor of Psychiatry
Harvard Medical School
Boston, MA
References
-
Gutheil TG: Common pitfalls in the evaluation
of testamentary capacity. J Am Acad Psychiatry Law 35:514 –7, 2007
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Gopal A, Bursztajn HJ: DSM misuse pitfalls
evident in clinical training and courtroom testimony. Psychiatr Ann
37:604 –17, 2007
-
Bursztajn HJ: Competency to make a will. Am
J Psychiatry 149: 1415, 1992
-
Cosgrove L, Bursztajn HJ: Undoing undue industry
influence: lessons from psychiatry as psychopharmacology. Organ Ethics
3:131–3, 2007