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19 Legal & Criminological Psych. 1 (2014)

handle is hein.journals/legadclpy19 and id is 1 raw text is: The British Legal and Criminological Psychology (2014), 19, 1-12 Psychological Society © 2013 The British Psychological Society www.wileyonlinelibrary.com Three faces of justice: Competing ethical paradigms in forensic psychiatry Gwen Adshead* Broadmoor Hospital, West London Mental Health Trust, Crowthorne, UK Respect for justice has traditionally been an essential principle of health care ethics. However, many bioethical accounts of justice focus only on distributive justice, and how resources for health care should be allocated. In this article, I will argue thatthe practice of forensic mental health care requires clinicians to engage with justice in three additional and different ways: justice as liberty and fairness; retributive justice and protection of the vulnerable; and justice as the promotion of virtue. I will argue that British forensic psychiatry favours retributive and protective justice; in contrast to a libertarian approach to forensic practice in the United States. I discuss how respect for justice as support for virtue complements therapeutic work with offenders, which aims at the development of pro-social character. I will conclude that without respect for justice as virtue, there is a danger that clinical forensic psychiatry risks doing harm to patients and bringing the profession into disrepute. The principle of respect for justice was one of the four principles of medical ethics described by Thomas Beauchamp and Childress (2013) in the first edition of what has become a standard text in bioethics. The 'four principles approach' (sometimes unkindly referred to as 'the Georgetown Mantra') has proved hugely valuable and influential: first by providing a framework for introducing ethical thinking to a whole range of health care professionals, and second by generating research into models of ethical thinking that extend or challenge the principlist approach. As conceived by Beauchamp and Childress, health care professionals have a duty to respect justice applied to health care; which generally refers to justice as the fair distribution of health care resources. Distributive justice in health care deals with ethical dilemmas such as debates about the funding of health care, how patients can access expensive and/or limited treatments that not all can access, and about how the quality and value of life can be measured. Forensic health care professionals, who work with men and women who have violated the criminal law, have to engage with different conceptions of justice, and rather different ethical dilemmas. As Ward (2013), has suggested, these dilemmas often involve the dual (or more) obligations that forensic professionals try to fulfil in their professional lives. In this article, I will describe some of the other conceptions of justice with which forensic health care professionals have to engage: specifically, justice as respect for individual rights, liberty and due process; justice as protection of the vulnerable in society, and justice as the promotion of the good life. I hope to show that different systems of forensic *Correspondence should be addressed to Gwen Adshead, Broadmoor Hospital, Crowthorne RG4S 7EG, UK (e-mail: gwen. adshead@wlmht.nhs.uk). DOI:10.l I/I l/crp.12021

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