Chapter 17: Legal and Ethical Issues
1. Be able to differentiate between the legal concepts of insanity and the various
standards for the insanity defense.
2. Be able to describe the issues surrounding competency to stand trial.
3. Be able to delineate between the conditions under which a person can be committed to
a hospital under civil law.
4. Be able to discuss the difficulties associated with predicting dangerousness and the
issues surrounding the rights to receive and refuse treatment.
5. Be able to describe the ethics surrounding psychological research and therapy.
Some civil liberties are rather routinely set aside when mental health professionals
and the courts judge that mental illness has played a decisive role in determining
an individual’s behavior. This may occur through criminal or civil commitment.
Criminal commitment sends a person to a hospital either before a trial for an alleged
crime because the person is deemed incompetent to stand trial, or after an
acquittal by reason of insanity.
Several landmark cases and principles in law address the conditions under which a
person who has committed a crime might be excused from legal responsibility for
it—that is, not guilty by reason of insanity. These involve the presence of an
irresistible impulse, the notion that some people may not be able to distinguish
between right and wrong (the M’Naghten rule), and the principle that a person
should not be held criminally responsible if his or her unlawful act is the product
of mental disease or mental defect (the Durham principle). The Insanity Defense ReformAct of 1984 made it harder for accused criminals to argue insanity as an
Today, “guilty but mentally ill” is in use in a number of states. This emergent legal
doctrine reflects an uneasiness in legal and mental health circles about not holding
people ascriptively responsible for crimes for which they are descriptively
There is an important difference between mental illness and insanity. The latter is a
legal concept.Aperson can be diagnosed as mentally ill and yet be deemed sane
enough both to stand trial and to be found guilty of a crime.
Even if a person has not broken a law, one who is considered mentally ill and
dangerous to themself and to others can be civilly committed to an institution or
be allowed to live outside of a hospital but only under supervision and with
restrictions placed on his or her activities.
Recent court rulings have provided greater protection to all committed mental
patients, particularly those under civil commitment. They have the right to written
notification, to counsel, to a jury decision concerning their commitment, and to
FifthAmendment protection against self-incrimination. Patients also have the
right to the least restrictive treatment setting, the right to be treated, and in most
circumstances, the right to refuse treatment, particularly any procedure that entails
considerable risk. However, there is a trend toward preventive detention when, for
example, convicted sexual predators are about to be released from prison with
every indication that they will harm others again.
Ethical issues concerning research include restraints on what kinds of research are
allowable and the duty of scientists to obtain informed consent from prospective
In the area of therapy, ethical issues concern the right of clients to confidentiality, the
question of who is the client (for example, an individual or the state mental hospital that is paying the clinician, and the question of who sets the therapy
Diagnosis of sexual abuse in childhood based on so-called recovered memories has
also presented ethical problems, as well as legal dilemmas, for therapists.
1. Frank suffers from schizophrenia. Allegedly, he has severely beaten another man in
the park after an argument. While he is being examined by a psychologist to see if he is
fit to stand trial, he is mandated to a mental health institution. This is an example of
a. civil commitment.
b. mandated reporting.
c. criminal commitment.
d. psychiatric commitment.
Answer: C Type: Factual Page: 564
2. Criminal and civil commitment can be best distinguished by
a. whether the one being committed is insane.
b. whether a crime has been committed by the individual.
c. the severity of the symptoms and the crime committed.
d. the type of police intervention necessary.
Answer: B Type: Factual Page: 564
3. George killed his two children because he believed he heard voices telling him that if
he did not kill them, his neighbor would. His defense attorney argued that due to
George’s insanity at the time of the crime, George should not be held responsible for the
crime and should thus be acquitted of the crime. Which of the following best describes
the plea that George’s defense attorney made?
a. Not Guilty but Mentally Ill
b. The Durham test
c. Not Guilty by Reason of Insanity
d. Guilty But Mentally Insane
Answer: C Type:Applied Page: 565-567
4. If an individual is acquitted with the Not Guilty by Reason of Insanity Plea, he or she
a. is committed to a forensic hospital for an indefinite amount of time.
b. is generally placed in a maximum security prison.
c. is able to walk free, but with strict requirements for outpatient psychiatric treatment. d. is placed in a psychiatric hospital until it is deemed that he or she is ready to reenter
Answer:AType: Factual Page: 565
5. If an individual is judged to be Guilty but Mentally Ill, he or she
a. is always put in the general prison population.
b. may be committed to a prison hospital or other type of suitable psychiatric facility.
c. is placed in a psychiatric hospital until it is deemed that he or she is ready to reenter
d. will receive inpatient psychiatric treatment at a local psychiatric hospital before being
moved into the general prison population.
Answer: B Type: Factual Page: 566
6. Insanity defense trials typically involve
a. considerable flexibility in determining who is most responsible for criminal actions.
b. subjective determinations of competency at the time of a crime.
c. individuals with antisocial personality and no other significant mental disorders.
d. All of the above are correct.
Answer: B Type:Applied Page: 565
7. The M'Naghten rule states that the insanity defense is appropriate if a person
a. has an irresistible impulse leading him or her to commit a crime.
b. has a diagnosable mental illness.
c. is not competent to stand trial.
d. does not know right from wrong at the time of the criminal act.
Answer: D Type: Factual Page: 566
8. Psychiatrist for the defense: "This man was clearly insane at the time of the crime."
Psychiatrist for the prosecution: "This man was clearly sane at the time of the crime."
What we have here is a problem of
b. etiological validity.
c. concurrent validity.
d. predictive validity.
Answer:AType:Applied Page: N/A 9. Jill attacked a man in the park during the day, with a crowd of onlookers present. In
order for Jill's attorneys to use the Durham rule, they would have to establish that the
attack was due to
a. an inability to distinguish right from wrong.
b. an irresistible impulse.
c. a low motivation to actually commit a crime.
d. a preexisting mental disease.
Answer: D Type:Applied Page: 567
10. Which legal precedent gave mental health professionals widest latitude in deciding if
an individual is legally insane?
a. irresistible impulse
b. M’Naghten rule
c. Durham test
d. American Law Institute Guidelines
Answer: C Type: Factual Page: 567
11.According to theAmerican Law Institute guidelines, which of the following mental
disorders would not qualify for the insanity defense?
a. paranoid schizophrenia
b. dissociative identity disorder
c. post-traumatic stress disorder
d. antisocial personality disorder
Answer: D Type:Applied Page: 568
12. Aprimary purpose of theAmerican Law Institute guidelines for defining the insanity
defense was to
a. avoid specifying symptoms of mental illness which might later become obsolete.
b. be more specific and informative to lay jurors.
c. allow greater leeway for expert witnesses to define the concept of mental illness.
d. open the defense to the full range of mental illnesses.
Answer: B Type: Factual Page: 567
13. TheAmerican Law Institute Guidelines for the insanity defense has been criticized as
a. too broad and inclusive.
b. too narrow.
c. too ambiguous. d. too dependent on expert witnesses.
Answer: C Type:Applied Page: 568
14. Amajor result of the Insanity Defense ReformAct was
a. to require that a documented, preexisting mental condition exist at the time of a crime
in order to use an insanity defense.
b. to clarify what specific crimes may be associated with insanity.
c. to restrict the insanity defense to multiple offenders.
d. to eliminate the irresistible impulse as a plausible insanity defense.
Answer: D Type:Applied Page: 568-569
15. The Insanity Defense ReformAct shifted the burden of proof onto the
c. expert witness.
Answer:AType: Factual Page: 568-569
16. According to the Insanity Defense ReformAct, a person who is deemed not guilty by
reason of insanity
a. must be suffering from at least a moderate mental illness.
b. must be incarcerated for the maximum allowable time for their crime if their mental
health improves to the point where hospitalization is no longer needed.
c. must lack the overall capacity to appreciate the wrongfulness of their behavior.
d. All of the above are correct.
Answer: B Type: Factual Page: 568-569
17. Szasz's argument against the insanity defense involves
a. a concern that too many individuals may take advantage of the system.
b. a criticism of the legal profession in allowing many rational individuals to legitimize
their crime by labeling themselves 'insane.'
c. the dehumanization of the perpetrator before attempting a means of rehabilitation.
d. All of the above are part of Szasz's argument against the insanity defense.
Answer: C Type:Applied Page: 570: Focus on Discovery 17.1
18. What verdict has been proposed most recently for mentally ill persons who commit
crimes? a. guilty (no allowance made for mental illness)
b. not guilty by reason of insanity
c. not guilty by reason of temporary insanity
d. guilty but mentally ill
Answer: D Type: Factual Page: 569
19. What is the rationale of laws that provide for legal verdicts of "guilty but mentally
a. to prevent the truly insane from being treated as criminals.
b. to provide treatment options for convicted criminals while still holding them
responsible for their actions.
c. to deal with mentally ill vagrants.
d. to permit consideration of whether the accused could appreciate the wrongfulness of
his or her actions.
Answer: B Type:Applied Page: 569
20. Patrick was found guilty of murdering his wife. Psychiatrists testified that Patrick
had paranoid schizophrenia and that his delusions led directly to the criminal act. If his
state allows the guilty but mentally ill verdict, what sentence would Patrick likely
a. Psychiatric commitment until a psychiatrist determines that he is cured of his mental
b. Psychiatric commitment until a psychiatrist determines that he is no longer dangerous.
c.Acriminal sentence but with psychiatric care provided during the incarceration.
d. The same criminal sentence as a non-mentally ill person convicted of murder.
Answer: C Type:Applied Page: 569
21. The case of Jeffrey Dahmer exemplifies
a. the plea of not guilty by reason of insanity.
b. the distinction between mentally ill and insane.
c. the aggressive behaviors of antisocial personality disorder.
d. how a psychologically healthy person can be temporarily insane.
Answer: B Type:Applied Page: 571
22. Jeffrey Dahmer, the serial killer, was an example of a criminal who was
a. mentally ill but not legally insane.
b. legally insane but not mentally ill. c. insane according to the rule of knowing right from wrong, but not according to the
irresistible impulse rule.
d. neither mentally ill nor legally insane.
Answer:AType:Applied Page: 571
23. In the case of Jones v. United States, Jones was hospitalized after stealing a jacket.
His attorneys argued before the court that he was
a. denied effective treatment for his insanity.
b. hospitalized for longer than he would have been imprisoned.
c. legally insane but had no mental illness requiring hospitalization.
d. never proven to be legally insane.
Answer: b Type: Factual Page: 572
24. The Jones v. United States case illustrated which problem with the insanity defense?
a. Mentally ill people may still be guilty of crimes.
b. People deemed to be insane may be treated for longer than they would have been
c. Committed patients have a right to refuse treatment.
d. People may be insane at the time of the crime but still competent to stand trial.
Answer: B Type: Factual Page: 571-572
25. In the Jones v. United States case, the Supreme Court decided that a person could be
a. if he/she is in a mental hospital and had previously committed a crime.
b. only if the prosecutor proved beyond a reasonable doubt that he/she represent a danger
c. only if he/she had previously committed a violent crime.
d. if he/she committed a crime that might have led to violence (even if not violent itself).
Answer: D Type:Applied Page: 571-572
26. The Supreme Court decided, in the case of Jones v. United States, that Jones
a. must be released as he was no longer dangerous to others.
b. could be hospitalized for longer than the normal prison term.
c. must be hospitalized although he had already served his sentence.
d. was not guilty by reason of insanity.
Answer: B Type: Factual Page: 571-572 27. What is the distinction between insanity and competency to stand trial?
a. Insanity is more serious than incompetency.
b. Competency, but not insanity, concerns persons accused of a crime.
c. Someone found competent to stand trial cannot also be found insane.
d. Insanity and competency concern different points in time during which the person's
mental state is being questioned.
Answer: D Type: Factual Page: 573
28. You are an attorney appointed to represent a poor client accused of rape who has a
history of mental illness. During your first several meetings, the man is completely
incoherent. Which of the following issues should you address first?
a. competency to stand trial
b. possibility of mens rea
c. a possible insanity defense
d. possible civil commitment
Answer:AType:Applied Page: 573
29. The difference between “insanity” and “competency” is that insanity
a. involves a person’s state at the time of the crime.
b. is a legal, not a mental health, category
c. has less serious consequences.
d. criteria are more clear cut.
Answer:AType: Factual Page: 573
30. Simon has been diagnosed with schizophrenia, paranoid type. He is accused of
murder, and his lawyers have suggested that he is not competent to stand trial. He is then
administered Haldol, and his symptoms remit significantly, and he stops experiencing
paranoid ideas and delusions. What is likely to happen next?
a. He would continue to be considered incompetent to stand trial as the medication
produced the effects.
b. He would not be tried in court.
c. His lawyers would have to reconsider their insanity defense.
d. He would be considered competent to stand trial.
Answer: D Type:Applied Page: 573-574
31. The competency to stand trial issue is based on the basic legal principle
a. that trials should not occur without the accused being present. b. that mentally ill persons may not be responsible for their crimes.
c. of innocent until proven guilty.
d. of free will and the knowledge of right and wrong.
Answer:AType: Factual Page: 574
32. Roger stole a watch from a store. His attorney proposed that Roger was incompetent
to stand trial because of his mental condition (schizophrenia), and both the judge and
prosecuting attorney agreed with this evaluation following testimony from several
psychiatrists. What will happen to Roger?
a. He will be found not guilty by reason of insanity and committed to a prison hospital
until he is judged to be sane.
b. He will be found not guilty by reason of insanity and committed to a prison hospital
until he is judged to be no longer dangerous.
c. He will be committed to a prison hospital, and his trial will be postponed until Roger is
judged to be competent.
d. He will be allowed to remain free in the community, but under observation, until he is
judged to be competent.
Answer: C Type:Applied Page: 573
33. When someone is determined incompetent to stand trial, what typically happens to
a. They are released.
b. They are treated and then tried for the original crime.
c. They are treated and then released.
d. They are treated while serving time in prison for the crime.
Answer: B Type: Factual Page: 575
34. In the Jackson v. Indiana case, it was decided that a person judged incompetent to
stand trial could be committed to a prison hospital
a. for an indeterminate period, as long as the accused is still considered a danger to
b. for an indeterminate period, as long as the accused is still judged to be insane.
c. only until it is determined whether or not the accused will ever become competent.
d. only if the competence of the accused is dependent on medication ("synthetic sanity.")
Answer: C Type: Factual Page: 575
35. Corey has been remanded to a psychiatric hospital to determine if he is competent to
stand trial. He has been diagnosed with schizophrenia and is responding well to
treatment with psychotropic medications. He is less delusional and his speech is more organized. Based on this, he is deemed competent and is scheduled to stand trial. This is
an example of
a. synthetic sanity.
b. being guilty but mentally ill.
d. temporary insanity.
Answer:AType:Applied Page: 575
36. What is "synthetic sanity?"
a. Faking of sanity by a deranged person.
b. Sanity measured only by psychological tests.
c. Sanity induced by psychotropic drugs.
d. Appearance of sanity under courtroom stress.
Answer: C Type: Factual Page: 575
37. Brian has been diagnosed with schizophrenia. He is accused of stealing from a
jewelry store and is currently being treated in a psychiatric hospital to assess his
competency. Which of the following are correct regarding Brain’s situation?
a. Brian cannot be forced to take Haldol, an antipsychotic medication.
b. Brian can be deemed competent even if his competency is the result of medication
c. The effects of Brian’s current antipsychotic medications can be explained to the jury.
d. All of the above are correct.
Answer: D Type:Applied Page: 575
38. The prosecution and defense in the trial ofAndrea Yates agreed
a. that she knew right from wrong.
b. she was not mentally ill at the time of the murders.
c. that she killed her children.
d. All of the above are correct.
Answer: C Type: Factual Page: 576: Focus on Discovery 17.2
39. The trial ofAndrea Yates caused great public debate because
a. the jury found her to be sane.
b. the jury found her to be insane.
c. the defense tried to use the rarely accepted “guilty by reason of insanity” defense.
d. she was taking care of her children while diagnosed with schizophrenia. Answer:AType:Applied Page: 576: Focus on Discovery 17.2
40. Saks' argument about dissociative identity disorder as an insanity defense is that
a. the body who commits the crime should be held responsible, regardless of whether the
"person" was conscious of the crime being committed.
b. the person, not the body, is responsible for a crime.
c. dissociative identity disorder is usually faked by criminals pleading insanity and thus
should not be an allowable defense.
d. since therapy for dissociative identity disorder is not usually effective, confinement to
a prison mental hospital is illogical.
Answer: B Type: Factual Page: 578: Focus on Discovery 17.3
41. Most states hold that a person can be involuntarily committed to a mental hospital
a. if found to be mentally ill.
b. if found to be mentally ill and dangerous.
c. only if he or she has committed a crime.
d. only if he or she has committed a violent crime.
Answer: B Type: Factual Page: 580
42. Despite her objections, the police took Elizabeth directly to a mental hospital after
they found her in an obviously deranged state attempting to kill herself. What is the
procedure the doctors used to keep her in the hospital after she arrived?
a. voluntary commitment
b. criminal commitment
c. formal commitment
Answer: D Type: Applied Page: 580
43. An "informal civil commitment"
a. applies only if there is no imminent danger.
b. can be used only if the person agrees.
c. is a short-term emergency procedure that can be accomplished without involving the
d. requires a court order.
Answer: C Type: Factual Page: 580
44. Which of the following statements are true regarding violence and the mentally ill? a. Nearly 25% of the violence in the United States is linked to mental illness.
b. 90% of psychotic patients are non-violent.
c. People with mental illnesses who are violent typically lash out in crowded public
d. None of the above are true.
Answer: B Type: Factual Page: 581
45. Which of the following statements are TRUE regarding the relationship between
mental illness and dangerousness?
a. Most mentally ill people are violent at some point during their illness.
b. More crimes are committed by mentally ill people than any other group.
c.Among mentally ill people, violence is most common among those with schizophrenia.
d. Substance abusers are much more likely to commit crimes than people with mental
Answer: D Type:Applied Page: 581
46. Mr. J. stood near an elementary school with a loaded gun, staring at the children and
teachers, every day for a week. Could he be incarcerated, even though he had a license
for the gun and had not been seen committing a crime?
a. Yes, since he is clearly a danger to others.
b. Yes, but only if he is found to have a prior record of criminal activity.
c. Yes, but only if he is judged to b