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Clinical Judgment and Value Judgment

Moral Foundations of Psychiatric and Legal Determinations of the Status of Homosexuality

  • Chapter
Ethical Practice in Psychiatry and the Law

Part of the book series: Critical Issues in American Psychiatry and the Law ((CIAP,volume 7))

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Abstract

In this chapter I will examine two truly momentous decisions about the status of homosexuality in our society, arrived at by the American Psychiatric Association 15 years ago and by the Supreme Court of the United States just two and one half years ago. The former decision relates to the diagnostic status of homosexuality; the latter to its criminal status. By juxtaposing these two epochal decisions, psychiatric and legal, I will attempt to demonstrate that within both systems value judgments and value-laden policy decisions played a major role and were decisive in reaching a resolution of the disputes over homosexuality. The two decisions which I will discuss are the 1973 decision of the APA’s Board of Trustees to remove homosexuality per se from the diagnostic nomenclature (DSM-II1 at the time) and the 1986 decision of the Supreme Court in Bowers v Hardwick,2 which upheld the constitutionality of Georgia’s sodomy law, thereby refusing to grant constitutional protection to private consensual homosexual acts. In discussing each of these landmark decisions, psychiatric and legal, I will review the process of how these decisions were arrived at, as well as the related scientific and legal conceptions of “Truth.” I will attempt to demonstrate how, within each model of decision making, the “truth” arrived at was determined in large measure by the value judgments and moral sentiments of the decision makers, notwithstanding their ostensible reliance on more objective touchstones consistent with their respective professional methodologies. I will not attempt to deal with the substance of the controversies in any depth. I do not propose, for example, to argue the merits one way or the other as to whether homosexuality should have been removed from the DSM. Instead of rehashing those old arguments, I prefer to focus on the process of decision making that took place and the explanations advanced as the basis for the decisions.

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Author information

Authors and Affiliations

  1. Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York, 10032, USA

    Robert Lloyd Goldstein

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  1. Robert Lloyd Goldstein
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Editor information

Editors and Affiliations

  1. Department of Psychiatry, New York University School of Medicine, 10016, New York, New York, USA

    Richard Rosner M.D. (Clinical Professor, Diplomate, American Board of Forensic Psychiatry and Medical Director) (Clinical Professor, Diplomate, American Board of Forensic Psychiatry and Medical Director)

  2. Forensic Psychiatry Clinic of the New York Criminal and Supreme Courts, 100 Centre Street, 10013, New York, New York, USA

    Richard Rosner M.D. (Clinical Professor, Diplomate, American Board of Forensic Psychiatry and Medical Director) (Clinical Professor, Diplomate, American Board of Forensic Psychiatry and Medical Director)

  3. Department of Mental Health, Mental Retardation, and Alcoholism Services of the City of New York, New York, New York, USA

    Richard Rosner M.D. (Clinical Professor, Diplomate, American Board of Forensic Psychiatry and Medical Director) (Clinical Professor, Diplomate, American Board of Forensic Psychiatry and Medical Director)

  4. Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California at Los Angeles, 90024, Los Angeles, California, USA

    Robert Weinstock M.D. (Associate Clinical Professor, Director, Diplomate, American Board of Forensic Psychiatry) (Associate Clinical Professor, Director, Diplomate, American Board of Forensic Psychiatry)

  5. Forensic and Ethical Consultation, Psychiatry Service, West Los Angeles Veterans Administration Medical Center, 90073, Los Angeles, California, USA

    Robert Weinstock M.D. (Associate Clinical Professor, Director, Diplomate, American Board of Forensic Psychiatry) (Associate Clinical Professor, Director, Diplomate, American Board of Forensic Psychiatry)

  6. Psychiatric Training, Student Psychological Services, University of California, Los Angeles, CA, USA

    Robert Weinstock M.D. (Associate Clinical Professor, Director, Diplomate, American Board of Forensic Psychiatry) (Associate Clinical Professor, Director, Diplomate, American Board of Forensic Psychiatry)

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Goldstein, R.L. (1990). Clinical Judgment and Value Judgment. In: Rosner, R., Weinstock, R. (eds) Ethical Practice in Psychiatry and the Law. Critical Issues in American Psychiatry and the Law, vol 7. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-1663-1_20

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  • DOI: https://doi.org/10.1007/978-1-4899-1663-1_20

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4899-1665-5

  • Online ISBN: 978-1-4899-1663-1

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