Responsibility, accountability and autonomy as key concepts in forensic psychiatric evaluation: a case report

Forensic psychiatry is a discipline that concerns human behavior and decision-making which encompasses several concepts that are not strictly medical, such as responsibility, autonomy and accountability. The authors analyze the interrelation between these concepts. Such background will guide the case study about a defendant whose psychiatric evaluation revealed a psychological pattern with obsessive-compulsive and also paraphilic traits, both reflecting impulse control disturbance which affected his executive capabilities. Since executive functions are essential to understand social principles and legal standards, the paper discussed the extent to which the psychological pattern described influences the defendant’s (criminal) behavior and compromises his autonomy and therefore his accountability and responsibility. The authors define the dimensions of the concept of accountability and argue that such psychological patterns may impair slightly the agent’s autonomy but not in a way that prevents him recognizing and acting within legal limits.