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Yıl:2011; Cilt: 4; Sayı: 1>> Özet
Türkiye Klinikleri Psikiyatri Özel Dergisi; 2011;4(1):52-59
Adli Psikiyatrik Uygulamalarda Tanı Geçerliği Kavramı
N Konuk, Z Kökrek, H Karadeniz
İstanbul Üniversitesi İstanbul Tıp Fakültesi Psikiyatri AD, İstanbul
Ülkemizdeki uygulamalarda bilirkişilik yapmak yasal zorunluluktur. Psikiyatri klinisyenleri sıklıkla bir bilirkişilik uygulaması olarak, karşılaştığı olguların cezai ya da hukuki ehliyetinin tesbiti ya da ilgili diğer adli tıbbi konularda kanaat bildirme durumu ile karşılaşırlar. Bu anlamda özel hukuki düzenleme ile kurulmuş Adli Tıp Kurumu ve İhtisas Kurulları ile Gözlem İhtisas Dairesi kanunen farklılaşmış yetki ve yükümlülükleri dışında yapılan işin adli psikiyatrik bilirkişilik olma mahiyeti değişmemektedir. Gerek klinisyenlerin gerekse Adli Tıp Kurumunda görevli üyelerin bildirdikleri kanaatler birbirleri ile çelişebilmekte bu durumda da konu bir üst değerlendirme kurumu olan Adli Tıp Kurumu Genel Kurulunda mütalaa edilmektedir. İşte bu mütalaalar sırasında, günlük klinik pratikte de çok karşılaşılan, iki psikiyatrın bir kanaat üzerinde ittifak etmelerinin güç olduğu yönünde eleştiriler yapılmakta yani ?tanısal güvenirlik?, ?diagnostic reliability? sıkça dile getirilerek sorgulanmaktadır. Hâlbuki daha temel sorunun, klinisyenlerin ihtisas alanları, tecrübeleri, ya da klinikten daha farklı bir ortamda uygulama yapılıyor olması ile ilgili olan güvenirliğin ötesinde, genelde tıpta, özelinde ise psikiyatride tartışılan ?tanı geçerliği? , ?diagnostic validity? kavramı ile ilişkili olduğunu düşünmekteyiz. Tıbbın ne kadarının sanat ne kadarının bilim olduğunun tartışıldığı ortamda derinlemesine bir düşünce üretimi olmaksızın, hele bir de yasal yetki ve sınırlandırmaların tesirinde adli psikiyatrik bilirkişiliğe yapılacak eleştiriler temelsiz kalmaktadır. Bu çerçevede ?hukuk bilimi? de benzer problemden ari olmayıp hüküm inşa etme süreci içinde bir hukukçu da kendi alanında aynı problematikle karşı karşıyadır. Aslen 'a dliyeyi? ve ?tıbbiyeyi? birleştiren 'a dli psikiyatri? basitçe bir uygulama alanları kesişmesi değil, mutlak hakikate ulaşmak gayretinin, asırlar süren bir bilim olma serüveninin, her iki disiplinde ayrı ayrı tezahürüdür. Bu yazıda tanısal geçerlik kavramı çevresinde adli psikiyatride yaşanan süreç gerek hukuk gerekse tıp perspektifinden, metodoloji ve bilim felsefesi bakımından değerlendirilecektir. Tablonun ortaya koyduğumuz biçimi ile adli psikiyatri alanında yaşanan pratik sorunlara da bir bakış açısı sunarak çözümlerine katkıda bulunacağını ummaktayız.
Concept of Diagnostic Validity in Forensic Psychiatric Applications
It is a legal obligation to make expertise in applications in our country. Psychiatric clinicians frequently as an expert witness practice, determine criminal or legal capacity and give their opinion on related forensic medical issues. In this sense, even if the authority and obligations of the Committee of Forensic Medicine, 4th Specialization Board (Forensic Psychiatry) and the Department of Psychiatric Observation which were established by a special legal regulation, have changed, function of making expertise in forensic medical cases continue. If the statements of the clinicians and the Committee of Forensic Medicine are in contradiction than they are discussed in a superior committee, in General Assembly of the Council of Forensic Medicine. In these discussions as a very common fact in daily clinical practice, the difficulty of agreement on a statement for two psychiatrists and ?diagnostic reliability? are the most frequent questioned topics, but we think that the main problem is related with the concept of ?diagnostic validity? discussed in medicine, especially in psychiatry, rather than the diagnostic reliability related with the specialization areas of the clinicians, their experiences and their distance with the clinic applications. In an atmosphere in which it is dicussed if much of medicine is art or science, the criticism of the psychiatric expertness under the influence of legal authority and restriction and without any production of ideas remains very superficial. In this context the science of law also has similar problems that a legal practicioner faces in his area in a progress of establishing statements. In fact forensic psychiatry that combines law and medicine is not just a simple intersection of application areas but the manifestation of an effort for achieving the absolute truth and a centuries-long process of becoming a science in two disciplines seperately. In this article the process of forensic psychiatry will be evaluated around the concept of diagnostic validity, in terms of methodology and phylosophy of science and from the perspective of both law and medicine. We hope that the description that we made will contribute to the solution of practical problems experienced in the field of forensic psychiatry, offering a new perspective.

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