VISUM ET REPERTUM PSIKIATRIKUM

H.SOEWADI

BAGIAN ILMU KEDOKTERAN JIWA

FAKULTAS KEDOKTERAN UGM/
RSUP DR. SARDJITO
YOGYAKARTA
2011
PSYCHIATRY

THE MEDICAL SPECIALTY CONCERNED WITH THE

STUDY, DIAGNOSIS, TREATMENT, AND
PREVENTION OF BEHAVIOR DISORDERS OR
MENTAL DISORDERS

PSYCHIATRIST IS :
A PHYSICIAN WHO HAS HAD ADVANCED
TRAINING IN THE DIAGNOSIS AND TREATMENT
OF MENTAL DISORDERS
 Frequently Asked Questions
About Forensic Psychiatry
What is forensic psychiatry?
What is a forensic psychiatrist?
Is a forensic psychiatrist the same thing as a forensic psychologist?
How is forensic psychiatry useful to the legal process?
Are forensic psychiatrists "advocates" for one side or the other in legal
matters?
Why does there always seem to be a psychiatrist (or other professional)
willing to testify on either side of a trial?
Doesnt the expert have an incentive to agree with the lawyer, so he or
she can testify and make money?
Why cant we just let the experts testify without being paid by one side or
the other?
Doesnt the lawyer always want to retain experts who agree with his or
her side of the case?
How are forensic psychiatrists paid?
Are there professional ethics to which forensic psychiatrists are expected
to adhere?
 What is forensic psychiatry?
Forensic psychiatry is a branch of medicine which focuses on the
interface of law and mental health.
It may include psychiatric consultation in a wide variety of legal
matters (sometimes with expert testimony), as well as clinical work
with perpetrators and victims.
This focuses on forensic work with attorneys, courts, or other
parties involved in actual or potential litigation (going to court in a
civil or criminal matter).
Incidentally, a few readers may confuse forensic psychiatry with
forensic pathology.
Forensic pathologists (one kind at least) are the physicians who
perform autopsies, a different medical specialty altogether.
So don't ask me (as a few people actually have), "how do you do
psychiatry on dead people." :-)
 What is a forensic psychiatrist?
A psychiatrist is a medical doctor (M.D.)
who has completed several years of
additional training in the understanding,
diagnosis, and treatment of mental
disorders.
A forensic psychiatrist is a psychiatrist
who has additional training and/or
experience related to the various
interfaces of mental health (or mental
illness) with the law.
FORENSIC PSYCHIATRY IS
IMPORTANT
ABOUT 30 % OF MEN IN PRISON HAVE
A PSYCHIATRIC DISORDER OF A SEVERITY
REQUIRING TREATMENT
THE COMMONEST DIAGNOSES ARE
SOCIOPATHY AND ALCOHOLISM;
THERE IS ALSO AN EXCESS OF MENTAL
SUBNORMALITY , FUNCTIONAL PSYCHOSIS,
ORGANIC BRAIN DISEASE, AND EPILEPSY
AMONG PRISONERS.
HOWEVER , SOCIAL AND CULTURAL FACTORS
ARE MORE IMPORTANT THAN PSYCHIATRIC
ILLNESS IN CAUSING CRIME
FORENSIC PSYCHIATRY IS
IMPORTANT
MALE PRISONERS OUTNUMBER FEMALE ONES
30-FOLDS
CULTURAL FACTORS PROBABLY ACCOUNT FOR
MOST OF THIS DISCREPANCY, BUT THE
INCREASED FREQUENCY OF CRIMINAL
BEHAVIOUR AMONG MEN WITH THE XYY
GENOTYPE SUGGESTS THAT BIOLOGICAL
FACTORS ALSO CONTRIBUTE
FEMALE PRISONERS HAVE MORE MENTAL AND
PHYSICAL DISEASE THAN MALE ONES
 MURDER
THERE ARE 400-500 MURDERS PER YEAR
IN ENGLAND AND WALES ,
IN 75 % OF CASES THE VICTIM IS WELL
KNOWN TO THE MURDERER, MOST OFTEN
THE SPOUSE.
ABOUT 50 % OF MURDERERS HAVE
A SERIOUS PSYCHIATRIC ABNORMALITY
MANY COMMIT SUICIDE AFTER THEIR
CRIME
THE MAIN PSYCHIATRIC CONDITIONS
WHICH CAN LEAD TO MURDER ARE :

1. PSYCHOSES : A SEVERELY DERPESSED

PERSON MAY MURDER CHILDREN OR OTHER
RELATIVES BECAUSE OF A DELUSION THAT
THEY ARE GOING TO SUFFER A WORSE FATE.
2. SCHIZOPHRENICS MAY COMMIT MURDER
UNDER THE INFLUENCES OF PARANOID
DELUSIONS.
3. PUERPERAL PSYCHOSIS ACCOUNTS FOR
SOME, BUT NOT ALL, CASES OF
INFANTICIDE.
4. SOCIOPATHIC PERSONALITY DISORDER
5. DRUG-INDUCED STATES
 THE MAIN PSYCHIATRIC CONDITIONS
WHICH CAN LEAD TO MURDER ARE :
MORBID JEALOUSY
MENTAL HANDICAP , IN WHICH
FRUSTRATION MAY BE
EXPRESSED BY VIOLENCE
EPILEPTIC AUTOMATISM : THIS IS A RARE
CAUSE , AND THERE IS NO SIGNIFICANT
ASSOCIATION BETWEEN MURDER AND EPILEPSY
 ABNORMAL EEG
ABOUT75 % OF
MURDERERS WHOSE
CRIME WAS APPARENTLY
MOTIVELESS HAVE AN
ABNORMAL EEG
 Roles and Responsibilities of
Forensic Psychiatrists
To describe the mental attributes,
define the issues (criminal, civil),
answer legal questions (consultation).
Source of information: defined in state
laws, cases, books.
Provide the court with information
based on knowledge, research, and
training.
PERAN PSIKIATRI
DALAM HUKUM

MEMBANTU LEMBAGA PERADILAN DALAM MENENTUKAN

KONDISI KESEHATAN MENTAL SESEORANG
MEMBUAT VISUM ET REPERTUM PSIKIATRIKUM
MEMBUAT SURAT KETERANGAN KESEHATAN JIWA
SEBAGAI SAKSI AHLI DALAM PERADILAN
MEMBERIKAN INFORMASI PADA MASYARAKAT LUAS
TENTANG PENTINGNYA PEMERIKSAAN PSIKIATRIK
MEMBANTU PERLINDUNGAN PENGOBATAN DAN
PERAWATAN PENDERITA GANGGUAN JIWA
Forensic Psychiatry
Is a general term that denotes the interface
between law and psychiatry.
The field of forensic psychiatry:
the psychiatric expert witness
criminal law and psychiatry
insanity
the guilty but mentally ill offender
diminished capacity
competency to stand trial
involuntary hospitalization and conservatorship
the right of patients, informed consent
the right to treatment and the right to refuse treatment
confidentiality and privileged communication
 Criteria for Commitment
Mental illness
Impaired capacity and competency to
make treatment decisions.
Danger to others
Danger to self
Inability to care for self
Need for treatment
Least restrictive alternative
 The Concept of Criminal
Responsibility
In order to be guilty of an offense, it is
necessary for the prosecution to prove
all the required elements of the charge
to the required standard of proof.
This standard is proof beyond all
reasonable doubt.
The prosecution must prove not only
that the accused committed the act
described, but also had the required
state of mind or mens rea.
 The Insanity Defense
Refers to mental state at the time of
crime.
Not Guilty by Reason of Insanity is a
legal argument that a defendant should
not be held responsible for an illegal act.
It applies if the act is attributable to a
mental illness that interferes with
rationality or that results from some other
excusing condition, such as not knowing
right from wrong.
 The Insanity Defense
Criminal law rests on the assumption that
people have free will and that if they do
wrong, they have chosen to do so, are
blameworthy, and should therefore be
punished.
The insanity defense applies to individuals
who are assumed to have less free will, or
responsibility for their actions, because of
a mental defect.
Legal Precedents/Considerations
in the Insanity Defense
M'Naghten Test: Did the person know right
from wrong?
Applies if reasoning was so defective that
the person didnt know what she or he
was doing, or if she or he was unable to
comprehend that the act was wrong.
Problems: Just cognitivefails to take
emotional, volitional factors into account.
 Competency to Stand Trial
Refers to mental state after arrest/before
trial.
Does the defendant have a factual
understanding of the proceedings?
Rational understanding of the
proceedings.
Can the defendant rationally consult with
counsel in presenting his or her own
defense.
 Informed Consent
Defined by willing acceptance of a medical
intervention by a patient after discussion with
a physician about the nature of intervention,
indications, risks, benefits, and potential
alternatives (including no treatment).
Exceptions include: Consent is implied when
emergency treatment is required, consent can
be obtained form a surrogate decision maker
when patients lack decision-making capacity.
Patients who sign waivers to the right of
informed consent.
 Competency and Decision-
Making Capacity
Competence is a legal term referring to a
patients authority to make personal and medical
choices.
Decision-making capacity is a medical term
referring to a patients capacity to accept or
refuse treatment.
All competent patients have the right to refuse or
discontinue treatment as long as this will not
harm other parties (e.g. Jehovahs Witnesses can
refuse blood products).
An incompetent or decisionally incapacitated
(intoxicated, altered mental status) cannot refuse
treatment
 Minors
Parental consent is not required if
minors requested treatment for
pregnancy, STDs, or substance abuse
and emancipated minors.
Consent is implied in life threatening
situations when parents cannot be
contacted.
 UNFIT TO PLEAD
LESS OFTEN, A MENTALLY
ABNORMAL OFFENDER ACCUSED
OF MURDER OR OTHER SERIOUS
CRIME IS FOUND UNFIT TO
PLEAD, AND IS SENT DIRECTLY TO
A PSYCHIATRIC HOSPITAL.
IF HE RECOVERS HE MAY BE
REQUIRED TO STAND TRIAL
 UNFIT TO PLEAD
THE GROUNDS FOR BEING UNFIT TO
PLEAD, ARE : INABILITY
TO INSTRUCT COUNSEL,
TO APPRECIATE THE SIGNIFICANCE OF
PLEADING,
TO CHALLENGE A JUROR,
TO EXAMINE A WITNESS, OR
TO UNDERSTAND THE EVIDENCE OR
COURT PROCEDURE
 PLEA IN MURDER
A RARE PLEA IN MURDER
CASES IS NOT GUILTY BY
REASON OF INSANITY, WHEN
THE OFFENDER FULFILS THE
MCNAUGHTEN RULES , THAT IS
HE EITHER DID NOT KNOW
THE NATURE AND QUALITY OF
HIS ACT, OR DID NOT KNOW
THAT IT WAS WRONG
 PLEA IN MURDER
A DELUDED PATIENT IS ASSUMED TO BE
UNDER THE SAME DEGREE OF
RESPONSIBILITY AS HE WOULD BE IF
THE DELUSIONS WERE TRUE.
IF THIS PLEA IS SUCCESFUL, THE
ACCUSED IS SENT TO A SPECIAL
HOSPITAL
ABOUT HALF THOSE ACCUSED OF MURDER
CLAIM AMNESIA FOR THE EVENT, BUT
THIS IS NOT AN ADEQUATE DEFENSE ,
NOR IS DRUNKENNESS
 PSIKIATRI FORENSIK ADALAH CABANG
ILMU KEDOKTERAN JIWA YANG
MEMPUNYAI FUNGSI FORENSIK
PSIKIATRI FORENSIK BIDANG PSIKIATRI
YANG MEMPELAJARI ASPEK HUKUM
MENGENAI GANGGUAN JIWA YANG
MENUNJUKKAN PENYIMPANGAN SOSIAL
PSIKIATRI FORENSIK ADALAH BIDANG
PSIKIATRI YG DIGUNAKAN UNTUK
KEPERLUAN HUKUM ATAU PERADILAN
VISUM ET REPERTUM PSIKIATRIKUM
MASUK DALAM LINGKUP PSIKIATRI
FORENSIK
 RUANG LINGKUP PSIKIATRI
FORENSIK
PERKARA PERDATA
PERKARA PIDANA
UU YANG BERKAITAN DG PSIKIATRI FORENSIK
CHILD ABUSE
KEKERASAN DALAM RUMAH TANGGA
HAK-HAK SESEORANG UNTUK MENDAPATKAN PEMERIKSAAN
PSIKIATRIK
PEMERIKSAAN PSIKIATRIK SEBELUM SIDANG PENGADILAN
MEMBUAT VISUM ET REPERTUM PSIKIATRIKUM
MEMBUAT SURAT KETERANGAN GANGGUAN JIWA
VANDALISME
HUKUMAN MATI
PENENTUAN KEMAMPUAN MELANJUTKAN STUDI/KERJA
ETIKA PSIKIATRI
PENENTUAN JENIS KELAMIN
Criminal Responsibility

It is established principle of English law that man is

responsible for his own actions-that is to say that
he intends their result
Therefore is follows that in the eyes of the law he
must bear the responsibility for them
In the case of serious offences, responsibility is the
more likely to be questioned
In the case of an individual suffering from mental
illness committing a crime, it has been for many
years argued that the mans state of mind must
impair his responsibility for his acts.
Test of Insanity

This has, however , not been easy to establish in a

court of law since the law assumes everyone is
sane , and insanity has to be proven
Since the law assumes everyone is sane , and
insanity has to be proven
Since 1843 the courts have used the
MacNaughten Rules as a test of insanity .
MacNaughten Rules

These rules arose following the trial for

murder of Daniel MacNaughten who killed
Sir Robert Peels private secretary
MacNaughten had paranoid delusions and
was acquitted on the direction of the judge
Subsequently judges formulated the rules
as they have been know ever since, as a of
answers to questions put to them by the
house of lords .
INSANITY STANDARDS
WILD BEAST TEST (REX V. ARNOLD 1724) --
A MAN MUST BE TOTALLY DEPRIVED OF HIS
UNDERSTANDING AND MEMORY SO AS NOT TO
KNOW WHAT HE IS DOING, NO MORE THAN AN
INFANT, A BRUTE, OR A WILD BEAST
IRRESISTIBLE IMPULSE TEST (REGINA V.
OXFORD 1840) - IF SOME CONTROLLING
DISEASE WAS, IN TRUTH, THE ACTING POWER
WITHIN HIM WHICH HE COULD NOT RESIST, THEN
HE WILL NOT BE HELD RESPONSIBLE
INSANITY STANDARDS
McNAUGHTEN RULE (McNAUGHTANS
CASE 1843) -- A MEN TAL DISEASE OR
DEFECT AT THE TIME OF THE ACT WHICH
CAUSED THE DEFENDANT NOT TO KNOW THE
NATURE AND QUALITY OR THE
WRONGFULNESS OF THE ACT
DURHAM RULE (DURHAM V. UNITED
STATE 1954) -- THE ACCUSED IS NOT
CRIMINALLY RESPONSIBLE IF HIS
UNLAWFUL ACT IS THE PRODUCT OF A
MENTAL DISEASE OR DEFECT
INSANITY STANDARDS
MODEL PENAL CODE (AMERICAN LAW
INSTITUTE 1955) -- A PERSON IS NOT
RESPONSIBLE FOR CRIMINAL CONDUCT IF
AT THE TIME OF SUCH CONDUCT, AS A
RESULT OF MENTAL DISEASE OR DEFECT, HE
LACKS SUBSTANTIAL CAPACITY TO
APPRECIATE THE WRONGFULNESS OF HIS
CONDUCT (COGNITIVE ARM) OR TO
CONFORM HIS CONDUCT TO THE
REQUIREMENTS OF THE LAW (VOLITIONAL
ARM)
 Definitions
Mental illness
Disease or condition that either
substantially impacts a persons
thoughts, perception of reality,
emotional process, judgement, or
grossly impairs a persons behavior,
as manifested by recent disturbance
behavior.
List of Items Relevant to Competency to Stand
Trial (Group for the Advancement of
Psychiatry)
Competency to Stand Trial may involve
the ability of a defendant:
1. To understand his current legal situation.
2. To understand the charges against him.
3. To understand the facts relevant to his case.
4. To understand the legal issues and procedures in his
case.
5. To understand legal defenses available in his behalf.
6. To understand the dispositions, pleas, and penalties
possible.
7. To appraise the likely outcomes.
8. To appraise the roles of defense counsel, the prosecuting
attorney, the judge, the jury, the witnesses, and the
defendant.
9. To identify and locate witnesses.
10. To relate to defense counsel.
11. To trust and to communicate relevantly with his counsel.
12. To comprehend instructions and advice.
13. To make decisions after receiving advice.
14. To maintain a collaborative relationship with his attorney
and to help plan legal strategy.
15. To follow testimony for contradictions or errors.
16. To testify relevantly and be cross-examined if necessary.
17. To challenge prosecution witnesses.
18. To tolerate stress at the trial and while awaiting trial.
19. To refrain from irrational and unmanageable behavior during
the trial.
20. To disclose pertinent facts surrounding the alleged offense.
21. To protect himself and to utilize the legal safeguards
available to him.
COMMON REASONS FOR
INCOMPETENCE TO STAND TRIAL

PARANOID DELUSIONS THAT IMPAIR THE DEFENDANTS

ABILITY TO WORK WITH DEFENSE COUNSEL
DISORGANIZED THINKING THAT IMPAIRS THE
DEFENDANTS CONCENTRATION AND ATTENTION
IRRATIONAL DECISION MAKING ABOUT THE DEFENSEAS
THE RESULT OF DELUSIONS, DISORGANIZED THINKING,
LOW INTELLECT, OR DEMENTIA
HALLUCINATIONS THAT DISTRACT THE DEFENDANT FROM
ATTENDING TO THE TRIAL
COMMON ERRORS IN COMPETENCY AND
SANITY EVALUATIONS

EQUATING PSYCHOSIS WITH INCOMPETENCE TO STAND

TRIAL
CONFUSING COMPETENCY TO STANDTRIAL WITH
INSANITY
EQUATING PSYCHOSIS AT THE TIME OF THE ACT WITH
INSANITY
CONCLUSORY REPORTS THAT FAIL TO STATE THE BASIS
FOR THE OPINION
PSYCHODYNAMIC EXPLANATION FOR THE OFFENSE
GIVEN AS AN EXCUSE, RATHER THAN FOCUSING ON THE
LEGAL STANDARD FOR SANITY
 PERKARA PERDATA

KONTRAK PERJANJIAN
PEMBUATAN SURAT WASIAT
KESAKSIAN DI PENGADILAN
KEMAMPUAN MELAKUKAN SEGALA
MACAM URUSAN (KOMPETENSI UMUM)
KETIDAK MAMPUAN SECARA PSIKIATRIK
 PERKARA PIDANA

KEMAMPUAN SEBAGAI TERDAKWA

KEMAMPUAN SEBAGAI TERGUGAT
KEMAMPUAN UNTUK DIHUKUM
KEMAMPUAN UNTUK DIADILI
KEMAMPUAN BERBUAT SECARA
KRIMINAL
GANGGUAN PSIKIATRIK SAAT
MELAKUKAN KEJAHATAN
 UU YG BERKAITAN DG
PSIKIATRI FORENSIK
UU KESWA NO 3 TH 66 TTG KESEHATAN JIWA
PS 1- KESEHATAN JIWA
PS 2- UPAYA PREVENTIF DAN KURATIF
Ps 3- MASA BAYI, ANAK,SEKOLAH
PS 4- PERAWATAN PEND.GG JIWA
PS 5- PER WALIAN
PS6- HAK FEND. DLM PERAWATAN
PS 7- DOKTER YANG MERAWAT
PS 8- MEMBERIKAN KETERANGAN
PS9-16..........................
PS 44 ayat 1 dan 2 KUHP tentang gangguan jiwa
CHILD ABUSE
MENELANTARKAN ANAK
PENYIKSAAN TERHADAP ANAK
KEKERASAN SEKSUAL THD ANAK
AYLA (ANAK YANG DILACURKAN)
EKSPLOITASI ANAK

KEKERASAN DALAM RUMAH TANGGA.

TERHADAP ISTERI/SUAMI
PEMAKSAAN SEKSUAL
ANCAMAN PENELANTARAN
FISIK
MENTAL: .INTIMIDASI
HAK MENDAPAT PEMERIKSAAN PSIKIATRI

HAK PASIEN
MEMILIH DOKTER DAN RUMAH SAKIT

MEMPEROLEH INFORMASI MEDIS TTG DIRINYA

MEMBERIKAN PERSETUJUAN PENGOBATAN

RAHASIA MEDIS

MENERIMA GANTI RUGI

KEWAJIBAN PASIEN
MEMBERIKAN INFORMASI YG SEBENARNYA

MEMATUHI NASIHAT DOKTER

MENJAGA PRIVACY KEDOKTERAN

MEMBERIKAN HONOR YANG PANTAS

VANDALISME
PERILAKU MENYIMPANG PADA SESEORANG YG SUKA
MERUSAK LINGKUNGAN DAN BERTENTANGAN DG
NORMA- NORMA MASYARAKAT YG BERLAKU
PENYIMPANGAN BISA BERUPA LINGKUNGAN FISIK DAN
SEKSUAL

HUKUMAN MATI
SEBELUM HUKUMAN DIJATUHKAN TERSANGKA
MEMPUNYAI HAK TENTANG STATUS PSIKIATRISNYA.

PENENTUAN JENIS KELAMIN

TERUTAMA BERKAITAN DENGAN HAK WARISAN
PERAN PSIKIATRI DALAM HUKUM

MEMBANTU LEMBAGA PERADILAN DALAM

MENENTUKAN KONDISI KESEHATAN MENTAL
SESEORANG
MEMBUAT VISUM ET REPERTUM PSIKIATRIKUM
MEMBUAT SURAT KETERANGAN KESEHATAN JIWA
SEBAGAI SAKSI AHLI DALAM PERADILAN
MEMBERIKAN INFORMASI PADA MASYARAKAT LUAS
TENTANG PENTINGNYA PEMERIKSAAN PSIKIATRIK
MEMBANTU PERLINDUNGAN PENGOBATAN DAN
PERAWATAN PENDERITA GANGGUAN JIWA
 ALAT BUKTI YANG SAH
PASAL 184 KUHAP:
KETERANGAN SAKSI
KETERANGAN AHLI
SURAT
PETUNJUK
KETERANGAN TERDAKWA
 PENGERTIAN SAKSI
PASAL 1 BUTIR 26 KUHAP:
ORG YG DPT MEMBERI KETERANGAN TTG
SUATU PERKARA PIDANA BERDASARKAN APA
YG DILIHAT, DENGAR DAN ALAMI
MENJADI SAKSI ADALAH KEWAJIBAN
HUKUM
UNUS TESTIS NULUS TESTIS
 PENGECUALIAN SAKSI
MEMPUNYAI HUBUNGAN KELUARGA
DENGAN TERDAKWA, KECUALI PASAL
168: BERSEDIA, PERSETUJUAN PU DAN
TERDAKWA
KARENA PEKERJAAN ATAU JABATAN
WAJIB MENYIMPAN RAHASIA (170)
ANAK DI BAWAH UMUR DAN ORG YG
SAKIT INGATAN (171)
 PEMERIKSAAN SAKSI
PERTAMA DIPERIKSA SAKSI KORBAN (PASAL 160 AYAT
1 SUB B)
SAKSI TIDAK BOLEH BERHUBUNGAN SATU SAMA LAIN
(159 AYAT 1)
SAKSI DAPAT DIPANGGIL SECARA PAKSA (159 AYAT 2)
KEWAJIBAN HAKIM UTK MENDENGAR KETERANGAN
SAKSI MERINGANKAN ATAU MEMBERATKAN DALAM BAP
(160 AYAT 1 SUB C)
JUGA SAKSI YG DIAJUKAN SELAMA SIDANG
BERLANGSUNG.
SAKSI HARUS BERSUMPAH DI PERSIDANGAN
 KESAKSIAN
Kesaksian adalah kepastian yang diberikan
kepada Hakim di persidangan tentang
peristiwa yang disengketakan dengan
jalan pemberitahuan secara lisan dan
pribadi oleh orang yang bukan salah satu
pihak dalam perkara, yang dipanggil
dipersidangan.
 KETERANGAN SAKSI
Keterangan saksi harus diberikan secara
pribadi dan lisan di persidangan dan tidak
boleh diwakilkan.
Pendapat atau dugaan khusus yang timbul
karena akal (ratio concludendi) tidak
dianggap sebagai kesaksian (Pasal 171
ayat 2 HIR, 308 ayat 2 RBG, 1907 BW).
 KESAKSIAN DAN GG JIWA
Kesaksian bahwa penggugat atau tergugat
dalam keadaan sedih, mabuk, terganggu
jiwanya tidak boleh diterima sebagai
kesaksian, karena hal tersebut hanya
merupakan kesimpulan atau dugaan saja.
Kesaksian hanya boleh diberikan oleh
orang yang mengetahui dengan mata
kepala sendiri (ratio sciendi).
 Yang tidak dapat didengar sebagai
saksi, adalah :
keluarga sedarah dan keluarga semenda
menurut keturunan yang lurus dari salah satu
pihak
Suami atau istri salah satu pihak, meskipun telah
bercerai
Anak-anak yang umurnya tidak diketahu dengan
benar bahwa mereka sudah lima belas tahun
Orang gila, walaupun kadang- kadang
ingatannya kembali
 HAK PENGADILAN

Pengadilan negeri berhak

mendengarkan diluar sumpah anak-
anak atau orang-orang gila yang
kadang-kadang membaik
ingatannya.

Akan tetapi keterangan mereka

hanya dipakai sebagai penjelasan
saja.
 Competency of a witness
The court listed several factors in its decision not
to testify :
1. Protection of the witnesss privacy interest
2. Potential for harassment of witness
3. The possibility that a mental exam will hamper
law enforcement by dettering potential to
come forward
4. Whether the witness was a key to the case
5. Whether there are substansial indications that
witness is suffering from a mental abnormality
at the time of trial
 The Expert Witness
The role of expert psychiatric witness most
closely resembles that of a consultant who is
providing teaching or education.
The consultation also draws on the witnesss
skill as teacher and in trial teaches the jury
Often the task of forensic psychiatrist is best
understood as a translation process, bridging
two disparate realms of discourse, pstchiatry
and law
Simon & Gold,2006
 KETERANGAN AHLI
PASAL 1 BUTIR 28 KUHAP:
KETERANGAN YG DIBERIKAN SEORANG AHLI YG
MEMILIKI KEAHLIAN KHUSUS TENTANG HAL YG
DIPERLUKAN UTK MEMBUAT TERANG SUATU
PERKARA PIDANA
PASAL 186 KUHAP:
APA YANG SEORANG AHLI NYATAKAN DI SIDANG
PENGADILAN
PASAL 120 KUHAP:
KETERANGAN SEORANG AHLI YG MEMILIKI
KEAHLIAN KHUSUS TENTANG SESUATU HAL
BERUPA KETERANGAN MENURUT PENGETAHUANNYA
 KETERANGAN AHLI
PASAL 179 KUHAP:
DOKTER FORENSIK DAN DOKTER
AHLI LAINNYA
SIFAT KETERANGAN AHLI:
KETERANGAN AHLI (DI DEPAN SIDANG)
SURAT ( LAPORAN TERTULIS YG DIMINTA
PENYIDIK) PASAL 186, 187 HURUF C KUHAP.
 ALAT BUKTI SURAT
PASAL 187 KUHAP:
SURAT DIBUAT ATAS SUMPAH JABATAN
SURAT YG DIKUATKAN DENGAN SUMPAH
BENTUK-BENTUK SURAT:
BERITA ACARA DAN SURAT RESMI YG DIBUAT
PEJABAT UMUM (AKTA NOTARIS, PPAT)
SURAT DALAM BENTUK DIATUR UU,AKTA
KELAHIRAN, KTP, IMB, DLL
SURAT KETERANGAN DARI AHLI
SURAT LAIN YG HANYA BERLAKU JIKA ISINYA ADA
HUBUNGAN DGN ALAT BUKTI LAIN
 Keterangan Ahli
adalah keterangan pihak ketiga yang objektif dan
bertujuan untuk membantu hakim dalam pemeriksaan
guna menambah pengetahuan hakim sendiri.

Pada umumnya hakim menggunakan keterangan

seorang ahli agar memperoleh pengetahuan yang lebih
mendalam tentang sesuatu yang hanya dimiliki oleh
seorang ahli tertentu, misalnya tentang hal-hal yang
bersifat tekhnis, dsb.

Keterangan ahli diatur dalam pasal 154 HIR, 181 RBG,

215 RV.
 Perbedaan saksi dan saksi ahli :

kedudukan seorang ahli dapat diganti

dengan ahli lain untuk memberi
pendapatnya.
Sedangkan saksi pada umumnya tidak,
karena saksi tidak dapat digantikan
dengan orang lain.
Jika dalam saksi biasa ada asas satu saksi
bukan saksi (unus testis nullus testis )
maka tidak demikian dengan saksi ahli.
 Seorang ahli pada umumnya
mempunyai keahlian tertentu
yang berhubungan dengan
peristiwa yang disengketakan,
sedangkan saksi untuk peristiwa
yang bersangkutan tidak
diperlukan mempunyai keahlian.
 Seorang saksi memberikan
keterangan atas apa yang
dialaminya sendiri sebelum
terjadi proses, sedang ahli
memberikan pendapat atau
kesimpulannya tentang suatu
peristiwa yang dipersengketakan
selama terjadinya proses.
 Saksi harus memberikan
keterangan secara lisan,
keterangan saksi yang ditulis
merupakan alat bukti tertulis,
sedang keterangan ahli yang
ditulis tidak termasuk dalam alat
bukti tertulis
 Hakim terikat untuk
mendengar saksi yang akan
memberikan keterangan
tentang peristiwa yang
relevant, sedangkan
mengenai ahli, hakim bebas
untuk mendengar atau tidak.
 Sebagaimana dalam pasal 338 Kitab Undang-
Undang Hukum Pidana (KUHP) berbunyi:
Barangsiapa sengaja merampas nyawa orang
lain, diancam, karena pembunnuhan, dengan
pidana penjara paling lama lima belas tahun.
Dan pasal 340 KUHP berbunyi: Barangsiapa
sengaja dan dengan rencana lebih dahulu
merampas nyawa orang lain, diancam, karena
pembunuhan dengan rencana (moord), dengan
pidana mati atau pidana penjara seumur hidup
atau selama waktu tertentu, paling lam dua
puluh tahun.
 Namun, tidak semua delik pembunuhan
dapat dipidana, baik dengan
menggunakan ketentuan KUHP maupun
undang-undang lainnya.
Pembunuhan yang dilakukan baik secara
sengaja, kealpaan, maupun percobaan
dapat dipidana.
sedangkan pembunuhan yang dilakukan
karena cacatnya jiwa atau terganggu
karena penyakit, tidak dapat dipidana.
(pasal 44 (1) KUHP)
 Hal hal yang menghapuskan
pengenaan pidana dalam KUHP
Karena tak mampu bertanggung jawab. Dalam pasal 44
(1) KUHP menyatakan bahwa:
Barangsiapa melakukan perbuatan yang tidak dapat
dipertanggungjawabkan padanya, disebabkan karena
jiwanya cacat dalam tumbuhnya (gebrekkige
ontwikkeling) atau terganggu karena penyakit (ziekelijke
storing), tidak dipidana. Dan ayat ke - (2) menyatakan:
jika ternyata bahwa perbuatan tidak dapat
dipertanggungjawabkan padanya disebabkan karena
jiwanya cacat dalam tumbuhnya atau karena gangguan
penyakit, maka hakim dapat memerintahkan supaya
orang itu dimasukkan ke dalam rumah sakit jiwa, paling
lama satu tahun sebagai waktu percobaan.
Pembelaan terpaksa.
Yaitu keadaan dimana orang melakukan
perbuatan yang dilarang oleh hukum
karena adanya ancaman yang serius yang
dapat membahayakan dirinya maupun
orang lain, terhadap kehormatan
kesusilaan atau harta benda sendiri
maupun orang lain.
Dilakukan karena melaksanakan perintah
undang - undang.
Misalnya: eksekutor tembakan mati.[4]
 Cara untuk membuktikan bahwa
seseorang telah melakukan pembunuhan
dalam keadaan tidur / sleep walking
murder adalah dengan melakukan
sejumlah pemeriksaan medik yang
dilakukan oleh orang yang ahli dibidang
kejiwaan dan kelainan tidur serta dilihat
juga sejarah dari sipelaku, apakah
memang benar bahwa dia memiliki
riwayat tidur sambil berjalan / sleep
walking.
 Untuk menyelesaikan kasus sleep walking
murder jika terjadi di Indoneisa adalah dengan
melakukan pemeriksaan kejiwaannya.
Namun sebelumnya petugas, dalam hal ini polisi
selaku penyelidik dan penyidik harus bisa tetap
menggunakan ketentuan tentang pembunuhan
yang biasanya digunakan, seperti pasal 338 dan
340 KUHP.
Hakim jika memutuskan untuk membebaskan
tedakwa, maka dia harus menganalogi pasal
44(1) dengan kelainan tidur, sehingga sipelaku
dapat dibebaskan
 Perintah/tindakan hakim
Tindakan yang harus dilakukan agar sipelaku
tidak menimbulkan peristiwa yang sama jika dia
dibebaskan kedalam lingkungan sosialnya, maka
hakim dapat memerintahkan agar sebelum
pelaku dikembalikan ke lingkungan sosialnya,
agar pelakudiisolasi terlebih dahulu di rumah
sakit atau suatu tempat yang dapat memulihkan
/ menyembuhkan pelaku dari kelainanya
tersebut

 Istilah-istilah Gangguan Jiwa

Mental disorder Psychopathic
Mental sickness Psychological
Mental impairment (p. abnormality
253) Insanity
Mental illness Psychiatric illness
Mental defectiveness Psychiatric
Mental retardation abnormality
Mental disease
Mental dysfunction
 MACAM GANGGUAN JIWA

PSIKOTIK
GANGGUAN KEPRIBADIAN
RETARDASI MENTAL
CULTURE BOUND PHENOMEN
EPILEPSI
SUBSTANCE ABUSE
DEVIASI SEKSUAL
GANGGUAN PENGENDALIAN IMPULS
GANGGUAN MENTAL ORGANIK
HISTERI KONVERSI
 Gangguan kejiwaan khusus
Schizophrenic tinggi ; menyumbang pada
kekerasan dengan mutilasi dan serial;
perbedaan agresivitas antara paranoid dan non-
paranoid
Affective psychosis rendah ; depresi
diasosiasikan dengan pembunuhan oleh wanita.
Mental retardation;
Post-traumatic stress disorder
Psychopathic
DEFINISI V. ET R. PSIKIATRIKUM

SURAT KETERANGAN SEORANG DOKTER AHLI

ILMU KEDOKTERAN JIWA SEBAGAI HASIL
PEMERIKSAAN, OBSERVASI, DAN PENILAIAN
YANG MENDALAM TERHADAP SESEORANG
TERSANGKA ATAU TERDAKWA ATAU SEORANG
YANG BERSENGKETA DALAM SUATU PERKARA
ATAU PERISTIWA HUKUM YANG DIBUAT ATAS
PERMINTAAN RESMI GUNA KEPENTINGAN
PERADILAN DAN DIBUAT BERDASARKAN
SUMPAH DOKTER
 TUJUAN DAN KEDUDUKAN
V.ET R. PSIKIATRIKUM
TUJUAN
MENENTUKAN ADA/TIDAKNYA
GANGGUAN JIWA
ADA/TIDAKNYA HUBUNGAN GANGGUAN
JIWA DENGAN PERILAKU YANG
MELIBATKAN PERISTIWA HUKUM
MENENTUKAN KEMAMPUAN TANGGUNG
JAWAB TERPERIKSA ATAU TERSANGKA
 KEDUDUKAN

SEBAGAI DOKUMEN MEDIK YANG

DAPAT DIGUNAKAN DALAM
PENENTUAN HUKUM BAGI
TERSANGKA
SEBAGAI ALAT BUKTI DALAM
PERADILAN
MEWAKILI SAKSI AHLI
 FUNGSI V.ET R. PSIKIATRIKUM
MEMBANTU PERADILAN DLM MENILAI
PENENTUAN SEORANG
DEWASA HARUS DIMASUKKAN DIBAWAH
PENGAMPUAN ATAU KURATELE
PENENTUAN SEORANG MEMILIKI
KECERDASAN UNTUK MEMBUAT ATAU
MENARIK KEMBALI WASIATNYA
MENENTUKAN PERJANJIAN DAPAT
DIBATALKAN
MENENTUKAN TENTANG PERKARA GUGAT
CERAI DAPAT DILANJUTKAN ATAU TIDAK
 LANDASAN PSIKODINAMIKA
BAHWA PENDERITA GANGGUAN JIWA
MENGALAMI INKOMPETENSI SHG IA TIDAK
MAMPU UNTUK MEMPERTANGGUNG JAWABKAN
PERBUATANNYA
KARENA ADANYA KEKURANGAN KEMAMPUAN
MENILAI DIRI SHG DAPAT MENIMBULKAN
DEVIASI/PELANGGARAN HUKUM
KETIDAK MAMPUAN DLM MEMBERIKAN KESAKSIAN
KEHILANGAN HAK DLM PENGURUSAN PERKARA
PERDATA/PIDANA
TERJADINYA MALPRAKTIS (O.K. WAHAM)
TUNTUTAN UTK DIAJUKAN KE PENGADILAN
KEHARUSAN HOSPITALISASI
 TATALAKSANA PEMBUATAN
V.ET R. PSIKIATRIKUM

PEMOHON
PEMBUATAN
PROSES PEMERIKASAAN UNTUK
PEMBUATAN V.ET R.
PENGIRIMAN
BIAYA (PS 18 AYAT 2)
DASAR HUKUM PEMBUATAN
 PRACTICE GUIDELINES

IN ASSESSING COMPETENCY TO STAND TRIAL,

FOCUS ON DEFENDANTS PRESENT MENTAL
FUNCTIONING
IN EVALUATING SANITY, FOCUS ON THE
DEFENDANTS MENTAL STATE AT THE TIME OF THE
OFFENSE
ASSESS THE IMPACT OF THE DEFENDANTS
MENTAL ILLNESS ON THE AREAS OF FUNCTIONING
ADDRESSED BY THE COMPE-TENCY AND SANITY
STANDARDS
 PRACTICE GUIDELINES

A DEFENDANT MAY BE SERIOUSLY MENTALLY ILL

BUT STILL BE COMPETENT TO STAND TRIAL OR
LEGALLY SANE
THE CRITICAL ISSUE IS THE IMPACT OF THE
DEFENDANTS MENTAL ILLNESS ON THE AREAS OF
FUNCTIONING ADDRESSED BY THE COMPETENCY
AND SANITY STANDARDS.
 PRACTICE GUIDELINES

GENERAL PSYCHIATRISTS WHO AGREE TO PERFORM A

COMPETENCY OR SANITY EVALUATION MUST KEEP IN MIND
THAT THEIR OPINION WILL BE HIGHLY INFLUENTIAL WITH
THE COURT AND WILL CARRY SERIOUS CON- SEQUENCES.
FORENSIC PSYCHIATRISTS ROUTINELY PERFORM
A COMPETENCY AND SANITY EVALUATION
Fee for testify

The psychiatrist who testifies as an expert in court

or in a deposition or who prepares a report for any
legal purpose is entitled to a reasonable fee.
In all cases it should be understood clearly how
much will be paid, when payment will be made, and
who is responsible for payment.
 ISI V.ET R. PSIKIATRIKUM

IDENTITAS PEMERIKSA
ALASAN PEMBUATAN
IDENTITAS TERPERIKSA
LAPORAN HASIL PEMERIKSAAN
ANAMNESIS
STATUS NT. & NEUROLOGIS
STATUS PSIKIATRIS
PEMERIKSAAN TAMBAHAN
 ISI V.ET R. PSIKIATRIKUM
DIAGNOSIS
NAMA PENYAKIT
FORMULASI DIAGNOSTIK
KESIMPULAN DAN SARAN
DISABILITAS YANG DIDAPAT
PENUTUP
- DEMIKIAN V.ET R. 1141 DIBUAT.....
NAMA TEMPAT PEMBUATAN
TGL BLN TAHUN
TANDA TANGAN PEMERIKSA, NAMA
LENGKAP DAN NIP
 ETIKA PSIKIATRI

PRINSIP ETIKA
HUBUNGAN DOKTER PSIKIATER-PASIEN

PENGAMBILAN KEPUTUSAN PADA

STADIUM TERMINAL
HUBUNGAN DOKTER - DOKTER

HUBUNGAN DOKTER - MASYARAKAT

PENELITIAN DALAM BIDANG PSIKIATRI

 HUBUNGAN DOKTER - PASIEN

MEMULAI DAN MENGHENTIKAN TERAPI

CONFIDENSIALITAS
PERSETUJUAN (INFORMED CONSENT)
MENYIMPAN RAHASIA
KONTAK SEKSUAL
PENETAPAN BIAYA
KONFLIK PERHATIAN