Ethical Dilemma with Treating Unethical Patients

I have been struggling with an ethical dilemma ever since my Level I fieldwork assignment, where I was doing my clinical at an outpatient facility within a hospital located near one of the local jails.

Since this hospital was affiliated with the city, we often got the prisoners that needed occupational therapy at this facility.  If a prisoner is scheduled to come in for an appointment, they are accompanied by two police officers and their hands and feet are both shackled.

As part of our assessments, we typically ask our patients what their own goals are for therapy.   Unfortunately, I had one patient (who had had an ulnar nerve and tendon injury from a knife fight) tell me that his goal for therapy was “to be able to close my hand into a fist so that I can fight again.”

When I hear something like that, I think to myself, “Why do I want to treat this person?  Why do I want to help this person meet his goals?”

This question bothered my enough that I knew right away that I would never want to work with forensic patients.  As an occupational therapist, I know that we have to work with patients to meet their goals and increase their occupational well-being.  But if that involves beating up other people and doing illegal things, how can I, in good faith, treat this type of patient?