Ethics in Psychiatry

• Ethics
• deal with the relations between people in different groups
• Often entail balancing rights
• Professional ethics
• Appropriate way to act when in a professional role
• Derive from a combination of morality, social norms, parameters of
relationships people have agreed to have
Basic Ethical Principles
• Autonomy
• Beneficence
• Nonmaleficence
• Justice
Basic Ethical Principles
• Autonomy: protect every person’s rights
• One ought to act in such a way that enables another person to act fully in
accordance with his/her chosen plan.
• Autonomy is present if the person has
• Liberty
• Agency
Basic Ethical Principles
• Beneficence: benefits, happiness
• One ought to provide benefit for others
• Prevent evil or harm
• Remove evil or harm
• Do and promote good
• Weak paternalism
• Strong paternalism
Basic Ethical Principles
• Nonmaleficence: first, do no harm
• One ought not to inflict harm
• Requires intentionally refraining from actions that may cause harm or risks
harm
Basic Ethical Principles
• Justice: distribution of scarce health resources
• One ought to give what is due a person
• Concerned with fair distribution of society’s benefits and burdens
• Necessary because of the inequalities in access to health care, scarce
resources and dramatic increases in costs
Specific Issues
• Sexual boundary violations
• Unethical to engage in sexual relationships with current or former patients,
with patient’s family member
• Nonsexual boundary violations
• Boundary violation is a boundary crossing that is exploitative.
• Violations of confidentiality
• Confidentiality - the physician’s responsibility not to release information
learned in the course of treatment to third parties
• Privilege – patient’s right to prevent disclosure of information from treatment
in judicial hearings
Ethics in Managed Care
• Responsibility to Disclose
• All treatment options should be fully disclosed. Always obtain informed consent for
treatments/procedures.
• Responsibility to Appeal
• Physicians have an ethical obligation to advocate for any care that they believe will
materially benefit their patients, regardless of any allocation guidelines or
gatekeeper derivatives.
• Responsibility to Treat
• The treating physician has sole responsibility to determine what is medically
necessary.
• Responsibility to Cooperate with Utilization Review
• Physician should cooperate with utilization reviewers’ requests for information
Impaired Physicians
• Impaired as a result of:
• psychiatric or medical disorder
• Mind-altering and habit-forming substances
• Incapacitated physician should be reported to an appropriate
authority
• Monitoring progress or fitness to return to work must be done by an
independent physician or group of physicians who have no conflicts
of interest.
Physicians in Training
• Unethical to delegate authority for patient care to anyone who is not
appropriately qualified and experienced (medical student or resident)
without adequate supervision from an attending physician
• May be involved with, and responsible for the day-to-day care of
many ill patients but must be supervised, supported, and directed by
highly trained and experienced physicians
Physician Charter of Professionalism
• Fundamental Principles
• Primacy of welfare
• Altruism contributes to the trust central to doctor-patient relationships.
• Patient autonomy
• Physicians must be honest with patients and empower them to make informed decisions
about treatment.
• Social justice
• Physicians should work actively to eliminate discrimination in health care.
Physician Charter of Professionalism
• A Set of Commitments
• Professional competence
• Honesty with patients
• Patient confidentiality
• Maintaining appropriate relations with patients
• Improving quality of care
• Improving access to care
• Just distribution of finite resources
• Scientific knowledge
• Maintaining trust by managing conflicts of interest
• Professional responsibilities