Ethics are principles that serve as codes of conduct about right and wrong behaviors to guide the actions of individuals. Although there are universal ethics, such as respect for others, ethics are often tailored for a specific professional culture. Psychiatric clinicians should understand ethical theories and use ethical principles to guide their decisions about patient care. They must clarify their own ethical beliefs and then combine their ideas with professional ethical principles to develop sound ethical decisions. By working to enhance their own positive character traits, psychiatric clinicians improve their potential to be able to be helpful. Positive character virtues that are likely to enhance the effectiveness of mental health professionals include respect for confidentiality, veracity, prudence, warmth, sensitivity, perseverance, patience, and generosity.

Ethical practice as a way of life focuses on interpersonal relationships and involves not only caring for but also caring about patients.

Responsibility and accountability are additional components of ethical practice. In addition to the universal principles of respect and responsibility, several other principles guide clinicians and other healthcare professionals in ethical decision making. They include autonomy, beneficence, paternalism, veracity, fidelity, and justice. As clinicians interact daily with patients, they make many ethical decisions and they must take full responsibility and accountability for his or her ethical decision-making. Such responsibility requires a code of ethics.

Ethical codes and principles are derived from and embodied or articulated in three sources: law, religion, and professional associations. Ethics and law are related but not synonymous. Each nation has a legal system that attempts to embody ethical principles in the creation and interpretation of the law. But not every legal mandate is necessarily consistent with medical ethics and not every ethically supportable course of conduct is codified in law or legislation (see Chapter 10).

Many ethical decisions that confront practitioners have their roots in religion. Many contemporary issues including termination of pregnancy, refusal of treatment, and others are guided by patients’ religious beliefs. Practitioners should be aware of these and the tensions that might inevitably arise when a patient’s religious belief conflicts with ethical behavior on the part of the professional.

Worldwide, the basic ideas of Hippocratic ethics are the cornerstone of professional behavior and the nucleus of subsequent ethical codes. Those are:

• Declaration of Geneva: (1948, amended in 1968) Adopted by the General Assembly of the World Medical Association (WMA), the Physician Oath seems to be a response to the atrocities committed by doctors in Nazi Germany. This oath requires the physician to “not use [his] medical knowledge contrary to the laws of humanity.”
  
• Nuremberg Code: The judgment by the war crimes tribunal at Nuremberg laid down 10 standards to which physicians must conform when carrying out experiments on human subjects. The code articulated the requirement of voluntary informed consent of human subjects, recognized that risk must be weighed against expected benefits, and that unnecessary pain and suffering must be avoided. The principles of the Nuremberg Code have been incorporated into all codes of general medical ethics.
  
• Declaration of Helsinki: Developed by the World Medical Association as a statement of ethical principles for medical research involving human subjects, including research on identifiable human material and data.
  
• Declaration of Madrid: Specific declaration on standards for psychiatric practice developed by the World Psychiatric Association (WPA). The first of these was the Declaration of Hawaii in 1977. Currently all 130 societies of the WPA have adopted the Declaration of Madrid and abiding by the declaration is a prerequisite for joining the WPA. Elements of the Declaration of Madrid are summarized in Boxes 9.1 and 9.2.