Ethical guidelines and a knowledge of ethical principles help psychiatrists avoid ethical conflicts (which can be defined as tension between what one wants to do and what is ethically right to do) and think through ethical dilemmas (conflicts between ethical perspectives or values).
Ethics deals with the relations between people in different groups and often entails balancing rights. Professional ethics refers to the appropriate way to act when in a professional role. Professional ethics derives from a combination of morality, social norms, and the parameters of the relationship people have agreed to have.
Most professional organizations and many business groups have codes of ethics that reflect a consensus about the general standards of appropriate professional conduct. The American Medical Association’s Principles of Medical Ethics and the American Psychiatric Association’s Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry articulate ideal standards of practice and professional virtues of practitioners. These codes include exhortations to use skillful and scientific techniques, to self-regulate misconduct within the profession, and to respect the rights and needs of patients, families, colleagues, and society. A summary of these principles is provided in Table 53-1.
Table 53-1 The Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry
Each of the AMA principles of medical ethics printed separately (in italics) along with annotations especially applicable to psychiatry.
Preamble
The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility not only to patients but also to society, to other health professionals, and to self. The following Principles, adopted by the American Medical Association, are not laws but standards of conduct, which define the essentials of honorable behavior for the physician.
Section 1
A physician shall be dedicated to providing competent medical service with compassion and respect for human dignity.a
1.
A psychiatrist shall not gratify his/her own needs by exploiting a patient. The psychiatrist shall be ever vigilant about the impact that his/her conduct has upon the boundaries of the doctor-patient relationship and thus upon the well-being of the patient. These requirements become particularly important because of the essentially private, highly personal, and sometimes intensely emotional nature of the relationship with the psychiatrist.
2.
A psychiatrist should not be a party to any type of policy that excludes, segregates, or demeans the dignity of any patient because of ethnic origin, race, sex, creed, age, socioeconomic status, or sexual orientation.
3.
In accord with the requirements of law and accepted medical practice, it is ethical for a physician to submit his/her work to peer review and to the ultimate authority of the medical staff executive body and the hospital administration and its governing body.
4.
A psychiatrist should not be a participant in a legally authorized execution.
Section 2
A physician shall deal honestly with patients and colleagues, and strive to expose those physicians deficient in character or competence, or who engage in fraud or deception.
1.
The requirement that the physician conduct himself/herself with propriety in his/her profession and in all the actions of his/her life is especially important for the psychiatrist because the patient tends to model his/her behavior on that of his/her psychiatrist by identification. Further, the necessary intensity of the treatment relationship may tend to activate sexual and other needs and fantasies of both patient and psychiatrist, while weakening the objectivity necessary for control. Additionally, the inherent inequality in the doctor-patient relationship may lead to exploitation of the patient. Sexual activity with a current or former patient is unethical.
2.
The psychiatrist should diligently guard against exploiting information furnished by the patient and should not use the unique position of power afforded by the psychotherapeutic situation to influence patients in any way not directly relevant to the treatment goals.
3.
A psychiatrist who regularly practices outside his/her area of professional competence should be considered unethical. Determination of professional competence should be made by peer review boards or other appropriate bodies.
4.
Special consideration should be given to psychiatrists who, due to illness, jeopardize the welfare of their patients and their own reputations and practices. It is ethical, even encouraged, for another psychiatrist to intercede in such situations.
5.
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