Volume 4 Issue 6 June, 2014
Psychiatric ethics is concerned with the application of moral rules to situations and relationships specific to the field of mental health practice. A myriad of ethical problems pervade clinical practice and research in psychiatry.
How a practitioner responds to an ethical issue affects a patient’s welfare as much as making the right diagnosis and selecting the optimal medication. Thus having clear ethical principles makes it easier to know what behavior is appropriate and what behavior is inappropriate. It also helps the patient know what to expect. When a psychiatrist engages in a social or business interaction, problems are bound to occur in the doctor-patient therapeutic relationship as transference can give a psychiatrist unusual influence over a patient, while motivated bias clouds the psychiatrist’s judgment concerning what is in the patient’s interest. Psychiatrists also face ethical dilemmas in which they must balance the rights and interests of the society (safety) with those of their patients (confidentiality, freedom).
The basic ethical principles include: Respect for autonomy, Beneficence, Nonmaleficence and Justice.
Autonomy means respecting the decisions of an individual. In the pursuit to ensure that patients obtain the best treatment possible a psychiatrist can easily slip into paternalism without realizing the harm that may be done in overriding a patient’s autonomy. Providing patients with a rational understanding of their disorder and options for treatment ensures that the patient is making an educated decision relating to his or her treatment. In case a patient is not in a state of mind to make decisions for himself, mechanisms for alternative decision making, such as via guardianship to be considered.
Beneficence refers to the obligation to ‘act for the benefit’ of others. The requirement for psychiatrists to act with beneficence derives from their fiduciary relationships to patients and the profession’s belief that it has an obligation to the society.
Nonmaleficence (primum non nocere) means ‘above all, do no harm’; states that physicians must be careful in their decisions and actions and ensure they have adequate training for what they are doing. They also need to be open to seeking second opinions or consultations, avoid creating risks for patients either by action or inaction, for eg. Failing to ask about suicidal feelings etc.
Justice refers to fairness in the distribution of benefits and risks. It addresses the questions of distribution of scarce health resources, respect for people’s rights and respect for the morally acceptable laws.
At times when the basic ethical principles are in conflict, decisions must be made concerning how to balance them. Knowledge of ethical guidelines and their underlying principles helps in dealing with the ethical challenges presented by each of these situations. Understanding the bases of these ethical guidelines is also necessary to adjust to changes in societal beliefs and values and respond to new issues.
Dr Smitha Tarachandra, Senior Resident, Department of Psychiatry, K S Hegde Medical Academy, Mangalore
