Presentation on theme: "Ethics As of &July2008. Answers from APA’s The Principles of Medical Ethics with Annotation Especially Applicable to Psychiatry."— Presentation transcript:
Ethics As of &July2008. Answers from APA’s The Principles of Medical Ethics with Annotation Especially Applicable to Psychiatry.
Ethics While it is possible that some ethical questions may come up on Part II [oral] examination, this PowerPoint is more likely to be of use on Part I or the ABPN’s Recertification exam.
Ethics question – romantic/sexual relationships Q. Are there any circumstances in which it would be ethically OK to have a sexual relationship with a psychiatric resident?
Ethical question – romantic/sexual relationship Ans. Not in your program, but OK to have a relationship with a resident in another program in which you have no role. [Basic issue: avoid dual roles of lover and evaluator of their training.]
Pt and supervisee Q. You have a social worker as a pt. She would like for you to supervise her clinical work. Would that be ethical?
Pt and supervisee Ans. No. Constitutes a potential exploitation as well as confusion of the therapeutic relationship.
Pt and employee Q. You have an unemployed pt who has skills that your office could use. It is ethical to hire him?
Pt and employee Ans. It is not ethical to switch a physician-pt relationship to an employer-employee relationship.
Confidentiality after death Q. Your patient has died after a long history of schizophrenia and lung cancer. It is OK to provide confidential information to members of his family who would like to know more about his life?
Confidentiality after death Ans. No. Ethical rules of confidentiality still apply.
Bequeath estate Q. Your 54 y/o pt of 20 years is dying of ovarian cancer. She has no family and wants to leave her estate of several thousand dollars to you as you’ve been invaluable to her over the past two decades. OK?
Bequeath estate Ans. No. OK for her to give to a charity whose goals might be the same as yours.
INS & homosexuality Q. In an INS investigation, is it ethical for a psychiatrist to certify that an immigrant is homosexual when that determination will result in exclusion of the person from the US?
INS & homosexuality Ans. No. A psychiatrist should not be party to any type of policy that excludes, segregates, or demeans the dignity of any pt because of ethnic origin, race, creed, age, socioeconomic status, or sexual orientation.
Missed appointments Q. Is it ethical to charge for missed appointments?
Missed appointments Ans. Yes, if part of the treatment contract.
Unaware Q. A pt with limited resources pays a small fee for seeing you, unaware that her mother pays the remainder of your usual fee. Ethical?
Unaware Ans. No. Physicians must be honest with their pts.
Christian psychotherapy Q. Is it proper to practice Christian Psychotherapy, a psychotherapy that may take fundamentalist positions on homosexuality, abortion, sex outside the marriage, and the concept that failure to pray causes illnesses?
Christian psychotherapy Ans. OK, if pt is fully informed and still seeks the Christian psychotherapy.
Can’t manage competently Q. You are working at a hospital that requires you to assume more responsibility than time or resources allows you to manage your pts competently. Ethical to continue under those circumstances?
Can’t manage competently Ans. You can continue to work under those conditions if you are advocating to the hospital leadership the need for additional resources. Otherwise, you should resign. [In general, whatever the unfavorable circumstances, if you are making efforts to change the circumstances, it is ethical to continue.]
Solicit money Q. You are working for a university in their clinic, and you are asked to solicit money from your wealthy ex-pts for a research program on schizophrenia. Is this ethical?
Solicit money Ans. Not ethical to exploit even ex-pts for a research program from which the pts will not directly benefit.
Proportion of the fee Q. In your town, there is a major law firm that refers out NQBRI cases to local psychiatrists. Is it ethical for you to have an understanding with them that, for each case that is sent to you, you will give them a $100? Or $1,000?
Proportion of the fee Ans. No, that is fee splitting.
Adopt Q. As a child psychiatrist, you are responsible for a hospital unit of 12 children. One of the children has recently had both parents killed in an auto accident, and there are no other relatives available. You and your significant other would like to adopt the child. Ethical?
Adopt Ans. No, as that is seen as exploiting the therapeutic relationship. Further, the impact on the other pts on the ward would likely be negative.
Clozapine program Q. As director of the state’s only public mental hospital, for pts with chronic schizophrenia, it is ethical to limit voluntary admissions to pts who will agree to be admitted to a clozapine program?
Clozapine program Ans. Not ethical unless the state has another program with equivalent services to which the chronically ill with schizophrenia can volunteer.
LEP Q. Do you have an ethical obligation to use interpreters when dealing with pts of limited English proficiency?
LEP Ans. To the extent possible, a psychiatrist should arrange to use interpreters when dealing with LEP pts so that the pts can communicate effectively, especially as to being able to provide informed consent. Interpreters are preferred to family members.
Change sexual orientation Q. Is it ethical to engage in a therapy [such as reparative or conversion therapy] to change the pt’s homosexual to heterosexual orientation when the pt has asked for such?
Change sexual orientation Ans. No. Any treatment based on an assumption that homosexuality per se is a mental disorder is unethical.
Parent Q. You are treating, with some success, a nine-year-old boy. His mother, long divorced, and you are both becoming attracted to each other. OK to have a romance with her?