By James L. Levenson, MD, DLFAPA
Dr. Levenson reviewed ethical issues in the practice of psychiatry. Key issues included confidentiality, maintaining boundaries, managing dual roles and avoiding conflicts of interest, not abandoning patients, informed consent surrogate decision makers, involuntary treatment, and impaired health care professionals. He reviewed 2 approaches to medical ethics; one based on the 4 major principles and the other on virtue ethics.
Dr. Levenson reviewed a number of clinical scenarios and questions posed by members of PSV as well as by psychiatric residents. Some of the issues discussed included:
- When is it justified to breach confidentiality?
- What if ethics and the law are in conflict?
- Under what circumstances should an adult patient be forced to accept treatment?
- How should one proceed when a psychotic patient’s surrogate decisionmaker is refusing consent for treatment?
Dr. Levenson also discussed the debate over physician-assistant suicide/medical aid in dying. He urged consideration of important factors for both sides to consider. Good palliative care is not universally available, especially in rural areas. Terminally ill patients may be clinically depressed, and nonpsychiatric physicians are not trained in the diagnosis of depression, especially in medically complicated patients. He urged physicians not to automatically take a patient’s request literally since it may mean something else such as “does anyone care about me”, or “I am too much of a burden on my family.”
