This document discusses ethics in psychiatry. It outlines professional codes from organizations like the APA and AMA that articulate ethical standards of practice. Some key principles discussed include respect for patient autonomy, beneficence, nonmaleficence, and justice. Specific ethical issues addressed include sexual and nonsexual boundary violations, violations of confidentiality, incompetent treatment, and illegal activities. Ethics in managed care and regarding impaired or trainee physicians are also covered.

1. Ethics in Psychiatry
 Ethics deal with the relations between people in different groups and often entail balancing rights.
 Professional ethics refer to the appropriate way to act when in a professional role.
 They derive from a combination of morality, social norms, and the parameters of the relationship people
have agreed to have.
Professional Codes
APA and AMA articulate ideal standards of practice and professional virtues of practitioners.
These codes include:
1. A physician shall be dedicated to providing competent medical service with compassion and respect for
human dignity.
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.
3. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements
which are contrary to the best interests of the patient.
4. A physician shall respect the rights of patients, of colleagues, and of other health professionals, and shall
safeguard patient confidences within the constraints of the law.
5. A physician shall continue to study, apply, and advance scientific knowledge, make relevant information
available to patients, colleagues, and the public, obtain consultation, and use the talents of other health
professionals when indicated.
6. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom
to serve, with whom to associate, and the environment in which to provide medical services.
7. A physician shall recognize a responsibility to participate in activities contributing to an improved community.
Basic Ethical Principles
1) Respect for Autonomy
­ Autonomy requires that a person act intentionally after being given sufficient information and time to
understand the benefits, risks, and costs of all reasonable options.
­ If a patient is not in a state of mind to make decisions for himself or herself, the psychiatrist should consider
mechanisms for alternative decision-making, such as guardianship, conservators, and health care proxy.
2) Beneficence
­ To prevent harm and promote well-being.
­ The expression of the principle is paternalism, the use of the psychiatrist's judgment about the best course of
action for the patient or research subject.
­ Beneficence may overrule patient autonomy; when the patient faces substantial harm or risk of harm.
3) Nonmaleficence "first do no harm"
­ Psychiatrists must have adequate training for what they do.
­ They need to avoid creating risks for patients by an action or inaction.
4) Justice
­ It concerns the issues of reward and punishment and the equitable distribution of social benefits.
Specific Issues
These include:
(1) sexual boundary violations
 Sexual activity with a current or former patient is unethical.
 Sexual activity between a doctor and a patient's family member is also unethical.
(2) nonsexual boundary violations
o Business:
­ Almost any business relationship with a former patient is problematic, and almost any
business relationship with a current patient is unethical.
o Ideological Issues:
­ Any clinical decision should be based on what is best for the patient; the psychiatrist's
ideology should play as little a part as possible in such a decision.

2. o Social:
­ Problems often arise in treatment situations when friendships develop between the psychiatrist
and the patient.
­ Such friendship should be avoided during treatment.
­ Similarly, psychiatrists should not treat their social friends except in emergency.
o Financial:
­ For psychiatrists in the private sector, dealing with the patient about money is a part of
treatment.
­ Issues surrounding setting the fee, collecting the fee, and other financial matters are grist for the
mill.
(3) Violations of confidentiality: see forensic.
(4) Mistreatment of the patient (incompetence, double agentry)
(5) Illegal activities (insurance, billing, insider stock trading).
Ethics in Managed Care
i. Responsibility to Disclose
­ Psychiatrists have a continuing responsibility to the patient to obtain informed consent for
treatments or procedures.
­ All treatment options should be fully disclosed, even those not covered under the terms of a
managed care plan.
ii. Responsibility to Appeal
­ Physicians have an ethical obligation to advocate for any care that will materially benefit their
patients, regardless of any allocation guidelines or gatekeeper directives.
iii. Responsibility to Treat
­ The treating physician has sole responsibility to determine what is medically necessary.
­ Psychiatrists must be careful not to discharge suicidal or violent patients prematurely merely
because continued coverage of benefits is not approved by a managed care company.
iv. Responsibility to Cooperate with Utilization Review
­ The psychiatrist should cooperate with utilization reviewers' requests for information on proper
authorization from the patient.
Impaired Physicians
A physician may become impaired as the result of psychiatric or medical disorders or the use of mind-
altering and habit-forming substances (e.g., alcohol and drugs).
Professional misconduct
One of the following:
 Practicing fraudulently and with gross negligence or incompetence.
 Practicing while the ability to practice is impaired.
 Being habitually drunk or being dependent on, or a habitual user of, narcotics or a habitual user of
other drugs having similar effects.
 Immoral conduct in the practice of the profession.
 Permitting, aiding, or abetting an unlicensed person to perform activities requiring a license.
 Refusing a client or patient service because of creed, color, or national origin.
 Practicing beyond the scope of practice permitted by law.
 Being convicted of a crime or being the subject of disciplinary action in another jurisdiction.
Physicians in Training
­ It is unethical to delegate authority for patient care to anyone who is not appropriately qualified, such
as a medical student or a resident, without adequate supervision from an attending physician.

3. Physician Charter of Professionalism
Fundamental Principles
 Primacy of patient welfare.
 Patient autonomy.
 Social justice.
A Set of Commitments
 Professional competence.
 Honesty with patients.
 Patient confidentiality.
 Maintaining appropriate relations with patients: Never exploit patients.
 Improving quality of care.
 Improving access to care.
 Just distribution of finite resources.
 Scientific knowledge.
 Maintaining trust by managing conflicts of interest: Relationships between industry and opinion
leaders should be disclosed.
 Professional responsibilities: Physicians are expected to participate in the process of self-regulation,
to meet professional standards.
Military Psychiatry
 Confidentiality does not exist under the military code of conduct.