Olive Harvey College Professional Ethics in Medical Practice Paper Write a one page page about professional ethics…………………………… Choose

Olive Harvey College Professional Ethics in Medical Practice Paper Write a one page page about professional ethics…………………………… Choose one scenario to write on:
● Summarize the situation and the findings of the APA ethics committee (briefly)
● Do you agree? If so why, if not why?
● Apply a least two of the four commonly accepted principles of health care ethics (yes,
you will have to do some research on these):
○ Principle of respect for autonomy,
○ Principle of Nonmaleficence,
○ Principle of Beneficence, and.
○ Principle of justice.
This should be no more than one page in length.
Opinions of the
Ethics Committee
on
The Principles of Medical Ethics
~
With Annotations Especially
Applicable to Psychiatry
2016 Edition
Published by the American Psychiatric Association
Arlington, VA
Copyright© 2016 American Psychiatric Association
ALL RIGHTS RESERVED
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2016 Edition
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Table of Contents
Foreword …………………………………………………………………………………………………………………………………..1
Principles of Medical Ethics ……………………………………………………………………………………………………….2
Opinions of the APA Ethics Committee
(To facilitate ease of use of this document, the Ethics Committee has categorized their opinions by topics (see below). The
topics are identified by a capital letter, followed by a number which refers to one of the nine Principles of Medical Ethics.
Small letters are used to identify the order in which the opinion was issued. For example, opinion “A.1.a” falls under the topic
of Boundary and Dual Relationship Issues, refers to Section 1 of the Principles of Medical Ethics and is the first opinion to be
issued on this topic under Section 1.)
A. Boundary and Dual Relationship Issues …………………………………………………………………………………3
B. Business Practices and Ancillary Professional Activities ……………………………………………………….13
C. Child and Adolescent Psychiatry (includes child custody and school issues) ……………………………17
D. Confidentiality and Informed Consent …………………………………………………………………………………20
E. Duty to Report and Professional Competency Issues …………………………………………………………….26
F. Ethics Procedures ……………………………………………………………………………………………………………..29
G. Forensic Issues …………………………………………………………………………………………………………………31
H. Interaction with Other Professionals ……………………………………………………………………………………36
I. Managed Care ………………………………………………………………………………………………………………….40
J. Military and Other Government Agencies ……………………………………………………………………………43
K. Payment, Fee and Fee Splitting Issues …………………………………………………………………………………45
L. Pharmaceuticals ………………………………………………………………………………………………………………..53
M. Philanthropy, Gifts and Wills ……………………………………………………………………………………………..56
N. Practice Issues ………………………………………………………………………………………………………………….59
O. Professional Listings, Announcements ………………………………………………………………………………..69
P. Referral Practices ……………………………………………………………………………………………………………..71
Q. Research and Scholarly Activities……………………………………………………………………………………….73
R. Resident, Student and Other Trainee Issues ………………………………………………………………………….76
Foreword
The Ethics Committee of the American Psychiatric Association receives frequent requests for opinions,
generally regarding the ethicality of conduct in professional and other settings. Answers to these
questions are drafted by “teams” composed of members and/or consultants of the APA Ethics
Committee. The answers are then reviewed by the Chairperson of the Committee before being sent to
the member. After review by the full Committee for confirmation, the opinions are provided in synopsis
form to the APA Board of Trustees and the APA Assembly. Beginning with the 2009 version, feedback
on the content of answers to questions slated for publication was solicited from the District Branch
Ethics Committees.
The questions and answers that follow in this booklet date back to 1973. They are presented in the order
of the date of response. Opinion in certain areas has evolved over time due to various factors, such as
the increasingly complex medical landscape upon which psychiatry is practiced. Thus this work is in
part a historical document that reflects the specific questions and perspectives of the particular time an
opinion was requested. Actual complaints have not been used so that this volume does not comprise a
casebook of unethical conduct.
The material is presented as responses to questions related to the seven Principles of Medical Ethics of
the American Medical Association (section citations are followed by “AMA”). References are made to
The Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry by the American
Psychiatric Association (section citations are followed by “APA”) and the American Medical
Association’s Current Opinions with Annotations of the Council on Ethical and Judicial Affairs (2000–
2001),herein referred to as “AMA Council Opinions.”
The published Opinions in this booklet are highly condensed versions that have been approved by the
Committee. These opinions are offered to assist our members and our district branches in understanding
the Principles. Only those questions and answers that address specific issues with heuristic value have
been included. Questions of a routine nature or those not clearly related to a Principle have been
excluded. Of note, these opinions are those of the APA Ethics Committee only. They do not represent
official positions of the American Psychiatric Association. The Principles of Medical Ethics with
Annotations Especially Applicable to Psychiatry (2013 edition) has been officially adopted by the
American Psychiatric Association and is binding upon all members.
1
Principles of Medical Ethics of the American Medical Association
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 to
patients first and foremost, as well as 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 care, with compassion and respect for
human dignity and rights.
Section 2
A physician shall uphold the standards of professionalism, be honest in all professional interactions, and
strive to report physicians deficient in character or competence, or engaging in fraud or deception, to
appropriate entities.
Section 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.
Section 4
A physician shall respect the rights of patients, colleagues, and other health professionals, and shall
safeguard patient confidences and privacy within the constraints of the law.
Section 5
A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to
medical education, make relevant information available to patients, colleagues, and the public, obtain
consultation, and use the talents of other health professionals when indicated.
Section 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 care.
Section 7
A physician shall recognize a responsibility to participate in activities contributing to the improvement
of the community and the betterment of public health.
Section 8
A physician shall, while caring for a patient, regard responsibility to the patient as paramount.
Section 9
A physician shall support access to medical care for all people.
2
A. BOUNDARY AND DUAL RELATIONSHIP ISSUES
Section 1
A physician shall be dedicated to providing competent medical care, with compassion and respect for
human dignity and rights.
A.1.a
Question: Is it ethical for a psychiatrist to perform routine and follow-up vaginal exams on his patients,
lead his patients into a fantasy of having sexual relations together, disclose his own sexual experiences,
or kiss his patients?
Answer: A psychiatrist, as a licensed physician, may carry out nonpsychiatric medical procedures
providing the psychiatrist is competent to do so and the procedures do not activate transference
distortions that preclude effective treatment. Pelvic examinations carry a high risk of the latter and
would be better provided by another physician. The other issues are addressed by Section 2, Annotation
1 (APA). These behaviors would appear to violate the prohibition of sexual exploitation. (1989)
A.1.b
Question: What are the ethical ramifications of a psychiatrist using a “psychotherapeutic technique” in
which he asks his female patients to describe vivid sexual fantasies that specifically involve him?
Answer: This is not usual or customary practice. The issue here is exploitation of a patient under the
guise of psychotherapy that may include gratification of the psychiatrist at the expense of the patient.
(1993)
A.1.c
Question: I am a retired psychiatrist. A friend and I are forming a group of 10 to 15 people who will
each contribute $25 a month to be invested in the stock market. Another person invited a former patient
of mine to join the group. Would it be ethical for me to participate in the same investment club as a
former patient?
Answer: This question is important because it points out that ethics principles must be viewed
in the context of the individual doctor, the individual patient, and the doctor–patient relationship. The
Principle involved is that it would be unethical to exploit a patient or a former patient. (See Section 1,
Annotation 1, and Section 2, Annotation 2, APA.) An investment club where the
contribution is $25 per member would not suggest exploitation of a patient or former patient. However,
in the spirit of the admonition to treat patients with respect and dignity, it might be appropriate for you
to contact your former patient, explain that you might be in the same investment club, inquire if that
might be troublesome for the former patient, and if so, make appropriate arrangements. If you believe
that social contact with this former patient might be problematic, it might be wise for you to quietly
remove yourself from the investment club. (1993)
3
A.1.d
Question: Is it ethical for me to have a romantic relationship with a key third party associated with my
patient, such as the parent of a child or adolescent patient?
Answer: No. Key third parties include, but are not limited to, spouses or partners, parents, guardians,
surrogates, and the like. (See AMA Council on Ethical and Judicial Affairs Report, Annual 1998, and
Opinion 8.14, AMA Council Opinions, 2000–2001.) Treatment of minors is typically rendered in the
context of the family; a parent plays an integral role in the treatment process. Romantic relationships
with parents, other family members, or key third parties may jeopardize the treatment of the child or
adolescent. By entering into a dual relationship,
the psychiatrist would face the incompatible task of trying to meet the medical needs of the patient
simultaneous with the romantic needs of the key third party. Such involvement with a key third party
raises concerns about the psychiatrist gratifying his or her own needs by exploiting
the patient; there is also a risk of breaching confidentiality. The priority of the patient’s needs is
compromised or rendered impossible by a romantic or sexual relationship with the patient’s primary
caretaker or other key third party. (2000)
A.1.e
Question: I am a divorced child psychiatrist. A couple consulted me as to how to inform and support
their children as they had decided to divorce. I successfully counseled them for a handful of sessions.
Afterward, the then ex-wife reconsulted me for assistance in improving her relationship with one child
in particular that had been polarized by the divorce. I saw her in this context for an additional series of
sessions.
Months later, I learned that this former patient was interested in a personal relationship with me. She had
been in long-term individual psychotherapy with another professional throughout my treatment of her. I
consulted a colleague, and he said the usual prohibitions about dating a former patient would not
necessarily apply given I never treated her as an individual. What is ethically appropriate in this
situation? Can I date this woman now?
Answer: It would not be ethical for you to have a social relationship with this former patient. You have
treated her and her family members. She has placed trust in you and disclosed matters of a highly
personal nature. She may also have developed a positive transference toward you. Establishing a dating
relationship with her could be exploitation of this therapeutic relationship. (2001)
A.1.f
Question: Is it ethical for a staff member in a psychiatric treatment facility to continue treating a patient
that the staff member has brought criminal charges against? Similarly, is it ethical for a staff member to
continue treating a patient when the staff member is or will be aiding in the criminal investigation and/or
prosecution of that patient?
Answer: Either of these dual role situations would be fatal to the establishment or continuation of a
mental health professional-patient relationship. The treatment relationship factors necessary
4
— like trust, beneficence, empathy, and confidentiality – cannot genuinely exist in these two examples. It
would be necessary to assign other staff members to work therapeutically with this patient preferably
assigning the patient to a separate unit with no contact to the staff member pressing criminal charges.
While the need for a legal response to some patients’ acts is at times necessary, the facility still has an
ethical duty to provide reasonable and appropriate care for the patient. (2006)
A.1.g
Question: I am studying a new career as a coach. I plan to coach professionals and organizations. I plan
to continue doing outpatient psychiatry on part-time basis while I develop my coaching career. I will
most probably do psychiatry on part-time basis until I retire. Will it be considered a conflict of interest
or unethical if a current or former patient of mine knowing that I am a coach wants to hire me as such?
Answer: You are switching a doctor-patient (or former patient) relationship to an employer- employee
one, regardless of who is hiring and who is being hired. Either way, it’s an exploitation of the doctorpatient relationship. In this case, it is compounded because of the overlap and potential confusion in
roles between a “coach” and a “therapist”, but the same admonition would apply even if the doctor was
now in a totally unrelated profession. I think you would be prudent to avoid mixing your roles, and to
limit you coaching clients to non-patients. (2008)
A.1.h
Question: We have learned that our psychiatry residents routinely “google” their patients. On one
recent occasion the resident discovered that an inpatient was on a most wanted list in another state for
arson despite having denied a history of illegal behavior. Is it ethical to do a google search of your
patient’s name? What is the ethical response to learning through a google search that your patient is
wanted by the police?
Answer: “Googling” a patient is not, in and of itself, unethical. First and foremost, the “googling” of a
patient should only be done in the interests of promoting patient care and wellbeing and never to satisfy
the curiosity or other needs of the psychiatrist. Also important to consider is how such information will
influence treatment, and how the clinician will ultimately use this information. The psychiatrist should
ask him or herself these questions before resorting to a Google search. A clinician who routinely
assumes information that cannot be verified as fact and directs treatment based on such information may
be at risk for practicing incompetently. It is prudent to identify the source of information that is entered
into a medical record.
The standard of practice for learning about a patient’s medical condition is through face-to-face
interviews, and this information may be supplemented by collateral information, e.g., medical records or
family members. Refusal or inability by patients to provide important historical information is not
uncommon; in this circumstance collateral data may assume an important role. “Googling” a patient in
such a scenario may provide useful information. However, information obtained this way, such as on a
My Space website, may not be current or accurate, especially for clinical purposes. Similarly, newspaper
articles may not be reliable. Information such as birth records and sex offender registration is more
likely to be trustworthy. Whenever information is obtained through “googling,” it is important to
corroborate it.
5
Reporting requirements vary state to state; those that supersede confidentiality regulations or laws are
generally relevant to public safety. Every psychiatrist should become familiar with their State reporting
laws. (2010)
A.1.i
Question: I just have a question on boundaries and implications with regards to jeopardizing the
confidentiality with a current situation. We have a fellow therapist with whom I share clients and she
wants to see me as a patient. Also the therapist’s case may be discussed (as a patient) in the team
meetings we have weekly with other psychiatrists in the group. All other psychiatrists in the group also
share patients with her. This is an awkward situation but the therapist wants to see me as a patient.
Technically, since she is a postdoctoral student and we are a part of a university we cannot refuse care if
the patient wants it. I am looking for APA guidelines in this type of situation.
Answer: The scenario you pose is a dual agency problem. You and the post doc student already have a
psychiatrist/co-therapist relationship, it would not be right to add a doctor/patient relationship on top of
that. Further, of course, you couldn’t discuss her personal treatment in their team meetings with the
other psychiatrists, but that would be just be the beginning of potential conflicts. You must decline to
treat her yourself. What you can, and should do, is to offer to help her find a psychiatrist away from
their university setting, someone whose work you respect, and thereby make a genuine eff…
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