Psychiatry - October 2008 - (Page 42)

Ethics in Psychiatry mandatory is that giving patients greater information respects them as persons by increasing their autonomy. This value is generally viewed as more important than maximizing patients’ consequences by withholding information, even though, when armed with more information, patients may make choices that go against their best interests. The sharing of information by psychiatrists and other care providers is often referred to as “transparency.”1 In addition to enhancing patients’ autonomy, sharing information also helps further patients’ equality by “leveling the playing field” to a greater degree. In psychiatry, there are three contexts in which sharing more information is particularly important: when psychiatrists’ decisions may oppose what patients want (e.g., hospitalizing them against their will), when psychiatrists anticipate future problems that may arise with particular patients and know how they can be prevented, and when psychiatrists can “warn” patients in advance of actions that the psychiatrists may later take against the patients. In this article, I give several examples of ethical problems psychiatrists may encounter in each of these three areas and suggest some prime concerns psychiatrists should consider. BEYOND INFORMED CONSENT: The Ethics of Informing, Anticipating, and Warning by Edmund Howe, MD, JD Psychiatry (Edgemont) 2008;5(10):42–47 INTRODUCTION When performing psychotherapy, psychiatrists initially tend to withhold some information from their patients. For example, they may not tell their patients all the psychodynamics they infer may be likely. Rather, they titrate the amount of information they give to patients over time. If they did not, patients might feel overwhelmed 42 Psychiatry 2008 [ O C T O B E R ] and not return. In other contexts, however, psychiatrists should consider sharing information more fully. They should sometimes consider this even when their sharing of more information with patients may cause them greater harm. Ethically, the reason that sharing more information with your patients may be justifiable or even INFORMING PATIENTS (EVEN WHEN THIS MAY HARM THEM) Psychiatrists may hospitalize patients against their will when they are dangerous to others or to themselves. Ethically, it may be optimal for psychiatrists to share with patients the criteria for hospitalization and their underlying rationales as soon as is clinically

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Psychiatry - October 2008 Editor’s Message Editorial Advisory Board Contents Psych Rx Treatment of Migraine and the Role of Psychiatric Medications Play Therapy: A Case-based Example of a Nondirective Approach Delirium and Antipsychotics: A Systematic Review of Epidemiologyand Somatic Treatment Options Severely Mood-disordered Youth Respond Less Well to Treatment in a Community Clinic than Youth with Bipolar Disorder Beyond Informed Consent: The Ethics of Informing, Anticipating, and Warning Asthma: Wheezing, Woes, and Worries Classified Advertising Journal Watch Information for Authors

Psychiatry - October 2008

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