Psychiatry is a specialty of medicine that inherently touches on great moral questions. The conditions we deal with often threaten the qualities that define human beings as individual, autonomous, responsible, developing and fulfilled. In addition, these conditions are often characterized by great suffering, disability and stigma, and yet people with these conditions show enormous adaptation and strength. If every work of physicians is ethically important, then it is our job in a very special way. As a service to Focus readers, this column provides ethical commentary on clinical psychiatry issues. It also provides clinical ethics questions and expert answers to sharpen readers` decision-making skills and advance astute and compassionate clinical care in the field. The APA sets out the general principles that clinicians should apply to pursue the highest ethical ideals. [1] These general principles include Principle A: Charity and Non-Evil and Principle C: Integrity. Charity and non-malevolence describe how clinicians strive to do good to those they work with and strive not to do harm. [1] Loyalty and responsibility involve the establishment of relationships of trust and awareness of one`s own professional responsibility. [1] Both principles must be considered when seeking to establish and maintain a strong therapeutic alliance with trauma survivors.
Ethical issues in counseling usually fall to the therapist. This means that it is the therapist`s responsibility to avoid unethical interactions with clients. This article will take a closer look at what the ethical responsibilities of the therapist entail and examine some common ethical issues that psychiatrists face. Sound ethical decision-making is essential to smart and compassionate clinical care. Savvy practitioners easily identify and reflect on the ethical aspects of their work. They engage, often intuitively and uneventfully, in cautious habits – adhering to therapeutic limits, advising experts in the management of patients who are difficult to treat or have particularly complex conditions, protecting themselves from dangers in high-risk situations, and trying to learn more about mental illness and its expression in the lives of patients of all ages. in all places and from all walks of life. These habits of thought and behaviour are signs of professionalism and help ensure ethical rigour in clinical practice. Research in the field of psychological trauma raises a number of complex ethical questions: questions about the unwarranted medicalization of trauma-trauma survivors who are exposed again, questions about the moral implications of research on perpetrators, and questions about neglect of appropriate interventions.
We discuss some of these issues in the context of a study on trauma in South Africa and the recent Truth to Reconciliation work in that country. Medical research, of course, was not a priority of the TRC and, unfortunately, there was no prospective attempt to investigate such matters. Nevertheless, we recently received funding to study a cross-sectional probability sample of South Africans to assess exposure to trauma, post-traumatic psychiatric symptoms, and attitudes toward TRC. In formulating this study, a number of different ethical issues were raised by the investigators and focus groups of participant-observers (e.g. individuals who had themselves suffered serious human rights violations). We review some of them here. If the therapist in question is responsible for an entire office or group of therapists, he or she should monitor what these other therapists are doing. You need to make sure that other therapists in your facility also adhere to the ethical guidelines discussed in this article.
If this is not the case, the therapist in charge is responsible for issuing reprimands, demanding additional training, or removing certain therapists from their positions. If they don`t, it could be considered an ethical violation. 3.2. The answer is D. In this question, autonomy against charity (paternalism) are again the ethical principles that must be weighed. In the first question, we discuss the balance between the benefits of evidence-based care and respect for patient autonomy and increased patient decision and control. In this question, the provider may consider using an element known to be essential in the treatment of trauma (exposure) as part of the rationale for collaboration with a male clinician. If the desired outcome of treatment is that the patient functions socially, overcoming fear of a particular sex could be a useful therapeutic goal. However, there is no factual basis for this approach (9).
In this situation, a potentially ethical position is to discuss the reasoning with the patient. For example, a male provider might say the following: The extent of dysfunction associated with symptoms is very important. This is the key question that addresses immediate safety concerns for patients and staff. Short-term safety concerns are an area where a paternalistic approach is often ethical. An example to illustrate this is a patient`s ability to concentrate. The extent of this may depend on the task at hand and low concentration. For example, what level of concentration is required for the Marine in this example to use his weapon again in combat? Would a soldier firing bombs need a different concentration threshold before returning to duty? What concentration should an air traffic controller who was on duty at the time of an aircraft accident have in the civilian world before returning to duty? It is also important to consider how the extent of the dysfunction can be measured. Is self-disclosure enough? Is an attempt at supervised work sufficient, or would a standardized test with a threshold be better to require this decision? These are all issues that play a role in the decision, as well as the balance between autonomy and paternalism in a situation where the patient has acute and active symptoms related to trauma.