1. The document discusses several ethical scenarios in psychiatry, including obtaining consent for treatment from family members and maintaining patient confidentiality.
2. It provides historical context on the development of medical ethics codes, noting that psychiatry developed specific ethics guidelines more recently.
3. Key aspects of psychiatric ethics discussed include obtaining informed consent, guidelines around voluntary and involuntary treatment, and balancing patient confidentiality with situations where a patient may pose a danger to others. Maintaining patient autonomy and welfare is emphasized.
Antipsychiatry Movement arose as a zeitgeist of the 1960s anti-establishment movements. It has in a way contributed to the development of psychiatry by pointing out its short comings.
Antipsychiatry Movement arose as a zeitgeist of the 1960s anti-establishment movements. It has in a way contributed to the development of psychiatry by pointing out its short comings.
Brief therapy, sometimes also referred to as short term therapy (usually 10 to 20 sessions) , is a generic label for any form of therapy in which time is an explicit element in treatment planning.
The somatoform disorders are a group of psychological disorders in which a patient experiences physical symptoms that are inconsistent with or cannot be fully explained by any underlying general medical or neurologic condition. Medically unexplained physical symptoms account for as many as 50% of new medical outpatient visits. [1] Physical symptoms or painful complaints of unknown etiology are fairly common in pediatric populations. [2] Many healthy young children express emotional distress in terms of physical pain, such as stomachaches or headaches, but these complaints are usually transient and do not effect the child's overall functioning. The somatoform disorders represent the severe end of a continuum of somatic symptoms.
Somatization in children consists of the persistent experience and complaints of somatic distress that cannot be fully explained by a medical diagnosis. They can be represented by a wide spectrum of severity, ranging from mild self-limited symptoms, such as stomachache and headache, to chronic disabling symptoms, such as seizures and paralysis. These psychological disorders are often difficult to approach and complex to understand. It is important to note that these symptoms are not intentionally produced or under voluntary control.
In somatoform disorders, somatic symptoms become the focus of children and their families. They generally interfere with school, home life, and peer relationships. These youngsters are more likely to be considered sickly or health impaired by parents and caretakers, to be absent from school, and to perform poorly in academics. Somatization is often associated temporarily with psychosocial stress and can persist even after the acute stressor has resolved, resulting in the belief by the child and his or her family that the correct medical diagnosis has not yet been found. Thus, patients and families may continue to seek repeated medical treatment after being informed that no acute physical illness has been found and that the symptoms cannot be fully explained by a general medical condition. When somatization occurs in the context of a physical illness, it is identified by symptoms that go beyond the expected pathophysiology of the physical illness.
Recurrent complaints often present as diagnostic and treatment dilemmas to the primary care practitioner (PCP) who is trying to make sense of these symptoms. The PCP may feel poorly prepared and/or may have little time to assess or treat the somatic concerns. While the more disabling somatic complaints are more likely to be referred to a mental health professional, these youngsters presenting with these disabling physical symptoms bridge both medical and psychological domains and present a puzzling quandary for professionals from either field if working with them alone. [3] The nature of these symptoms requires an integrated medical and psychiatric treatment approach to successfully decrease the impairment caused by these disorders.
Psychoeducation is an important element of psychiatric treatment. It has a significant role in
promoting mental health, preventing mental illness, increasing mental health awareness, creating opportunities
and improving the quality of life of the patient, caregivers and the community. To achieve these goals,
psychoeducation programmes seek to provide families with the information they need about mental illness
and the coping skills that will help them to deal with their loved one's psychiatric disorder. In a nutshell
Psychoeducation’s goal is to offer education and therapeutic strategies to improve the quality of life for the
family while decreasing the possibility of relapse for the patient (Solomon, 1996).
Ethics Grand Rounds presented at Providence Health Care on 9/29/15 regarding questions and dilemmas in psychiatric care, particularly in the hospitalized medical patient
Anti psychiatry is like feedback for psychiatry that motivate for continue improvement in psychiatry. Everyone knows what is psychiatry, here is what is anti psychiatry. It helps to keep treatment standard and inward facilities up. Mainly opposing restrain against patients denial for treatment.
Medical ethics is an important concern for all junior doctors but also for anyone working in mental health. This engaging text is written specifically for junior doctors who have an interest in psychiatry.
Brief therapy, sometimes also referred to as short term therapy (usually 10 to 20 sessions) , is a generic label for any form of therapy in which time is an explicit element in treatment planning.
The somatoform disorders are a group of psychological disorders in which a patient experiences physical symptoms that are inconsistent with or cannot be fully explained by any underlying general medical or neurologic condition. Medically unexplained physical symptoms account for as many as 50% of new medical outpatient visits. [1] Physical symptoms or painful complaints of unknown etiology are fairly common in pediatric populations. [2] Many healthy young children express emotional distress in terms of physical pain, such as stomachaches or headaches, but these complaints are usually transient and do not effect the child's overall functioning. The somatoform disorders represent the severe end of a continuum of somatic symptoms.
Somatization in children consists of the persistent experience and complaints of somatic distress that cannot be fully explained by a medical diagnosis. They can be represented by a wide spectrum of severity, ranging from mild self-limited symptoms, such as stomachache and headache, to chronic disabling symptoms, such as seizures and paralysis. These psychological disorders are often difficult to approach and complex to understand. It is important to note that these symptoms are not intentionally produced or under voluntary control.
In somatoform disorders, somatic symptoms become the focus of children and their families. They generally interfere with school, home life, and peer relationships. These youngsters are more likely to be considered sickly or health impaired by parents and caretakers, to be absent from school, and to perform poorly in academics. Somatization is often associated temporarily with psychosocial stress and can persist even after the acute stressor has resolved, resulting in the belief by the child and his or her family that the correct medical diagnosis has not yet been found. Thus, patients and families may continue to seek repeated medical treatment after being informed that no acute physical illness has been found and that the symptoms cannot be fully explained by a general medical condition. When somatization occurs in the context of a physical illness, it is identified by symptoms that go beyond the expected pathophysiology of the physical illness.
Recurrent complaints often present as diagnostic and treatment dilemmas to the primary care practitioner (PCP) who is trying to make sense of these symptoms. The PCP may feel poorly prepared and/or may have little time to assess or treat the somatic concerns. While the more disabling somatic complaints are more likely to be referred to a mental health professional, these youngsters presenting with these disabling physical symptoms bridge both medical and psychological domains and present a puzzling quandary for professionals from either field if working with them alone. [3] The nature of these symptoms requires an integrated medical and psychiatric treatment approach to successfully decrease the impairment caused by these disorders.
Psychoeducation is an important element of psychiatric treatment. It has a significant role in
promoting mental health, preventing mental illness, increasing mental health awareness, creating opportunities
and improving the quality of life of the patient, caregivers and the community. To achieve these goals,
psychoeducation programmes seek to provide families with the information they need about mental illness
and the coping skills that will help them to deal with their loved one's psychiatric disorder. In a nutshell
Psychoeducation’s goal is to offer education and therapeutic strategies to improve the quality of life for the
family while decreasing the possibility of relapse for the patient (Solomon, 1996).
Ethics Grand Rounds presented at Providence Health Care on 9/29/15 regarding questions and dilemmas in psychiatric care, particularly in the hospitalized medical patient
Anti psychiatry is like feedback for psychiatry that motivate for continue improvement in psychiatry. Everyone knows what is psychiatry, here is what is anti psychiatry. It helps to keep treatment standard and inward facilities up. Mainly opposing restrain against patients denial for treatment.
Medical ethics is an important concern for all junior doctors but also for anyone working in mental health. This engaging text is written specifically for junior doctors who have an interest in psychiatry.
The dilemma to use drugs for treatment as the standard for care creates problems for drug side effects that cause harm and death of patients.
The problem of the drug side effects and prescription errors kill more patients, according to Lazarus et al (1998), an "estimated of 106,000 deaths occur annually due to adverse drug side effects" for standard of care for "practicing medicine".
In the case of prescription drug, the ethical issue is standard of care for treatment, and is complicated because of adverse drug effect.
The dilemma for standard of care by drugs is the problem for unexpected adverse reaction to drug that harms patients for medical law, ethics, and bioethics.
The standard of care for practicing medicine is a drug for a treatment can never be about ethics between a doctor and a patient.
To think health care coverage for vaccination and immunization is standard of care for introducing virus, bacteria and toxin cause sickness for practicing medicine (use of drugs) for treatment.
There are no medical ethics that said 'to treat patients right by giving advice' instead, the standard of care is prescribing drugs with side effect is practicing medicine "drug" for compliance with treatment that cannot apply to the doctrine "to do no harm".
According "to the ethical guidance in the Era of managed Care" by Higgins & Hackett (2000), an analysis of the American College of Healthcare Executives' (ACHE) Code of ethics suggests, "the managed care revolution undermining the medical ethics and that it does not adequately address several ethical concerns." Bioethics is the study of life, moral and ethical issues for debate as it relates to medical policy and practice that were appropriate for legal standard and standard of care, which can arise from the relationship between biology, technology, medicine, politics, law and philosophy, especially in the application for life and reproduction such as the recent event about plan parenthood.
Without a change to the current system for standard of care of practicing medicine by diagnose diseases to prescribe drugs for treatment for health care coverage, the answer is no.
It gives an overview on the concept of paternalism and autonomy and which principle prevails in the current situation. The opinion is the writer personal opinion.
Complementary and Alternative therapies in Psychiatrydonthuraj
This is a seminar which i had presented as a part of academic activity in my department. Please comment on the seminar, so that i can make any future changes... Thank you.
this is a discussion not a paper I need a paragraph under each quest.docxabhi353063
this is a discussion not a paper I need a paragraph under each question. each paragraph need to be at least 250 words with up to date references.
HAS 515 Week 8 Lecture:
Patient Rights and Responsibilities and Acquired Immunodeficiency Syndrome
Slide #
Scene/Interaction
Narration
Slide 1
Intro Slide
Slide 2
Scene 1
Professor Charles enters classroom and introduces the topics for today’s lesson and begins the lecture.
Prof Charles
: Hello everyone….welcome back to class. Today, we are going to discuss patient rights and responsibilities and acquired immunodeficiency syndrome.
The Patient Self-Determination Act of 1990 (PSDA) made a significant advance in the protection of the rights of patients to make decisions regarding their own health care. Healthcare organizations may no longer passively permit patients to exercise their rights but must protect and promote such rights. The PSDA provides that each individual has a right under state law to make decisions concerning his or her medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives.
Let’s first discuss the rights of the patient. How are patient rights classified?
Casey:
Patient rights may be classified as either legal (those emanating from law) or human statements of desirable ethical principles (such as the right to healthcare or the right to be treated with human dignity). Both staff and patients should be aware and understand not only their own rights and responsibilities, but also the rights and responsibilities of each other.
Donald
: Patients also have a right to receive a clear explanation of tests, diagnoses, treatment options, prescribed medications, and prognosis; participate in healthcare decisions; understand treatment options; and discontinue or refuse treatment options. It is recognized that the relationship between the physician and the patient is essential for the provision of proper care.
Casey
: In addition to what has already been noted, I would say that legal precedent has established that not only does the institution have responsibility to the patient, but also the patient has responsibility to the institution.
Prof. Charles
: Absolutely… What does the federal and state law and the Constitution have to say about discriminatory practices?
Casey
: Most federal, state and local programs specifically require, as a condition for receiving funds under such programs, an affirmative statement on the part of the organization that it will not discriminate. For example, Medicare and Medicaid programs specifically require affirmative assurances by healthcare organizations that no discrimination will be practiced. Healthcare organizations who do not comply may lose Medicare and Medicaid certification and reimbursement.
Prof. Charles
: Excellent. What is an example of discrimination by a hospital?
Donald:
There was a case,
Stoick v. Caro Community Hospital
, where the patient brought a medical ...
Archer USMLE step 3 Ethics lecture notes. These lecture notes are samples and are intended for use with Archer video lectures. For video lectures, please log in at http://www.ccsworkshop.com/Pay_Per_View.html
Medical Research: conflicts between autonomy and beneficence/non maleficence, euthanasia, informed consent, confidentiality, criticisms of orthodox medical ethics
Series of lectures I gave for the PEER (Professionalism and Ethics Education for Residents) Project sponsored and organized by the Saudi Commission for Health Specialties (SCHS).
OUTLINE:
What is an informed consent to treatment?
What is the elf basis to consent?
What makes the consent an ethically valid one?
Types of Consent
When it is needed? When could it be waived?
How to take an informed consent?
What if the patient is not able to give consent?
Documentation of Consent
Special Issues about Consent
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. Scenarios- How to go about???
1. 60 year old elderly female from a poor back ground,
married, with a single girl child presenting in delerium.
Attendee(patient’s daughter) could not comprehend the
nature of illness or the treatment options available even
after explaining many times. After two days of treatment
she would not consent for any treatment despite
deterioration in the patient’s condition.
2. A 28 yr female, a case of BPAD confesses about her
series of extra marital relations during a past manic
episode and is currently being threatened by one of
those males demanding for a continuous relationship
with the patient. The husband is apparently unaware of
any of these.
3. Word ethics has been derived from the Greek term
ethikos, meaning “rules of conduct that govern
natural disposition in human beings”.
simpler terms means principles of right conduct
Encyclopedia Britannica – “ethics as a systematic
study of the ultimate problems of human conduct ”.
Ultimate problems the concepts of right and wrong,
morality etc.,
E-T-H-I-C-S
4. Historical:
The Charaka Samhita- 600 BC
The Hippocratic Oath, devised about 400 BC
the sixth century Hebrew Book of Asaph Harofe
the tenth century Persian physician, Haly Abbas.
The direct forerunner of modern codes, “the Code of
Institutes and Precepts”, (1803 AD) by the English
physician, Thomas Perceval.
5. Psychiatric ethics is of a recent origin
In 1973 the American Psychiatric Association-
First code of ethics in Psychiatry
In 1977, the World Psychiatric Association --
code of ethics which is known as the
"Declaration of Hawaii".
Indian Psychiatric Society adopted its ethical
code in 1989.
6. Rapid advancement of medical knowledge.
Today ,organ transplantation, euthanasia, & artificial
prolongation of life are issues on which clear ethical
guidelines are required.
without adequate standards, self-regulation can
degenerate into self-protection; and self-protection
ultimately damages the profession.
7. Ethics is much more relevant to psychiatry because….
Line of demarcation between normal & abnormal is hazy
and psychiatric diagnosis & treatment can be easily
questioned.
The treatment aims at modifying behavior, perceived as an
implied threat may be utilized for controlling behavior for
certain vested interests.
Intense transference between the patient & therapist which
may be maliciously utilized.
Psychiatric patients may not be fully in contact with reality,
they might consent to decisions which are not ultimately to
their benefit.
Ex:A manic patient may give a blank cheque to the therapist
8. Concepts:
In psychiatry, by contrast to medicine, there are a
number of important prima facie connections
between our diagnostic concepts and ethics
justification for involuntary psychiatric treatment
the insanity defence- ’mad but not bad’
Medical/Moral dimension:
psychopathic personality (a medical concept) and
delinquency (a moral concept).
hysteria/malingering
alcoholism/drunkenness.
• abuses of psychiatry: USSR-Delusions of reformism
9. Objectives of professional ethics
To provide guidelines of conduct among the
professionals themselves.
To formulate guidelines in dealing with the patients, their
relatives and third parties in areas of
1. Psychiatric diagnosis.
2. Informed consent.
3. Voluntary and involuntary treatment & hospitalization.
4. Confidentiality.
5. Respect for the patient and his human rights.
6. Third party responsibility.
7. Psychiatric research.
10. Humanists raised objections, pointing out that
dissenters in the various political systems are labeled
as mentally sick.
The boundaries of mental illness. ???
WHO published the ICD-10 making the diagnoses
precise & more acceptable.
APA -- 5th revision of its diagnostic system, DSM – IV.
Both diagnostic systems are compatible with each
other puts to end the controversy of psychiatric
diagnosis.
1.PSYCHIATRIC DIAGNOSIS
11. However,
One should not equate a psychiatric diagnosis with
legal insanity or it should not be used as a defense
for reduced responsibility.
Because large number of psychiatric diagnoses do
not fulfill the legal conditions required for insanity.
Only for clinical purposes, as it provides a
reasonable guideline regarding etiology,
management & prognosis.
12. 2.INFORMED CONSENT
Medical paternalism: seeking consultation = consent for
treatment
NOW, a greater emphasis the patient's human rights
the nature of illness
treatments available
take part in the decision-making process.
Consumer protection movement compels the medical
profession to provide a detailed information for their
own safeguard.
13. Constituents of an Informed Consent:
A. Information to be provided by the treating
physician.
B. Competence of the patient to comprehend the
information provided.
C. Freedom to choose.
A specific statement that the consent could be withdrawn
whenever the patient wishes so.
Liberty to ask any further clarification or information.
14. several practical problems.
Informing a patient of schizophrenia / BPAD
Information of treatment options, like drugs &
ECTs, may not be fully understood by the patient &
make decisions on the basis of certain prevailing
biases and prejudices against each of these
treatment methods.
15. Competence of Patient:
Competence in this context refers to the patient's
ability to understand the nature & severity of his
presenting problems, and need of suggested
therapeutic help and its limitations.
How to asses competence ?
By asking a few questions on the information made
available to him.
Whether patient is able to objectively understand that he
is ill & requires treatment?
Can he understand the nature of each treatment option
& their consequences?
16. However,
Pt can be treated in an emergency even without the
consent.
Stuporose or acutely excited patient
Minors (below the age of 18 years) Relatives consent
Mental Health Act (1987) allows specified relatives to
give consent for admission in mental hospitals & for
treatment of pts on an outdoor basis.
One should take such consent in writing & as soon as the
patient is competent, his consent should be obtained.
17. 3.INVOLUNTARY vs VOLUNTARY
TREATMENT
As psychiatric patients do not consider themselves to
be ill, they have to be hospitalized or treated against
their will.
It is undeniable that most of the so called voluntary
patients are coerced to some extent for accepting
hospitalization. coercion may be from employer,
family or medical personnel.
Demand discharge after a few days of
hospitalization & they need to be persuaded to
continue treatment.
To be evaluated on the principle of beneficence.
18. Temporary hospitalization to regain sanity is a much
preferable alternative to staying chronically sick
Evidence for mentally ill in court of law Order for
admission can be secured.
Problem : 1% of the Indian population (12 million) should
be screened by the judiciary
A large number of such patients are treated as outpatients
& the only available consent is that of the concerned
relatives.
Peele, Chodoff & Taub state that "it is a perversion
and travesty to deprive these needy and suffering
people of treatment in order to preserve a liberty
which is in actuality so destructive as to constitute
another form of imprisonment.”
19. The Hawaii declaration of the WPA
“No procedure must be performed or
treatment given against or independent of a patient's
own will, unless the patient lacks capacity to express his
or her own wishes, or owing to psychiatric illness can not
see what is in his best interest or, for the same reason, is
a severe threat to others. In these cases, compulsory
treatment may or should be given, provided that it is
done in the patient's best interest and over a reasonable
period of time, a retroactive informed consent can be
presumed and, whenever possible, consent has been
obtained from someone close to the patient.”
20. As soon as the above conditions for compulsory
treatment or detention no longer apply the
patient must be released, unless he or she
voluntary consents to further treatment.
Whenever there is compulsory treatment, there
must be an independent and neutral body of
appeal for regular inquiry into these cases.
Every patient must be informed of its existence
and be permitted to appeal to it, personally or
through a representative without interference by
hospital staff or by anyone else.
Continued…
21. 4.CONFIDENTIALITY
Anything learned during the professional relationship
should not be revealed to others without the consent of
the patient.
Records of the patient should be strictly safeguarded,
so that no unauthorized person can have access.
Unauthorized person include any person other than the
treating team & the family member on whose consent
patient has been admitted
However after having achieved recovery, if the patient
advises the therapeutic team that even the admitting
family member/relative should not have access to
the patient's record.
The employers, insurance companies & other
interested parties should be provided information after
obtaining consent from the patient.
22. Protective Privilege Vs Public Peril:
EX: if a patient is planning to kill Mr. X, should the
psychiatrist inform Mr. X or the police, so that
protective measures could be taken?
Similarly, a bus or train driver suffering psychosis poses
threat to the public safety. Again, should the psychiatrist
inform or remain silent?
Consider the nature & the severity of the risk involved,
and then decide on an appropriate measure which
may cause least breach of confidentiality.
Discuss with the close family members & a colleague
to decide on an appropriate action.
23. When courts summon the psychiatrist to testify.
One should obtain the consent from the patient, and if
that is not forthcoming, then one has to depose after
lodging protest with the judge.
The confidentiality clause will require more careful
monitoring as the new Mental Health Act has come
into operation.
The records of the patient may be inspected by the
"inspectors" at any time. Some of these "inspectors"
may not be professionally trained. Therefore, one
must only record all the observations which seem to
be relevant to diagnosis and treatment.
24. 5.RESPECT FOR THE PATIENT
AND HIS HUMAN RIGHTS
Each patient has to be respected as an individual and
the aim of the treatment should be towards an early
restoration of the functioning of the individual.
Nothing should be done which could be perceived as
violation of human rights of the individual. Ex:
Restrains
Keeping in Solitary cell
ECT as punishment
Pain or torture as aversive methods
25. 6.THIRD PARTY RESPONSIBILITY
Many external agencies influence both the content as well
as the form of treatment.
In Western countries, insurance companies often provide
funds for the treatment, likely to influence policy of
hospitalization and its duration and sometimes provide
treatment option guidelines.
In India Govt. funded availability of drugs & trained
personnel might affect treatment.
Pharmaceutical companies undue importance on newer
anti depressant much costlier than TCAs
26. 7.PSYCHIATRIC RESEARCH
Helsinki Declaration guidelines regarding the use of human
subjects in research.
1.Any research which is not likely to directly benefit the patient
should not be undertaken.
2.No human subject should undergo research without adequate
safeguards. The researcher has to be a protector of the interest
of the patient.
3. Any patient, who is not able to give informed consent, should
not normally be included for purposes or research, unless such a
permission has been sought from the concerned family member
or relative.
4. While publishing research material, one should take care that
the research publication does not violate the confidentiality.
Declaration of Madrid 1996-WPA
27. In India there are few legislations for the
professional service & the public gives carte
blanche (unlimited authority) to the therapist.
A mechanism of inner controls has to be evolved to
maintain a high standard of practice & to develop
public confidence.
Some more points:
Fees should be appropriate to the local conditions &
should not be increased without appropriate reason.
Gifts of any kind during the therapy are not permitted.
Any kind of sexual advance towards the patient is
strictly prohibited
28. Ethics --- the relationship among psychiatrists
themselves.
Entertain a patient only after a due referral from
the treating psychiatrist.
Psychiatrists often do not react to the
malpractices of their colleagues misguided
notion disservice to the profession.
On the contrary, such black sheep in reality bring
the profession to disrepute and their exposure in
public would cleanse the profession.
29. Training the young:
Unfortunately, ethical issues are not given any
attention in the undergraduate & postgraduate
medical education.
Ethical issues should be discussed formally, so that
young doctors are sensitized to the kind of problems
they are likely to face.
Ethical practices are largely learned by the process of
imitation and, as such, it is mandatory that teachers
should themselves put up exemplary models for the
young medicos.
30. IPS code of ethics for psychiatrists(1989)
1. Responsibility
2. Competence
3. Benevolence
4. Moral standards
5. Patient welfare
6. Confidentiality
Principles in West:
1. Autonomy
2. Beneficence
3. Non-maleficence
4. Justice
32. Ethical codes have to be implemented with
sincerity.
Ethical committees may be formed at central
and zonal levels.
Should consider complaints either from public or
from fellow professionals and then, carefully
investigate them.
33. One should be clear with…..
1. Psychiatric diagnosis.
2. Informed consent.
3. Voluntary and involuntary treatment & hospitalizatio
4. Confidentiality.
5. Respect for the patient and his human rights.
6. Third party responsibility.
7. Psychiatric research.
34. References
1. Vyas JN, Niraj Ahuja. Textbook of postgraduate psychiatry,
vol-2 : Ethics in psychiatry. 2nd edition. New Delhi : Jaypee
brothers medical publishers;2008.
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