This document outlines key concepts in medical ethics and legal issues in psychiatry. It discusses objectives of teaching ethics, including respecting patient autonomy, acting within legal and professional boundaries, and being responsible to society. Key concepts covered include informed consent, confidentiality, voluntary vs involuntary treatment, and competence. Several ethical scenarios are presented, such as a patient asking the doctor not to disclose a terminal cancer diagnosis or HIV status. Throughout, the document emphasizes that psychiatric practice requires upholding patient rights and welfare above all other considerations.

1. Prof. Dr. T. Bedirhan Üstün
Ethical
Legal
Issues
In
Psychiatry

2. Objectives of this lecture
At the end of the lecture, the student should be able to
• Understand and use basic ethical concepts in psychiatry to deliver
competent & respectful care:
• Respect the rights & autonomy of patients.
• Act within the boundaries of rules of good conduct and law.
• Be responsible to the community and society.

3. Some questions:
• A student asks for a sick note for preparing exams
• Patient’s family asks doctor not to tell the patient that s/has cancer
• A patient may give an expensive gift to the doctor
• An HIV+ patient asks doctor not to tell his status to his/her partner
• A teenager asks doctor not to tell the family that she is pregnant
• Patient’s family asks to give a competency report for a demented patient
• An terminally ill patient asks for high doses of morphine to die
• A patient says that s/he is in love with you and invites you for dinner
• A bipolar patient wants to marry
• A transsexual patient wants to have surgery for sex-reassignment surgery

4. ETHICS
• Ethics has been derived from the Greek term ethikos,
“rules / principles of conduct”
• A dynamic & systematic evaluation about:
• values
• Fairness
• Actions and consequences

5. RELEVANCE OF ETHICS TO PSYCHIATRY
• Demarcation between normal & abnormal:
• psychiatric diagnosis & treatment can be easily questioned.
• The psychiatric treatment may be utilized for controlling behavior.
• Psychiatric practice involves close relationship between the doctor and
the patient

9. Key Concepts in Ethics and Legal Issues in Psychiatry
1. Psychiatric diagnosis
2. Confidentiality
3. Informed consent
4. Voluntary and involuntary treatment & hospitalization
5. Respect for the patient and his human rights

10. CONFIDENTIALITY
• Anything learned during the professional relationship should not be
revealed to others
• If necessary the consent of the patient should be obtained.
• Others include: the employer, insurance companies, government
• Records of the patient should be strictly safeguarded, so that no
unauthorized person can have access
• Includes family members.

11. Questions
• a patient informs his therapist that he is
planning to kill Mr. A, should the
psychiatrist inform Mr. A or the police, so
that protective measures could be taken?
• if a bus or train driver, airline pilot
suffering mental illness poses threat to
the public safety, should the psychiatrist
inform the police, employer or remain
silent?

12. Conflicts in HEALTH CARE
• VALUES: doctor’s vs. patients vs. state
• Abortion
• Homosexuality
• …
• Organ transplantation
• Assisted suicide
• Interest of the patient vs. state
• sick note
• cost
• Interest of individual patients vs. wider population
• Cosmetics vs essential care
• Immunization vs treatment of end-stage illness
• Confidentiality

13. 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.

14. Competence of Patient:
Competence refers to the patient's ability to understand the nature &
severity of his/her actions (including presenting problems, and need of
suggested therapeutic help and its limitations).
Children – Under 18: “is the child responsible of his/her actions”
Adults:
- permanent - mental retardation, dementia…
- temporary - transient psychosis, bipolar disorder…

15. Voluntary vs. Involuntary admission
• Some voluntary patients are coerced for accepting hospitalization
• coercion may be from family, police or others.
• Some psychiatric patients have to be hospitalized or treated against their
will.
• Psychosis
• Anorexia
• …
• Demand discharge after a few days of hospitalization & they need to be
persuaded to continue treatment.
• To be evaluated on the principle of benefit

16. I, Pierre Riviere, Having Slaughtered My Mother,
My Sister, and My Brother
Michel Foucault, author of Madness and Civilization and Discipline and Punish,
• Idiot of the village – kept chained
• Kills mother, sister and brother
• Learns to write in jail and defends himself
• How did 19th century
• medical doctors
• Legal experts

17. Some questions:
• A student asks for a sick note for preparing exams
• Patient’s family asks doctor not to tell the patient that s/has cancer
• A patient may give an expensive gift to the doctor
• An HIV+ patient asks doctor not to tell his status to his/her partner
• A teenager asks doctor not to tell the family that she is pregnant
• Patient’s family asks to give a competency for a demented patient
• An terminally ill patient asks for high doses of morphine to die
• A patient says that s/he is in love with you and invites you for dinner
• A bipolar patient wants to marry
• A transsexual patient wants to have surgery for sex-reassignment surgery

18. Summary
• All relations/treatment should do no harm - be humane and never
punitive.
• Know your boundaries:
• Know the limits of medical knowledge:
• No experimentation
• No sexual advance towards any patient.
• In case of doubt, a second opinion must be obtained.

19. Questions & Answers
bustun@ku.edu.tr
@ustunb
bedirhan-ustun