Sections
The Doctor–Patient Relationship | Maintenance of Therapeutic Boundaries in Psychopharmacological
Treatment | Informed Consent for Psychopharmacotherapy | Working With "Difficult" Patients | Ethical Use of High-Risk Pharmacotherapy | Ethical Use of Long-Acting Medications | Ethics of Off-Label Prescribing and Clinical Innovation
Excerpt
The therapeutic relationship in medicine and psychiatry is rooted
in the principles of beneficence and respect for autonomy. Historically,
an emphasis on beneficence over autonomy has been the hallmark of
paternalism, in which the physician acts benevolently and at times
unilaterally, like a parent, in dealings with patients. By contrast,
an emphasis on respect for autonomy over beneficence in the therapeutic
relationship highlights the importance of patients' rights.
Patients' rights in pharmacotherapy have been described
as including the following: "access to treatment; provision
of necessary information [about treatment]; the
freedom to accept or refuse treatment; and a voice in the selection
of specific drugs and the conditions under which to take them" (Brown and Pantelis 1999, p. 257). At its most extreme, a strictly
beneficence-based practice may diminish the ill individual, violating the
cardinal ethical principle that governs all actions in medicine
and human science: respect for persons. On the other hand, a strictly
autonomy-based practice at its most extreme appears to be akin to
a mere business transaction—a trade of goods and services
between two "equal" individuals, one with a product
or service and the other with an identified interest or need, with
no specific moral obligation between the two parties (Dyer 1988; Wise 2007).