APA Ethics Update Offers ‘Bonanza’ of New Material

A new version of the document Opinions of the Ethics Committee on the Principles of Medical Ethics—With Annotations Especially Applicable to Psychiatry has been published by APA.

It was compiled by members of APA's Ethics Committee. Burton Reifler, M.D., a member of the committee, spearheaded the project. It replaces the version published in 2001.

The new document, like its predecessor, is based on real-life ethical questions that psychiatrists have forwarded to the Ethics Committee for answers. The answers provided by the committee are suggested guidelines, not policy that must be approved by the APA Board of Trustees. And the new document, like the old one, covers a wide swath of ethical territory.

For example, it addresses questions as diverse as “Is it ethical for a psychiatrist to have a platonic friendship with a sibling or a parent of a former patient?,” “Is it ethical for a colleague to make a diagnosis of mental illness solely because the individual has joined a new religion or cult?,” and “Can I give confidential information about a recently deceased mother to her grieving daughter?”

The document adds new material as well. For example, a new opinion has been added regarding the psychological profiling of historical figures. This new opinion states: “The psychological profiling of historical figures designed to enhance public and governmental understanding of these individuals does not conflict with the ethical principles outlined in Section 7, Paragraph 3, as long as the psychological profiling does not include a clinical diagnosis and is the product of scholarly research that has been subject to peer review and academic scrutiny, and is based on relevant standards of scholarship.”

“As for especially important opinions, it is difficult to pick out a favorite or two,” Wade Myers, M.D., chair of the Ethics Committee, told Psychiatric News. “If pressed, I would say the two new opinions in the ‘Resident, Student, and Other Trainee Issues’ section—one regarding residents' refusal to admit patients from certain hospitals or with certain diagnoses and the other on whether it is ethical to date the mother of a former patient—would rank as the most important for two reasons. First, they expand our ethics focus on the practice issues that arise with psychiatric residents. Residents are the future of our profession, and the more we can help them prepare to practice ethically, the stronger psychiatry will be.

“Secondly, these two new opinions provide a bonanza of ethical material for consideration by the practitioner and for teaching purposes. Together they bring into play confidentiality, boundary issues, family dynamics, informed consent in minors, collaborative therapy, organizational ethics, access-to-care issues, duty to report suspected deficient patient care, respect for the law, and the Emergency Medical Treatment and Active Labor Act.”

But probably the biggest difference between the new and old documents “is that the material has been totally reorganized,” said Linda Hughes, director of APA's Office of Ethics and District Branch and State Association Relations. “Previously, the opinions were all listed under the principles of medical ethics. Now they are listed by topic. And that is going to be really helpful to readers, including people who teach ethics.”

Reifler agreed: “The revised format should prove more useful to members as a quick-reference guide when an issue comes up.”

In addition to issues particularly relevant to residents, students, and other trainees, the new document covers such topics as boundary and dual-relationship issues, business practices and ancillary professional activities, confidentiality and informed consent, duty to report, and professional-competency issues, interactions with other professionals, managed care, referral practices, and research and scholarly activities.

The ethics document is posted at <www.psych.org/MainMenu/PsychiatricPractice/Ethics/ResourcesStandards/OpinionsofPrinciples>.