Subject Index

Abandonment, of patient,

63

Academic psychiatry,

33

Access, to health care,

xviii–xix, 89

Accountable care organizations,

87

Accreditation Council for Graduate Medical Education,

13, 20, 102

Addiction psychiatry,

33

Adolescents, ethical issues in mental health care for,

105–106

Advance directives,

73–75

Advocacy, and social stigmatization of mental illness,

88–89

Age

. See also Adolescents; Children; Elder abuse

cognitive impairment in colleagues and,

91–92

consent for treatment by children and,

106

Algorithms, and new issues in ethics,

xvi–xvii, 96–98

Alternative decision-making,

73–75

Altruism,

xiv, 32, 47

practitioner’s needs as secondary to patient’s, xiv American Academy of Pediatrics,

8

American Board of Internal Medicine (ABIM),

12, 17

American Medical Association (AMA),

9, 52, 61, 80, 81, 89–90

American Nurses Association,

55

American Psychiatric Association (APA),

52, 53–54, 61, 80, 84, 87, 89, 93, 104

American Psychological Association,

9, 52, 55, 61, 90, 93, 102

Appreciation, and decisional capacity,

71, 72

Artificial intelligence,

xvi, 96

Association of American Medical Colleges,

101, 107

Autonomy

definition of,

47, 50

example of in common clinical situation,

29

involuntary treatment and,

76

precision psychiatry and,

98

stigmatization of mental illness and,

89

Awareness of limits, as key ethics skill,

35

Beauchamp, Thomas,

45

Belmont Report (National Commission et al. 1979),

57, 58

Beneficence

definition of,

47, 50

ethical decision-making and,

42

examples of in common clinical situations,

29, 31, 32

Bentham, Jeremy,

45

Bias

. See also Implicit bias; Racism

algorithms and perpetuation of,

xvii, 96

in clinical decision-making,

75

empirical research on,

42

patterns of in medical profession and inequities in mental health care,

15

professional burnout and,

24

Bioethics,

xviii

Bipolar disorder,

74–75

Boundaries, and boundary violations

. See also Boundary crossing

definition of,

49

example of in common clinical situation,

32

maintenence of,

61–63

psychotherapy and,

xix

sexual relationships and,

61–62, 107–108

warning signs of,

64–65

Boundary crossing,

62–63

BRAIN 2020 initiative,

xvi

“Break the glass” protocols, for access to medical records,

84

Burnout

. See also Well-being

as continuum,

22

factors influencing,

24

as new issue in medical ethics,

xv

patient abandonment and,

63

risk factors for,

22, 25

symptoms of,

23

Canada, and euthanasia,

79

Care ethics,

45–46

Case-based approach, to teaching about ethics,

20

Case studies, of ethics in clinical situations,

xiii, 118–121

Case Western Reserve University School of Medicine,

90

Casuistry, and ethical decision-making,

45

Charity, definition of,

47

Child abuse

confidentiality and,

84

female genital mutilation as,

81

reporting of suspected,

xii

Child and adolescent psychiatry, examples of ethical challenges in,

33

Children, ethical issues in mental health care for,

105–106. See also Child abuse

Childress, James,

45

Client, use of term,

xviii

Climate change, and extreme weather events,

ix

Clinical competence, and holistic concept of professionalism,

12

Clinical innovation, decision tree for ethical use of,

95

Clinical medical ethics,

5, 6

Code of Ethics (National Association of Social Workers 2017),

21, 55

Code of Ethics (National Board for Certified Counselors 2016),

55

Code of Ethics for Nurses: With Interpretive Statements (American Nurses Association 2015),

55

Code of Medical Ethics (American Medical Association),

52, 80

Code of silence, and colleague impairment or misconduct,

92

Coercion, definition of,

47

Cognitive functioning, and informed consent,

70

Colleagues, responding to impairment or misconduct of,

89–93

Common Rule (1981),

58, 59–60

Communication of preference, and decisional capacity,

70, 72

Communitarian ethics,

46

Compassion, definition of,

47, 51

Competency,

70. See also Decisional capacity

Complex patients

. See Difficult patients

Comprehension, and decisional capacity,

72

Concepts of Psychiatry: A Pluralistic Approach to the Mind and Mental Illness, The (Ghaemi 2003),

xix

Confidentiality

children and adolescents as patients and,

106

definition of,

47, 50–51, 82–83

do’s and don’ts for protecting,

86

electronic health records and,

83–84

examples of clinical issues,

29, 30, 31, 60

informing patient about,

84–85

legal issues and,

83

LGBTQ+ patients and,

105

need-to-know approach to,

84

“open notes” and,

84

research and,

114–115

Conflict of commitment,

47

Conflict of conscience,

47

Conflicts of interest,

47, 85, 87–88

Consent, for treatment of children and adolescents,

105–106. See also Informed consent

Consultation

confidentiality and,

86

difficult patients and,

102

LGBTQ+ patients and,

105

willingness to seek as key ethical skill,

36

Consultation-liaison psychiatry,

33

Context, and ethics of mental health practice,

xiii

Convention Against Transnational Organized Crime (United Nations 2004),

82

Conversion therapy,

104–105

Core competencies, and professionalism,

13

Countertransference

. See also Doctor-patient relationship

difficult patients and,

101

patient abandonment and,

63

personal values of mental health professionals and,

35

psychotherapy and training in,

xix

COVID-19 pandemic,

ix, xvi, xvii

Cultural competence,

102–103

Culture

ethical issues in caring for culturally diverse patients,

102–104

ethics-related education for mental health professionals and,

20–21

professional burnout and,

24

Daily diary app,

98–99

Data presentation, and research,

116

Decisional capacity

. See also Decision-making

advance directives and,

75

informed consent and,

67, 69–72

research protocols and,

115–116

Decision-making

. See also Decisional capacity

definition of,

49

ethical use of power in,

75–82

models for ethical,

39, 40, 41, 43

patient-centered care and,

65–66

Declaration of Helsinki (World Medical Association 1964),

55, 56–57

Deinstitutionalization, and involuntary outpatient treatment,

77

Dementia,

70

Deontology,

45

Depression

. See Psychotic depression; Treatment-resistant depression

Diagnostic-driven restrictions, on research,

109

Differential diagnosis, and difficult patients,

102

Difficult patients

ethical issues in caring for,

99, 100, 101–102

examples of ethical challenges and,

34

Digital medicine, and new ethical issues,

98–99

Discernment, and insight,

51

Discussion-oriented approaches, to education on ethics,

20

Distributive justice,

50

Doctor-patient relationship

. See also Boundaries; Countertransference

informed consent and,

66, 69

personal values of mental health professionals and,

35

Dual agency,

85, 87–88. See also Multiple roles

Duty of care,

48

Education

. See also Training

dual roles and,

85

on ethics,

17–21, 43–44

importance of lifelong learning,

xxi–xxii

public professionalism and,

11

Elder abuse, and confidentiality,

84

Empathy, definition of,

48, 51

Empathy-focused approach, to education on ethics,

20

Empirical basis, of ethics,

41–44

Equipoise,

48

Ethical Principles of Psychologists and Code of Conduct (American Psychological Association 2017),

52, 55

Ethics

. See also Autonomy; Beneficence; Boundaries; Confidentiality; Decision-making; Education; Informed consent; Legal issues; Nonmaleficence; Power; Professionalism; Research

advance directives and,

73–75

case studies of,

118–121

centrality of in mental health care,

13–16

codes and practical guidelines for,

51–58

conflicts of interest and,

47, 85, 87–88

definitions of and examples of principles,

xi, 4, 46, 50–51

difficult patients and,

99, 100, 101–102

empirical basis of,

41–44

essential skills of mental health professionals and,

27–28, 34–36

examples of challenges in,

ix, 33

examples of clinical issues,

xi–xii, 29–32, 58, 60

future directions in,

117–118

glossary of terms,

47–49

impairment or misconduct of colleagues,

89–93

involuntary treatment and,

76–78, 79

multidisciplinary practice and,

94

multiple roles and,

37, 85, 87–88

neuroethics and neuroscience,

16, 17

new modes of prediction, evaluation, and treatment,

95–99

philosophical basis of,

44–46

practical problem-solving and,

36, 39, 41

special populations and,

102–106

Euthanasia

controversial aspects of ethics and,

xv

definition of,

48, 78

legal status of,

78–79

Evaluation, new diagnostic tools for,

98–99

Exploitation Index,

62–63

Facebook,

97. See also Social media

Faculty, ethical obligations of toward trainees,

107

Family

boundary violations and,

63

culturally diverse patients and,

103, 104

Favorable risk-benefit ratio, in research,

111

Fee-splitting arrangements,

87

Female genital mutilation (FGM),

81–82

Fidelity

definition of,

48, 50, 51

examples of in common clinical situations,

30, 31

as principle of professionalism,

9

Fiduciary, definition of,

48, 51

Financial issues

. See also Pharmaceutical industry

access to health care and,

xviii–xix

conflicts of interest and,

87

Forensic psychiatry,

33

Four-step procedure, for dealing with colleague impairment or misconduct,

92

Four-topics method, of ethical decision-making,

39, 43

Futility, definition of,

48

Gabbard, Glen,

91

Gender-affirming therapy,

105

Gender identity

ethical decision-making and,

42

professional burnout and,

24

Genetic testing,

98

Geriatric psychiatry,

33

Germany, Nazi era and history of psychiatry,

75–76

Gifts, and pharmaceutical industry,

87–88

Harvard Medical School,

90

Health care, and health care system

. See also Access; Medical illness; Mental health care; Nurses; Patient-centered care; Primary care physicians

changes in and provider burnout,

22

financial considerations and,

xviii–xix

integrated systems of,

14–15, 87

mental illness diagnoses and risk of inadequate,

89

Health insurance

. See Managed care

Health Insurance Portability and Accountability Act (HIPPA 1996),

83

High-risk situations, recognition of as key ethical skill,

35–36

Hippocrates, and Hippocratic oath,

xviii, 8, 51–52, 82–83

Homelessness, and patients with overlapping vulnerabilities,

106

Honesty, definition of,

48. See also Veracity

Human dignity, definition of,

48

Human subjects, and regulations on research,

18–19

Human trafficking,

82

Identification, of ethical issues,

28, 34

Impairment, in colleagues,

89–93

Implicit bias, impact of on health care,

35. See also Bias

Incentives, for research participation,

116

Independent review, of research,

111, 113, 116

Information sharing, and informed consent,

67–69, 70–71

Informed consent

. See also Consent

decisional capacity and,

66–67, 69–72

definition of,

48, 63, 65

examples of clinical issues,

60

patients as participants in training and,

108

research and,

19, 55, 109–110, 111, 113, 115–116

treatment refusal and,

73

voluntarism and,

72–73

Insight, and decisional capacity,

71

Institute of Medicine,

66

Institutional review board (IRB),

18, 58

Integrated health care systems,

14–15, 87

Integrity, definition of,

49

Interpersonal professionalism,

9, 10, 11

Interrogation, and medical or psychiatric ethics,

81

Intrapersonal professionalism,

9, 10, 11

Invasive treatments, and emerging issues in ethics,

117

Involuntary treatment, and ethical uses of power,

76–78, 79

Jaffee v. Redmond (1996),

83

Joint Commission,

xx

Justice

. See also Social justice

as component of professionalism,

9

definition of,

49, 50

ethical decision-making and,

42

example of in common clinical situation,

32

utilitarianism and,

45

Kant, Immanuel,

44

Kantianism,

44–45

Kendra’s Law (New York),

77

Language

culturally diverse patients and,

103

LGBTQ+ patients and,

105

Legal issues

confidentiality and,

83, 86

consent for treatment of children or adolescents,

105–106

decisional capacity and,

70

female genital mutilation and,

81

impairment or misconduct in colleagues and,

90, 91, 92, 93

informed consent for research participation,

19

involuntary treatment and,

76–78

physician-assisted suicide and euthanasia,

78–79

LGBTQ+ patients, ethical issues in caring for,

104–105

Lieber, Charles,

88

MacArthur Treatment Competence Study (1995),

43

Machine learning,

96–97

Managed care, and conflicts of interest,

87

Medical Ethics; or a Code of Institutes and Precepts (Percival 1803),

52

Medical illness, and patients with overlapping vulnerabilities,

106

Medical records, and confidentiality,

86

Medical School Graduate Questionnaire (Association of American Medical Colleges),

101, 107–108

Mental health care

. See also Mental illness; Outpatient setting; Psychiatry; Psychology; Psychotherapy

centrality of ethics in,

13–16

changes in systems of as emerging issue in ethics,

117–118

Mental illness, social stigmatization of,

88–89. See also Bipolar disorder; Mental health care; Posttraumatic stress disorder; Psychotic depression; Treatment-resistant depression

Military psychiatry,

34, 85, 87

Mill, John Stuart,

45

Misconduct, of colleagues,

89–93

Moral trust, and professional behavior,

5

Multidisciplinary practice, and ethical issues,

94

Multiple roles, ethical risks associated with,

37, 85, 87–88

National Association of Social Workers,

21, 55

National Board for Certified Counselors,

55

National Commission for the Protection of Human Subjects of Research

. See Belmont Report

“Need to know” approach, to confidentiality,

84

Negligence, definition of,

49

Neuroethics, and neuroscience,

xv, 16, 17

Neurosurgery, and novel therapies in psychiatry,

99

New England Journal of Medicine, The,

41

New York, and involuntary outpatient treatment,

77

“No free lunch” (www.no-free-lunch.org),

xxi

Nonmaleficence

definition of,

46, 49

ethical decision-making and,

42

examples of in common clinical situations,

29, 30, 31, 32

involuntary treatment and,

76

Nuremberg Code,

55, 56, 111

Nurses

. See also Health care

codes of ethics for,

55

multidisciplinary practice and,

94

“Open notes,” and confidentiality,

84

Outpatient setting, and involuntary treatment,

77–78

Parens patriae, and involuntary treatment,

76–77

“Parity” legislation,

50

Participant-oriented approach, to education on ethics,

20

Patient(s)

. See also Confidentiality; Difficult patients; Doctor-patient relationship

abandonment of,

63

ethical decision-making and preferences of,

40

psychiatric training and,

107, 108

use of term in context,

xviii

Patient-centered care, and shared decision-making,

65–66

Percival, Thomas,

52

Perspectives of Psychiatry, The (McHugh and Slavney 1998),

xix

Personality style, and difficult patients,

102

Pharmaceutical industry

challenge of managing relationships with,

xxi

conflicts of interest and,

87–88

education on ethics and,

20

Philosophical basis, of ethics,

44–46

Physician-assisted dying,

xv, 78–80. See also Euthanasia

Physician Suicide: Cases and Commentaries (Yellowlees 2019),

91

Police power, and involuntary treatment,

76–77

Posttraumatic stress disorder (PTSD),

82

Poverty, and overlapping vulnerabilities of patients,

106

Power

ethical use of in clinical decision-making,

60, 75–82

faculty-trainee relationship and,

107

informed consent and differential in clinician-patient relationship,

69

Precision psychiatry,

98

Prediction, ethical questions for emerging methods of,

96–98

Prescribing, of medications, and boundary violations,

63

Primary care physicians

. See also Health care

mental health care functions by,

14

multidisciplinary practice and,

94

Primum non nocere (“first do no harm”),

xviii, 46

Principle-based approach, to definition of professionalism,

6, 8, 9

Principle-based ethics,

45

Principles of Medical Ethics (American Medical Association 1957),

52, 90

Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry, The (American Psychiatric Association 2010),

52, 53–54

Privacy, definition of,

50

Professionalism

. See also Ethics; Fidelity; Justice; Veracity; Well-being

components of,

8–9

core competencies and,

13

definitions of,

xiv, xviii, 4, 6, 8

different conceptualizations of,

7

emphasis on in health care education,

18

holistic concept of,

12

moral standing and,

4–5

standards for training in medical residency and,

21

thematic approach to,

6, 8, 9–12

“weaponized” or criticisms of,

19

Professionalism Charter (American Board of Internal Medicine Foundation et al. 2002),

17

Professionalism and Ethics: Q & A Self-Study Guide for Mental Health Professionals (Roberts 2008),

xiv–xv

Professional standard, for informed consent,

68

Project Professionalism (American Board of Internal Medicine 1999),

12

Psychedelic drug compounds,

99

Psychiatric advance directives,

74–75

Psychiatry

. See also Forensic psychiatry; Mental health care; Military psychiatry; Psychotherapy; Rural psychiatry

ethical issues in training,

108

four-topics method of ethical decision-making and,

39, 41

importance of ethics education,

20, 44

moral standing of as profession,

5

professionalism competencies and,

13

Psychology, and psychologists

codes of ethics for,

52, 55

ethical issues in training,

108

LGBTQ+ cultural competence and,

105

Psychotherapy

boundary violations and,

xix

examples of ethical challenges in,

34

Psychotic depression,

74–75

Public health, dual roles and conflicts of interest,

85

Public professionalism,

9, 10, 11

Quality of life

definition of,

49

ethical decision-making and,

40

Racism

. See also Bias

ethical decision-making and,

42

professional burnout and,

24

Reasonable person standard, for informed consent,

68

“Reasonable probability,” and reporting of suspected child abuse,

xii

“Reasonable risk,” and professional training,

108

Reasoning, and informed consent,

71–72

Refusal, of treatment and informed consent,

73

Relationship ethics,

46

Remotely delivered psychiatry, examples of ethical challenges in,

34

Research

codes of ethics for,

55, 56–57, 57–58

dual roles and,

85

examples of ethical issues in,

xxi, 108–13, 114–116

neuroscience and,

16

regulations involving human volunteers or participants,

18–19

safeguarding of participants,

38

Respect

. See also Autonomy

definition of,

49, 50, 51

research subjects and,

111, 113

Risk-benefit ratio, and research,

111, 113, 114

Risk factors, for professional burnout,

22, 25. See also High-risk situations

Roberts Ethical Valence Model,

110–111, 112, 113

Rural psychiatry

confidentiality as problem in,

83

examples of ethical challenges in,

34

problem of provision of competent care in,

35

Safeguards

for euthanasia,

79

practice of mental health professionals and ethical,

36

Safety, and difficult patients,

102

Scientific validity, of research,

111, 113, 114

“Secondary traumatization,” and professional burnout,

22

Self-understanding, definition of,

49

Sexual Exploitation in Professional Relationships (Gabbard 1989),

91

Sexual relationships, and boundary violations,

61–62, 107–108

Sliding-scale, and informed consent,

66–67, 68, 73

Socialization, of emerging professionals,

6

Social justice

. See also Justice

as core value of social work,

21

ethical decision-making and,

42–43

Social media

. See also Facebook

boundary violations and,

62

as new issue in ethics,

xv, 96

Social relationships, and boundary violations,

62, 63

“Social suicide prediction,”

97

Social work, and social workers

burnout and,

23

codes of ethics for,

21, 55

culture and social justice as core value,

21

ethical issues in training,

108

multidisciplinary practice and,

94

Soviet Union, and history of ethics in psychiatry,

76

Special populations, ethical issues in caring for,

102–106

State licensing boards, and physician impairment,

93

Stigmatization, of mental illness,

88–89

Students, and school review committees,

90

Subject selection, and research,

111, 113

Substance abuse, confidentiality and treatment of,

83–84

Suicide, and suicidal ideation

case study in management of,

xx–xxi

gender-diverse and LGBTQ+ patients,

105

physician-assisted dying or euthanasia and,

80

risk prediction algorithms and,

97

Tarasoff v. Regents of the University of California (1976), and Tarasoff ruling,

84

Technological advances, and future directions in ethics,

xv, 117

Thematic approach, to definition of professionalism,

6, 8, 9–12

Therapeutic relationship

. See Countertransference; Doctor-patient relationship; Transference

Torture, and interrogation,

81

Training, ethical issues in professional,

107–108. See also Education

Transference

. See also Doctor-patient relationship

personal values of mental health professionals and,

35

training in psychotherapy and,

xix

Treatment-resistant depression, and novel therapeutics trial,

99

Trust

professional behavior and,

5

of public in research,

111

Trustworthiness, definition of,

49

Understanding of information, and decisional capacity,

70–71

United Nations,

81, 82

Utilitarianism,

45

Utility, definition of,

50

“Valence” factors, and ethical issues in research,

110–111, 112

Values

influence of personal on care of patients,

34–35

research and,

111, 113

Veracity

definition of,

50

example of in common clinical situation,

29

as principle of professionalism,

9

Veterans Affairs,

85, 87

Virtue(s), definitions and examples of ethical,

46, 50–51

Virtue ethics,

46

Voluntarism, and informed consent,

67, 72–73, 74

Voluntary, definition of,

49

Vulnerability, definition of,

49

Well-being, professional

. See also Burnout

example of in common clinical situation,

32

fundamental role of in ethics and professionalism,

21–25

as new issue in medical ethics,

xv

Wellness checks, and algorithms,

97

World Health Organization,

82

World Medical Association,

55, 56–57, 81

Wuhan University of Technology,

88

Yellowlees, Peter,

91