Q&A Index

Abandonment, of patient,

4.9, 4.30, 4.47

Ability to reason, and decisional capacity,

3.6

Access, to health care,

3.20

Accountability,

7.4

Accreditation Council for Graduate Medical Education,

6.8

Active euthanasia,

3.4

Addington v. Texas (1979),

3.33

Adherence,

7.4

Adolescents

. See also Child and adolescent psychiatry

child abuse and evaluation of,

4.12

decision-making capability and confidentiality,

7.14

laws on medical and mental health care for,

4.14, 7.51

Advance directives,

3.28, 3.39, 4.23, 4.32, 6.12

Adverse events, in research,

5.30

Advocacy,

3.2, 4.11, 7.12, 7.43

African Americans, and historical examples of research abuses,

3.21

Against medical advice (AMA) discharge,

4.25

Aggressive behavior, substancerelated,

4.40

Alcohol intoxication and withdrawal,

4.40, 7.8

Altruism,

5.3, 7.47

Alzheimer’s disease,

3.21, 4.15, 7.53

American Medical Association,

3.4, 3.16, 3.27

American Psychiatric Association,

3.26, 6.5, 6.9, 7.48

American Psychological Association,

6.14, 6.18, 7.48

Americans with Disabilities Act (1990),

6.35, 6.36

Analogy, and casuistry,

3.24

Animals, and ethical research,

5.8, 5.32

Anonymous methods, for data collection,

5.14

Antipsychotics,

3.7, 4.36, 7.33, 7.55. See also Medications

Anxiety disorders,

4.1, 4.31, 7.64

Appreciation, and decisional capacity,

3.6, 7.55

Area of expertise,

3.12

Artificial intelligence algorithms,

4.50

Assessment

. See Decisional capacity; Decision-making; Risk assessment

Assisted suicide,

3.4, 7.29

Audit, of research,

5.30

Authorship,

5.20, 6.21, 7.70

Autonomy

beneficence and,

3.30, 3.41, 7.5, 7.27, 7.42

definition of,

3.1, 7.7, 7.47

emergency medical care and,

4.3, 7.30

examples of,

7.21, 7.53, 7.74

Beauchamp, Tom,

3.27

Belmont Report, (1979),

3.21, 5.1, 5.33, 7.44

Beneficence

autonomy and,

3.30, 3.41, 7.27, 7.41

confidentiality and,

7.5

definition of,

5.33, 7.7, 7.47

duty of care and,

4.19

examples of,

7.46

human subjects research and,

5.1

medication trials and,

7.33

Bentham, Jeremy,

3.24

Bias, definition of,

6.28. See also Discrimination

Bipolar disorder

consultation on psychopharmacology for,

3.7

decisions on health care and,

7.24

fidelity in prescribing practices and,

3.26

health care and stigmatization of mentally ill,

6.17

nonmaleficence and autonomy in treatment of,

7.74

religious beliefs and,

3.19

Boundaries, and boundary violations

boundary crossings and,

4.42

disability evaluations and,

7.19

examples of,

7.57

multiple roles and,

3.14

physical contact and,

4.23

sexual relationships and,

3.13, 7.14, 7.48

social relationships and,

3.3

Cannabis,

4.40

Casuistry, and analogy,

3.24

Centers for Disease Control and Prevention (CDC),

6.36

Child abuse

cultural differences and,

3.38

reporting of suspected,

3.38, 4.1, 4.12, 4.22, 4.24, 6.33, 7.5

Child and adolescent psychiatry,

4.53, 7.21, 7.22. See also Adolescents

Children

. See also Child abuse

decisions related to health care for,

4.10

genetic testing and,

4.15

informed consent by,

4.29, 5.21

as research subjects,

5.21, 5.22

Cocaine, and cocaine dependence,

4.40, 6.17

Code of Federal Regulations,

3.14, 3.21

Coercion,

4.41, 6.26

Colleagues, misconduct or impairment

definition of impairment,

6.2, 7.75

education of on requirements for reporting child abuse,

6.33

gestures of support for,

7.28

interns and reporting of in peers,

6.31

issues of power and reporting of,

6.4

obligation to intervene in cases of,

7.75

referral and,

6.1

Committee on Publication Ethics,

6.27

Common Rule,

5.34, 5.36

Communication, and decisional capacity,

3.6, 4.46

Community, and multiple roles of mental health professionals,

6.9. See also Small communities

Compassion,

3.1, 3.12, 4.33, 7.34

Competency, for decision-making,

3.39, 4.20, 7.13, 7.67

Confidentiality

adolescents and,

7.14

beneficence and,

7.5

consultation and,

6.30

data collection and,

5.14

death of patient and,

4.35, 7.60

dual agency situations and,

4.21, 7.38

examples of,

7.23, 7.39, 7.40, 7.43, 7.46, 7.50, 7.72

Hippocratic Oath,

3.32

importance of and exceptions to,

4.1

inadvertent breach of,

3.9

informed consent and,

6.29

letters of recommendation and,

6.13

media inquiries and,

3.22, 7.8

medical records and,

4.16, 7.1, 7.8

rural psychiatry and,

3.14

Conflicts of interest

. See also Dual roles; Financial incentives; Pharmaceutical industry

conduct of research and,

5.11, 5.18, 5.27

definition of,

7.15

paid consulting roles and,

6.6

public disclosure of,

3.35

techniques for managing,

3.40

Consultation,

3.7, 3.36, 3.37, 5.7, 6.30

Continuing education,

3.7, 7.31

Copyrights,

5.17

Countertransference,

4.47. See also Transference

Couples therapy,

7.5

COVID-19 pandemic,

3.43, 4.56, 6.36

Creative Commons,

5.17

CRISPR-Cas9 gene-editing technology,

5.25

Cruzan v. Director, Missouri Department of Public Health (1990),

3.33, 7.67

Culture

discipline of children and,

3.38

examples of,

7.68

influence of on behavior,

4.44

informed consent and,

4.26

role of family in medical decisions,

7.54

therapist unfamiliarity with,

3.25

Dangerousness, and involuntary commitment,

4.7, 7.31. See also Duty to warn; Violent behavior

Data safety monitoring boards, and data use agreements,

5.35

Death, of patient,

4.35, 7.60. See also Assisted suicide; Euthanasia; Suicide

Decisional capacity

. See also Competency; Decision-making

assessment of,

4.3, 7.37

components of,

3.6, 7.12, 7.55

dementia and,

4.46

mental illness and compromised,

5.10

refusal of treatment and,

4.39, 6.24, 7.2, 7.56

Decision-making

. See also Advance directives; Competency; Decisional capacity

assessment of,

3.39

four-topics method for,

3.20

medical care and capacity for,

4.25

Declaration of Helsinki,

3.21

Deidentification, of research data,

5.35

Delirium,

4.39

Delusional disorder,

7.72

Dementia,

4.46, 7.37, 7.66

Deontology,

3.24

Depression

. See also Major depression

confidentiality and,

7.64

consultation and,

7.22

disclosure of errors to patients,

3.29

evaluation for,

7.42

language and cultural issues,

3.31

referral for urgent care,

7.6

suicidality and choice of treatments for,

4.52, 6.15

therapeutic alliance and referral,

4.47

Difficult patients,

4.8, 4.30, 4.33

Disability determinations,

3.18, 4.11, 7.19

Disclosure

of conflicts of interest,

3.35, 3.40

of errors to patient,

3.29

Discrimination,

3.8, 6.28, 6.32, 7.20. See also Bias

Distributive justice,

3.43, 5.33

Doctor-patient relationship

. See also Countertransference; Therapeutic alliance

confidentiality and,

4.1, 6.5

gifts and,

4.17, 4.34

new or controversial treatments and,

4.5

social relationships and boundaries,

3.3

Do-not-resuscitate/do-not-intubate (DNR/DNI) orders,

4.4

Double-blind studies,

5.35

Down syndrome,

7.53

Dual roles

confidentiality and,

7.38

conflicts of interest and,

3.23, 6.9

fellowship programs and,

6.18

forensic evaluations and,

4.11

military psychiatry and,

4.21

peer review and,

6.27

residency programs and,

6.14

rural communities and,

3.14

veracity and,

7.71

Duty of care,

4.19

Duty to warn,

7.46, 7.62

E-cigarettes,

7.76

Education

. See also Continuing education; Faculty; Medical students; Residents; Trainees

of colleague on reporting of child abuse,

6.33

dual roles and fellowship programs,

6.18

of medical colleagues by psychiatrists,

6.17

Elder abuse,

4.24

Electroconvulsive therapy (ECT),

7.5

Emergency situations, and emergency department

duty of care and,

4.19

informed consent and,

4.18, 4.41, 7.58

language and patient interviews,

7.9

justice and,

7.30

presumed consent and,

4.32

refusal of medical care in,

4.3, 6.24, 7.2

Employee assistance program,

7.5

Employment

appropriate topics in interviews,

6.32

confidentiality and dual roles in assessments for,

7.38, 7.71

disclosure of personal health information,

6.36

genetic information and,

4.38, 4.43, 6.33

salary equity and,

6.23

End-of-life treatment,

4.49

Engelhardt, H. Tristram Jr.,

3.27

Equipoise, scientific,

5.15

Errors

disclosure of to patients,

3.29

integrity and reporting of,

5.4, 7.69

research and,

5.24

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

6.14, 6.18

Ethics

. See Autonomy; Beneficence; Confidentiality; Informed consent; Justice; Nonmaleficence; Veracity

Ethics committees (hospital),

3.37, 3.42, 6.24

Euthanasia,

3.4, 7.29

Eye movement desensitization and reprocessing (EMDR),

4.5

Faculty

authorship and,

6.21

consultation by,

6.30

depression in resident and,

6.15

impairment in colleagues and,

6.4

psychiatric opinion on colleague and,

6.5

social relationships with residents,

6.11

Family

alternative decision-makers and,

6.12

cultural issues and,

3.25, 3.31, 4.26, 7.54

refusal of treatment and,

4.39

Female genital mutilation (FGM),

3.16

Fidelity,

3.1, 3.26, 7.47

Financial issues

. See also Pharmaceutical industry

conflicts of interest and,

5.18

dual roles and,

6.18

incentives for research participation,

5.12

salary equity and,

6.23

Firearms, and suicide,

4.51, 4.55

Food and Drug Administration,

5.18, 7.33

Forensic evaluations,

3.18, 4.11

Fraud,

7.16

Galen,

3.32

Gene editing,

5.25

Genetic information,

4.38, 4.43

Genetic testing,

4.15, 6.10, 7.64

Gifts,

4.17, 4.34, 4.42, 7.3

Global Assessment of Functioning (GAF),

3.18

Gregory, John,

3.27

Grief,

4.8

Group therapy,

3.17

Guantanamo Bay detention facility,

3.10, 7.39

Guatemala experiments,

7.25

Hallucinogens,

4.40

Harassment, and discrimination,

6.28

Health care

. See also Access; Emergency situations; Insurance; Nurses; Primary care physicians; Public health

autonomy and,

4.3, 7.30

decisions related to children’s,

4.10

LGBTQ+ patients and,

4.54

medical futility and,

7.65

organ donation and,

7.9

role of psychiatrists in education of colleagues,

6.17

Health Insurance Portability and Accountability Act (HIPAA),

4.48, 5.23, 5.35

Hippocratic Oath,

3.32

HIV status,

3.30, 4.13

Human genome editing,

5.25

Human radiation experiments,

3.21

Human subjects

. See Research

Hume, David,

3.27

Huntington’s disease,

7.64

Impairment

. See Colleagues

Implicit bias,

3.8, 7.20. See also Bias; Discrimination

Incentives, for research participation,

5.12

Inequity, definition of,

6.28

Informed consent

advance directives and power of attorney,

4.32

children and,

4.29, 5.21

coercion and,

4.41

confidentiality and,

6.29

COVID-19 vaccine and,

4.56

culture and,

4.26

definition of,

3.6

exceptions to,

4.18, 7.58

research and,

3.11, 5.12, 5.21

trainee’s level of expertise and,

6.3

Insomnia,

7.6. See also Sleep disorders

Institutional review boards (IRBs), and human subjects research,

3.15, 3.37, 5.7, 5.26, 5.29, 5.30, 5.31, 7.49

Insurance, and managed care,

4.6, 4.31, 4.43

Integrity,

5.4, 7.34, 7.68

Intellectual property, and trademarks,

5.13

Intern, use of title,

6.25. See also Residents

Interrogation,

3.10, 7.39

Involuntary commitment, or involuntary treatment

“least restrictive alternative” concept,

4.52

legal issues and,

7.32

parens patriae and,

4.36

religious beliefs and,

3.19

standards for,

4.2, 4.7, 7.32

veracity and expert opinions on,

4.27

Jewish Chronic Disease Hospital Study,

3.21

Joint Commission,

3.37

Justice

. See also Distributive justice

definition of,

3.2, 3.39, 5.33, 7.7, 7.47

distribution of COVID-19 vaccine and,

3.43

health care and,

7.30

organ donation and,

7.11

research and,

5.1, 5.6, 5.9

Lake v. Cameron (1966),

3.33

Language, and culture,

3.25, 3.31, 7.9

Least restrictive alternative, for treatment,

4.52

Legal issues

assisted suicide and euthanasia,

3.4

employment discrimination and,

6.32

execution of prisoners,

7.63

female genital mutilation and,

3.16

Good Samaritan statutes,

4.18

involuntary treatment and,

4.2, 7.31

medical and mental health care for adolescents,

4.14, 7.51

reporting of suspected child abuse,

3.38, 4.1, 4.12, 4.22, 4.24, 6.33, 7.5

refusal of treatment and,

7.67

use of medicolegal terms,

3.28

LGBTQ+ patients,

4.54

Living will,

3.28, 4.4

Major depression,

3.18, 4.6, 7.5, 7.66

Media, and patient confidentiality,

3.22

Medical Ethics (Percival 1803),

3.27

Medical records, and confidentiality,

4.16, 7.1, 7.8, 7.46

Medical students

. See also Education; Residents; Trainees

confidentiality and letters of recommendation,

6.13

confidentiality and medical charts,

7.1

power and requests for personal errands,

6.26

use of titles for,

6.7, 6.25

Medications, and prescribing practices,

3.26, 3.29, 3.30, 6.1, 6.17. See also Antipsychotics; Opioids

Mental illness

. See also Anxiety disorders; Bipolar disorder; Depression; Obsessive-compulsive disorder; Panic disorder; Personality disorders; Posttraumatic stress disorder; Psychosis; Schizoaffective disorder; Schizophrenia

safeguards for patients as research subjects,

5.10, 5.19

violent behavior and,

4.45, 4.55

Milgram experiment,

7.25

Military, and dual agency situations,

4.21

Mill, John Stuart,

3.24

“Minimal risk” benchmark, for research,

5.34

Multiple roles

. See Dual roles

Narcissistic personality disorder,

4.47

National Cancer Institute,

5.15

National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research

. See Belmont Report

National Practitioner Data Bank,

7.31

Navajo, and historical example of research abuses,

3.21

Nazi hypothermia experiments,

3.21

Negligence, in research situation,

5.35

Netherlands, and legalization of assisted suicide,

3.4

Nonmaleficence

definition of,

3.1, 7.7, 7.47

examples of,

7.35, 7.46, 7.53, 7.74

impairment in colleague and,

6.2

recommendations on health care,

7.18

Nuremberg Code,

3.21

Nurses,

3.22, 6.10, 7.69

Obsessive-compulsive disorder (OCD),

5.7

O’Connor v. Donaldson (1975),

3.33

Operation Midnight Climax,

7.25

Opioids, and opiate dependency,

4.33, 4.37, 4.40, 7.46

Opt out approach, to HIV testing,

4.13

Organ donation,

7.9

Overlapping roles

. See Dual roles

Panic disorder,

4.21

Paranoid schizophrenia,

4.34, 4.36

Parens patriae,

4.2, 4.36

Passive euthanasia,

3.4

Patient(s)

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

death of,

4.35

disclosure of errors to,

3.29

preferences of,

3.20

sexual relationship with former therapist,

6.22

Patient Self-Determination Act of 1990,

3.28

Peer review,

5.28, 6.27, 7.4, 7.31

Percival, Thomas,

3.27

Personality disorders,

4.55. See also Narcissistic personality disorder

Pharmaceutical industry,

3.5, 5.18, 6.16, 7.21

Physician orders for life-sustaining treatment (POLST),

4.4

Plagiarism,

5.28, 7.52

Police power,

4.2

Posttraumatic stress disorder,

3.33, 4.5

Power

consultation and,

6.30

impairment in colleagues and,

6.4

self-regulation and,

3.36

sexual relations and differentials of,

3.13

Power of attorney,

3.28, 4.32

Primary care physicians,

6.17

“Principles of Humane Experimental Technique, The” (Russel and Burch 1959),

5.8

Principles of Medical Ethics Relevant to the Role of Health Personnel, Particularly Physicians, in the Protection of Prisoners and Detainees against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (United Nations),

3.10

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

6.5, 6.9

Prisoners

ethical guidelines for treatment of,

7.63

as research subjects,

5.19

Privacy Rule, and data deidentification,

5.35

Process-based approach, to end-of-life treatment,

4.49

Professionalism

. See Fidelity; Justice; Veracity

Public health,

3.2, 4.12, 4.25

Psychiatric advance directives,

3.28, 4.32

Psychology,

6.14, 6.18, 6.22

Psychosis,

4.45, 5.10, 7.27

Pythagoras,

3.32

Quality of life,

3.20, 4.49

Referrals,

3.26, 4.47, 6.1, 7.6

Refusal of treatment,

4.39, 6.24, 7.2, 7.56, 7.67

Release-of-information forms,

4.31

Religion,

3.17, 3.19, 3.41, 6.24, 7.2

Reporting

. See Child abuse

Research

. See also Belmont Report; Institutional review boards

adverse events and audit of,

5.30

animals and ethical conduct of,

5.8, 5.32

anonymous methods for data collection,

5.14

children and,

5.21, 5.22

conflicts of interest and,

5.11, 5.27

data safety and data use,

5.35

errors in,

5.24

examples of ethical violations,

3.21, 5.9, 7.25

human subjects and regulations,

3.15, 5.16, 5.19, 5.26, 5.34, 5.36, 7.17, 7.61

incentives for participation,

5.12

informed consent for,

3.11, 5.12, 5.21

justice as bioethics principle for,

5.6, 5.9

“minimal risk” benchmark for,

5.34

misconduct and,

5.2, 5.5, 5.24, 5.28, 7.52, 7.73

motivations for participation,

5.3

safeguards for patients with mental illness,

5.10, 5.19

scientific equipoise and,

5.15

scientific rigor and value of,

5.18

therapeutic misconceptions and,

3.11, 7.26

Residents

. See also Education; Medical students; Trainees

depression and suicidality in,

6.15

pharmaceutical industry and conflicts of interest,

6.16

power and requests for personal errands,

6.26

social relationships with faculty,

6.11

use of titles,

6.24

veracity of process notes,

6.19

veracity in letters of recommendation,

6.20

working relationships and behavior of,

6.8

Respect

. See also Autonomy

definition of,

5.33

examples of,

7.53

group therapy and,

3.17

history of psychiatry and violations of,

3.34

human subjects research and,

5.1, 5.9

Risk assessment

human subjects research and,

7.17

suicide and,

4.55

Rural psychiatry,

3.14, 3.23

Rush, Benjamin,

3.27

Safe harbor, and data deidentification,

5.35

Safety

. See also Dangerousness

confidentiality and,

4.1

management of occupational risks,

4.28

Schizoaffective disorder,

4.56, 7.44

Schizophrenia,

3.17, 4.56, 6.10, 7.33, 7.55. See also Paranoid schizophrenia

Scientific misconduct,

7.52

Scope of practice,

3.12, 3.39

Self-awareness,

3.19

Self-effacement,

3.13

Self-regulation,

3.36, 6.22

Self-sacrifice,

3.13

Serotonin syndrome,

3.29

Sexual abuse,

4.16

Sexual relationships,

3.13, 4.53, 6.22, 7.48

Sign language,

7.9

Sleep disorders,

4.55. See also Insomnia

Sliding scale of competency,

4.20

Small communities, and conflicts of interest,

3.23

Social media,

4.8

Social relationships, and boundaries,

3.3, 4.53, 6.11

Socioeconomic factors, in decision-making,

3.20

Soviet Union, and history of psychiatry,

3.34

Substance abuse,

4.37, 4.40, 4.45, 7.5. See also Alcohol intoxication; Cocaine; Opioids

Suicide, and suicidal ideation

confidentiality and,

7.40, 7.60

culture and patient behavior,

4.44

firearms and,

4.51, 4.55

insurance and treatment of,

4.6

involuntary treatment and,

4.2

language and communication with patient,

7.9

least restrictive alternative for treatment of,

4.52

nonmaleficence and autonomy in treatment of bipolar disorder and,

7.74

veracity and,

7.66

Supervision,

3.19, 4.47, 6.11, 6.19, 6.34

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

3.33

Tearoom trade study,

7.25

Termination of Life on Request and Assisted Suicide (Review Procedures) Act (Netherlands),

3.4

Testamentary will,

3.28

Therapeutic alliance,

4.9, 4.47. See also Doctor-patient relationship

Therapeutic misconceptions, and research,

3.11, 7.26

Therapeutic privilege,

4.18

Titles, of medical students,

6.7, 6.25

Tobacco products,

7.35, 7.76

Torture,

3.10

Trademarks,

5.13

Trainees

. See also Education; Medical students; Residents

alternative decision-makers and,

6.12

dual roles and,

6.14

ethically appropriate behavior between supervisors and,

6.34

informed consent and level of experience,

6.3

Transfer, of patient’s care,

4.30

Transference,

3.13. See also Countertransference

Treatment, withholding versus withdrawing of,

3.4. See also Involuntary commitment; Least restrictive alternative, Refusal

Truth, and competency hearings,

7.13

Tuskegee Syphilis Study,

3.21, 7.25

22q deletion syndrome,

6.10

United Nations,

3.10

U.S. Department of Health and Human Services,

3.14, 3.21, 5.16, 5.21, 5.26, 5.29, 5.31, 7.61

Utilitarianism,

3.24, 7.9

Utility, and beneficence,

5.33

Veracity

beneficence and,

7.5

definition of,

3.1, 3.12, 3.39, 7.7, 7.34

dual roles and,

7.71

examples of,

7.21, 7.35, 7.36, 7.43, 7.46, 7.47, 7.66

insurance companies and fraud,

4.6

involuntary commitment and,

4.27

letters of recommendation for residents and,

6.20

of process notes by resident,

6.19

Veterans Affairs (VA) medical center,

3.18

Violent behavior, and mental illness,

4.45, 4.55, 7.46. See also Dangerousness; Duty to warn

Virtue-based approach, to moral philosophy,

7.59

Virtue ethics,

3.24

Voluntarism,

3.6, 5.19

Whistle-blowers,

6.31

Willowbrook Hepatitis Studies,

3.21, 7.25