Case Studies in Ethics

A junior faculty member in an academic department of psychiatry and behavioral medicine is told by a resident supervisee that a senior member of the faculty has been behaving erratically. The resident says that she suspects that the senior clinician has been abusing alcohol and that she believes his clinical judgment has been adversely affected. The faculty member has had little contact with his senior colleague, but he has no reason to question the resident's judgment. He encourages the resident to speak to her training director about her concerns. She refuses, saying that she fears retribution.

Which of the following is the junior faculty member's next best course of action?

Determining when and how to report suspected impairment in a colleague is often extremely difficult for physicians, and it becomes especially tricky if the colleague is in a position of power over the person who believes that impairment may be an issue. In this case, because the resident believes the senior colleague's clinical judgment is affected and the safety of patients is at stake, immediate action must be taken. By speaking to the senior colleague directly about the concern and then reporting it to the department chairman, the junior faculty member will fulfill his ethical duties to expose impaired colleagues and to deal honestly with other doctors (1, 2).

A psychiatrist has been treating a female patient for depression. During the course of psychotherapy, the patient reveals that she had sexual relations with a previous therapist.

Which of the following is the therapist's most appropriate immediate response to this revelation?

As a member of a profession charged with self-regulation, the psychiatrist has a duty to help identify colleagues who behave unethically. However, in this case, that duty does not outweigh the responsibility to be clinically helpful to this patient. At some point, it may be therapeutic for this patient to take action, such as reporting her previous therapist to the state licensing board or professional ethics committee. However, the psychiatrist should not push the patient to do anything before the patient is prepared to do so. In addition, taking matters into the psychiatrist own hands may also have detrimental effects on the patient. When and if the patient is ready to proceed, options for reporting should be explained. Some states have criminalized therapists' sexual relationships with patients and have codified the response subsequent treating therapists should follow (3, 4).

Answer for Vignette 1: A

Answer for Vignette 2: A