Volume 37 · Number 12
DECEMBER 2007

Care Ethics: What Psychiatrists have been Waiting for to Make Sound Ethical Decisions

By Sidney Bloch, MD, PhD

Psychiatrists have to contend with myriad ethical dilemmas in their clinical encounters, including such profound issues as suicide, patients threatening to harm others, impaired reasoning capacity to provide informed consent, involuntary treatment, therapists imposing their personal values on patients, the use of treatments with potentially irreversible side effects, and maintaining a person’s most intimate secrets. Furthermore, the profession has been buffeted by external pressures, which derive from its unique role in society in tandem with its blurred professional boundary and erratic diagnostic criteria. The place of the asylum as essentially a custodial institution and form of social control for more than three centuries, the abuse of psychiatry to suppress dissent as occurred in the former Soviet Union, the societal stigma of suffering from a mental illness, and psychiatry in Nazi Germany when it metamorphosed into a profession governed by an abhorrent ideology are but a few of the events or realities that have shaken the profession and all it stands for.

ABOUT THE AUTHOR

Sidney Bloch, MD, PhD, is Professor, Department of Psychiatry and Centre for Health and Society, University of Melbourne, Australia.

Address correspondence to: Prof. Sidney Bloch, Department of Psychiatry, University of Melbourne, St. Vincent’s Hospital, Melbourne, Australia 3065; or e-mail: [email protected]. Dr. Bloch has disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

1. Assess the limitations of current ethical theories applied to psychiatry.
2. Describe the care dimension to resolution of ethical dilemmas.
3. Summarize the potential contribution of care ethics to psychiatry.

This CME activity is primarily targeted to patient-caring physicians specializing in psychiatry. Physicians can receive AMA PRA Category 1 Credits™ by reading the CME articles in Psychiatric Annals and successfully completing the quiz at the end of the articles. Complete instructions are given subsequently. Educational objectives are found at the beginning of each CME article.

CME ACCREDITATION

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Vindico Medical Education and Psychiatric Annals. Vindico Medical Education is accredited by the ACCME to provide continuing medical education for physicians.

Vindico Medical Education designates this educational activity for a maximum of 3 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

FULL DISCLOSURE POLICY

In accordance with the Accreditation Council for Continuing Medical Education's Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of the planners, teachers, and authors involved in the development of CME content. An individual has a relevant financial relationship if he or she has a financial relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Relationship information appears at the beginning of each CME-accredited article in this issue.

UNLABELED AND INVESTIGATIONAL USAGE

The audience is advised that this continuing medical education activity may contain references to unlabeled uses of FDA-approved products or to products not approved by the FDA for use in the United States. The faculty members have been made aware of their obligation to disclose such usage.

INSTRUCTIONS

1. Review the stated learning objectives of the CME articles and determine if these objectives match your individual learning needs. You must read each of the CME articles in this issue carefully in order to take the quiz. Do not neglect the tables and other illustrative materials as they have been selected to enhance your knowledge and understanding.
2. The cost of taking the CME quiz is $25; you must pay this fee prior to completing the quiz online.
3. The quiz questions have been designed to provide a useful link between the CME articles in the issue and your everyday practice. Read each question and choose the correct answer by checking the box next to your desired answer.
4. After you answer all questions, your quiz is graded. A score of at least 80% is required to pass
5. If you passed the quiz, you will receive by mail a CME certificate of within 4 to 6 weeks. If you failed the quiz, you may retake the quiz at another time by returning to the CME articles and then registering again for the quiz.

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Ethics and Design Flaws of Humanity
Jan Fawcett, MD

Psychiatric Ethics — A Complicated Challenge
Michael Robertson, MB, BS, FRANZCP; Garry Walter, MB, BS, PhD, FRANZCP

Psychiatry in the News

 The Ethics of Psychiatric Diagnosis
Michael Robertson, MB, BS, FRANZCP; Garry Walter, MB, BS, PhD, FRANZCP

 Neuroethics and Psychiatry: New Collaborations for Emerging Challenges
Emily R. Murphy, PhD; Judy Illes, PhD

Narrative Ethics in Psychiatry and the Literature of Youth
Karen Fisher, MB, BS; Garry Walter, MB, BS, PhD, FRANZCP; Michael Robertson, MB, BS, FRANZCP