Does the American Psychiatric Association Need a New Ethics Compass?

When you think of ethics and psychiatry what comes to mind? Probably physicians' financial relationships with drug companies and sexual relationships with patients. While I do not deny the importance of either I believe APA's handling of many other ethical matters warrants improvement, and I hope to address these in more detail in subsequent posts. A list of planned topics follows:

Last time I looked APA had not revised its online Opinions of the Ethics Committee on The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry since 2001. I know the ethics committee has issued opinions since then. Only those members who can access them can benefit from those opinions.

Psychiatrists have published online or in print case histories sufficiently detailed that the patient or those who know the patient could identify them. In many of these cases if they are fiction this fact was not mentioned. It is possible that patients consented to publication, but the patient may have felt pressure to consent, and there is little likelihood that the patient might benefit from the publication. APA has not dealt adequately with this problem.

APA published Questions & Answers About Procedures for Handling Complaints of Unethical Conduct as an addendum to the Code, but the most recent answer I could find was published in 2003.

Section 9 of the Code states: "A physician shall support access to medical care for all people." There is no associated "Annotation Especially Applicable to Psychiatry" except this: "New section recently adopted by the AMA." As far as I can determine recently means 2001. This feel good "principle" has clear political implications but only questionable applicability in the context of the physician patient relationship. Do we need a test case?

APA has addressed ethical considerations related to availability for patient emergencies, but the opinion (at least the only one with which I have been provided) seems to ignore realities and refers to factors which seem extraneous or indeterminable.

Third parties regularly exploit treating psychiatrists for cheap or free opinions related to obtaining benefits for patients or to return to work. APA seems unwilling to take a firm stance regarding the ethical implications.

For many years psychiatry and psychodynamic psychotherapy have been inseparable. Ethics opinions still occasionally refer to dynamic/analytic concepts like transference. Today many psychiatrists either provide psychotherapy using other methods such as CBT or provide no psychotherapy at all. Published psychiatric ethics principles and determinations should refer only to principles related to all psychiatrists and should scrupulously avoid imposition of psychoanalytic principles to psychiatrists outside the context of that method of treatment.

I will devote an extended series of posts to an ethical question I posed over three years ago which has never been addressed definitively despite referral to a number of district branches and state associations. Even when initiated at the local level APA should ultimately address ethics questions with national applicability at the national level. What is unethical in Nebraska is unethical in Florida.

Commentary on Opinions of APA Ethics Committee I