Wednesday, February 24, 2010

Commentary on Opinions of APA Ethics Committee VI

Continued from Commentary on Opinions of APA Ethics Committee V this post focuses on opinions relating to role conflict in:

The Opinions of the Ethics Committee on The Principles of Medical Ethics

Other authors have discussed the damage that can result from role conflict extensively, primarily in the context of forensic psychiatry. For example, if a treating psychiatrist provides an opinion regarding her patient in litigation, the opinion may damage the treatment or the treatment relationship, or (less importantly) the psychiatrist may bias her opinion to help the patient.

B.4.a. (2002, page 15)

In this case it appears that action by a government agency may have appeared to create a risk to the patient. The agency has then asked the treating psychiatrist whether "it is OK to proceed." Presumably the agency, by asking whether it is "OK" seems to innocently give the appearance of valuing the patient's health interest. But in reality the agency may simply want the treating psychiatrist to assume responsibility for any adverse consequence. A treatment contract does not include providing such advice to a third party. I agree with the committee's advice to refuse to provide such an opinion. The agency always has the option to retain an independent examiner.

G.4.a. (1973, page 33)

The committee addresses this case as involving conflict of interest. The hospital which employs the psychiatrist to care for a patient also wants the psychiatrist to assess the patient's "competency" (for what?) in pursuing collection of money the patient owes the hospital. The employment situation already constitutes conflict of interest for the psychiatrist: If the psychiatrist treats more patients, the hospital makes more moneys. A similar conflict of interest occurs in all fee for service medicine: If the doctor cures the patient, the doctor loses a source of income. This fact makes professional ethics necessary. So in this case the conflict of interest differs, but only slightly . The role conflict more than any conflict of interest requires the psychiatrist to decline to offer an opinion regarding the patient's competence.

R.4.a (1977, page 80)

The committee seems to have inferred facts not presented in the question as written. A psychiatrist for a student health services inquires about ethical considerations in providing treatment to some students while "seeing others for administrative reasons." The committee seems to assume the psychiatrist might assume both roles with the same student. I see no ethical conflict provided these are different students. If, however, the psychiatrist tries to assume both roles with the same student, I agree that role conflict would create an ethical problem.

Commentary on Opinions of APA Ethics Committee VII

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