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The 2011 Psychiatric Times Ethics Survey: Moral Struggles

The 2011 Psychiatric Times Ethics Survey: Moral Struggles

An Apology to Our Readers
 
Not long ago, we posted a survey on our website that included a series of questions about ethical dilemmas mental health professionals face in daily practice. Exactly 1400 of you responded to that survey. . . and more than half of the respondents were psychiatrists. The idea for the survey came from our editorial board member, Cynthia Geppert, MD, PhD, MPH, who subsequently wrote an overview of the survey results. Dr Geppert's commentary, which was based on a summary of the copious data derived from the survey, was published in the May issue of
Psychiatric Times, and —- on June 7th—- it was posted to our website.

When that essay was posted, it contained a live link to the original ethics survey. Our intent in including that link was to give interested readers a chance to review the original survey questions and to click on the hundreds of detailed responses to those questions. The day after the essay was posted, it was brought to our attention by a reader that – with enough drilling down –  the names and email addresses of some of the respondents could be found. Dr Geppert was not aware of this, nor were we because we worked from the same data summary instead of the live survey. We immediately deleted the link and disabled the survey itself so that it would no longer be accessible to anyone. Still, the survey was live for about 16 hours.
 
The irony that this breach occurred in the context of one of the largest surveys ever on ethical issues facing psychiatrists – and in the middle of an essay about whether ethical dilemmas have changed in recent years and how prepared we are to manage changing dilemmas –- is not lost on us.
 
We know full well how much you value your privacy and we sincerely apologize to our survey respondents. We’ve taken steps to ensure that this won’t happen again.
 
We and Dr Geppert plan another ethics survey next year. We hope you’ll join in.
 
Please let us hear from you? Slings? Arrows? We’d welcome your thoughts and comments.

--Susan Kweskin
Group Editorial Director

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The pages of Psychiatric Times and other journals and newspapers both scholarly and popular are replete with stories about the ethical controversies of modern psychiatry and the crises of the profession. The overwhelming response among physicians in general to a recent Medscape ethics survey1 inspired me to work with Psychiatric Times to develop a survey uniquely geared toward psychiatrists and other mental health professionals. The goal of the survey was to go beyond ethical lessons, useful as these may be, and to learn how Psychiatric Times’ readers—who are on the front line of psychiatric practice—handle a series of hypothetical ethical scenarios. The survey ran from January 13 through February 28, 2011. The responses were all anonymous and reported in aggregate.

The thoughtfulness and courage of the psychiatrists who participated was impressive. They volunteered a window into their personal moral struggles regarding a host of sensitive ethical subjects as evident in this prcis. Two questions dealt with emerging end-of-life issues in psychiatry—involvement in physician-assisted suicide and whether patients with mental illness ever reach the state where continued care is futile. Three others focused on the more familiar boundary concerns of personal disclosure and romantic involvement.

Two scenarios described patients with difficult behaviors and asked how the clinician would handle the problems. Respondents were asked how they would deal with the conflict between confidentiality and nonmaleficence when a patient threatens an identified victim and how they handle the increasingly common dilemma of an elderly patient for whom driving preserves independence but threatens the public. There were also questions about the influence of third-party forces such as insurance companies, managed care, regulatory authorities, and the pharmaceutical industry on contemporary practice.

Survey overview

I hope this brief description whets your appetite for future fare. Here I offer a tentative and broad interpretation of what the results tell us about how often psychiatrists grapple with complex ethical issues, whether those dilemmas have changed in recent years, and how prepared psychiatrists feel they are to manage these challenging dilemmas.

The survey asked participants to respond to a range of ethical dilemmas encountered in daily practice. The questions were multiple choice, with space provided for free text comments. The first 3 questions asked for basic demographic information such as age, whether the respondent was a physician, and his or her specialty. An amazing 708 psychiatrists took the time to respond to the survey along with other mental health professionals, including nurses, psychologists, and students, for a grand total of 1400 responses. The survey participants ranged in age from 20 years to 71 and older.

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