Living the Questions: Cases in Psychiatric Ethics

The past several years have been a time of radical change in the economic, technological, social, and political landscape of our country. These developments, of necessity, affect education in all its forms—including continuing medical education. Increasingly, the print medium is becoming an endangered species and previously unimagined modes of information transmission, such as blogs, RSS feeds, and podcasts, have emerged as common forms of communication. The exponential growth of medical knowledge and the increasingly rapid pace of scientific discovery have made it nearly impossible for the print medium to keep abreast of new developments. The Internet has therefore become crucial as a source of up-to-date information to ever more intellectually overwhelmed clinicians. It is no wonder that many in medicine regard the Internet and its electronic affiliates with periodic ambivalence despite their enormous potential to catalyze adult learning.¹

Many practitioners experience a version of shell shock from this information explosion—at least in part because missing in the flood of facts is any discussion of higher purpose or deeper meaning, especially for the practice of psychiatric medicine. Ethics and humanities are the areas of contemporary medicine that most often foray into the neglected territory of meaning and purpose, striving to interpret and apply the ancient tenets of professionalism for a brave new world of neuroethics, genetics, and pandemics.

We invite you listen to this podcast, in which ethicist and psychiatrist Cynthia Geppert, MD, PhD, tackles the ethical considerations when a patient asks you to pray along. Click here to review the case and listen to the podcast.

Yet, these “neon” issues² are far removed from the everyday practice of mental health practitioners struggling with the more prosaic challenges of maintaining high-risk patients, providing good-quality care in an ever more constrained and fragmented system, and keeping their own ideals of psychiatry as a profession and a vocation alive against mounting pressures to transform it into a business or simply a “job.”

Over the decade that I have taught, written, and worked as a clinical ethicist and humanistic educator, I have become convinced that clinicians have a hunger for ethical education in values and virtues that is at least as strong as their thirst for scientific learning. Bhugra³ conducted a brief survey of 66 British psychiatrists regarding professionalism and found that 94% resoundingly believed that professionalism is important in modern-day clinical practice. Those surveyed identified the internal and external threats to the practice of our specialty, including loss of auton-omy and self-regulation, pharmaceutical companies, and policy-dictated changes in service delivery and training. While this is a small survey and not a random sample of psychiatrists in the United Kingdom, there is no indication that the findings would not generalize to the majority of American psychiatrists.

Here, too, the abundance of scientific and clinical data is in stark contrast to the poverty of relevant, accessible resources available for ethical counsel, professional guidance, and humanistic renewal. Clinicians who do not have easy access to academic medical centers or major ethics institutes may not have the time or training to track down the ethics literature, professional codes, or literary works that could help illuminate their dilemmas, structure their responses, and support their decisions. In response to this unmet moral need, a number of medical journals and newsmagazines have added regular features addressing ethical and professional issues. It is at this juncture that the World Wide Web returns this time as an effective ally in the search for salience, ironically precisely because it allows readers to have a real-time and interactive relationship with publications.