Medication management
The respondents singled out the ascendancy of psychopharmacology in an era of limited resources as the postmodern focus of many ethics conflicts between patient autonomy and the physician’s duty to do no harm. “Persons presenting on medication without clear symptom-derived diagnoses. Over prescribing of potentially damaging medication. Persons requesting medication to solve lifestyle and nonpsychiatric issues.” Several practitioners mentioned the role of the pharmaceutical industry and managed care to explain why ethics questions more frequently come up in medication management. “Related to consumer marketing of medications, differences between docs on prescribing patterns—use of controlled substances.”
Ethics out in the open
Psychiatrists are obviously frustrated with many of the countervailing movements in the social, economic, and legal sphere that jeopardize their efforts to provide efficacious and humanistic care for patients who have mental illness. Yet these physicians also speak with a clear and strong voice that the greater attention given to ethics is a salutary advance. “It’s a good thing. Ethical issues used to just get buried in denial, now they are out in the open.” In subsequent columns and podcasts, I plan to explore the wisdom of readers regarding specific survey topics along with the best current legal and ethical thinking regarding the subject. We hope to make the ethics survey an annual event as one small contribution to what the results of our survey show is a growing ethical awareness among psychiatrists, “Ethical dilemmas are becoming more nuanced as different issues are identified and brought to the fore of one’s consciousness.”
