Fifth is the ability to anticipate and work responsibly through high-risk ethical situations, such as reporting suspected abuse, hospitalizing patients against their preferences or caring for an especially difficult patient. In such situations where the clinician must intentionally use power in a manner that encroaches upon usual rights of individuals in order to assure safety, every effort must be made to do so respectfully and in a manner that minimizes the invasiveness and burden of the intervention.
The sixth skill is appropriate use of consultants (e.g., clinical or ethical specialists) and information resources (e.g., clinical data, codes of ethics, legal guidelines) to clarify ethical choices.
Finally, ethical psychiatric practitioners will have the skill of building in additional protections (e.g., advance directives, alternative decision-makers, confidentiality safeguards) for individuals who are especially vulnerable due to illness or circumstance.
In recent years, there is an increasing emphasis on empirical evidence in shaping ethical practices in psychiatry. Examples include the positive role of education in protecting confidentiality in small communities, strategies for enhancing informed consent processes, the creation of empirically derived and validated tools for assessing the clinical decision-making capacity of mentally ill people, the influence of pharmaceutical marketing in clinicians' choices, and the effectiveness of training interventions in enhancing clinicians' ethical problem-solving skills. With the intensified focus on measurable skills in diverse competence domains, including ethics and professionalism, data-driven, performance-based testing in psychiatry residencies and specialty certification exams is also growing.
It is clear that ethical ideals, skills and evidence-based approaches map nearly exactly upon excellent clinical care practices for mentally ill patients. This is the essence of the field of clinical ethics, which is the application of insights from the multidisciplinary field of bioethics to address morally important aspects of everyday care for individual patients. The ethical dimensions of patient care are inseparable from other aspects of clinical excellence, in meaning and in action. In this approach, ethics is not extrinsic or supplemental: it is an endeavor fundamental to the care of the mentally ill and to the work of the psychiatrist.