Concise Guide to Ethics in Mental Health Care (Concise Guides)

Contents......Page 6
Contributors......Page 20
Introduction to the Concise Guides Series......Page 22
Preface......Page 24
1 Ethics: Principles and Professionalism......Page 26
Traditional Principles of the Clinical Professions......Page 28
Professionalism and the Evolution of Bioethical Principles......Page 30
Principles, Rules, and Contextualism......Page 35
References......Page 41
2 Clinical Decision-Making and Ethics Skills......Page 44
Ethics Skills in Mental Health Care......Page 45
A Strategy for Ethical Clinical Decision Making......Page 47
Patient Preferences......Page 49
Socioeconomic or External Factors......Page 51
Case Scenarios......Page 52
References......Page 53
3 The Psychotherapeutic Relationship......Page 56
Professionalism in the Psychotherapeutic Relationship......Page 57
The Nature of the Psychotherapeutic Encounter......Page 59
Case Scenarios......Page 67
References......Page 68
Appendix: The Exploitation Index......Page 70
The Therapeutic Relationship......Page 76
Information......Page 77
Decisional Capacity......Page 79
Voluntarism......Page 82
Differing Standards for Consent......Page 84
Emergency or Acute Care......Page 85
Care for Chronic Illness......Page 87
Advance Directives and Surrogate Decision Making......Page 89
Examples of Empirical Studies Related to Consent......Page 91
Constructive Approaches to the Process of Consent......Page 94
Case Scenarios......Page 96
References......Page 97
Appendix: Cases for Discussion......Page 100
5 Ethical Use of Power in High-Risk Situations......Page 102
Power and Vulnerability in Therapeutic Work......Page 103
Ethical Considerations in High-Risk Situations......Page 104
Suicide, Violent Behavior, and Mental Illness......Page 105
Prediction......Page 107
Duty to Intervene......Page 109
Duty to Warn and Duty to Protect......Page 111
Strengths and Accountability of Mentally Ill Persons......Page 112
Ethical Use of Power and Treatment Refusal......Page 113
Ethical Use of Coercive Pressure in Mental Health Care......Page 115
Endeavoring to Use Power Ethically in Mental Health Care......Page 117
References......Page 119
6 Confidentiality and Truth Telling......Page 122
Examples of Empirical Studies......Page 124
Confidentiality and Truth-Telling Dilemmas......Page 128
Responding to Confidentiality and Truth-Telling Dilemmas......Page 132
References......Page 140
Professional Competence......Page 144
Consent......Page 146
Confidentiality......Page 148
Practice Dilemmas......Page 150
Protecting Children and Reporting Child Abuse......Page 152
Research......Page 153
Consent......Page 154
Risk......Page 155
Dilemmas......Page 156
Conclusions......Page 157
Case Scenarios......Page 158
References......Page 159
Prevalence and Seriousness of Addiction and Comorbid Disorders......Page 162
Stigma......Page 164
Parity......Page 166
Personal Responsibility......Page 167
Criminal Justice Involvement, Truth Telling, and Confidentiality......Page 168
“First, Do No Harm”......Page 170
Harm Reduction......Page 171
Pseudoaddiction and Pain Management......Page 172
Empirical Ethics Studies......Page 173
Case Scenarios......Page 174
References......Page 175
Recognizing “Difficult” Patients......Page 178
Prevalence and Attributes of “Difficult” Patients in Medical and Psychiatric Settings......Page 181
Understanding “Difficult” as a Clinical Sign......Page 183
Identifying Ethical Pitfalls in the Care of Difficult Patients......Page 184
Responding Therapeutically......Page 186
Case Scenarios......Page 190
References......Page 191
10 Caring for People in Small Communities......Page 192
Overlapping Relationships, Conflicting Roles, and Altered Therapeutic Boundaries......Page 193
Confidentiality......Page 198
Cultural Dimensions of Care......Page 199
Limited Access to Clinical Care, Mental Health, and Ethics Resources......Page 200
Stresses of Small-Community Caregivers......Page 203
Constructive Approaches......Page 204
References......Page 208
Six Domains for Careful Attention......Page 210
Comfort......Page 212
Capacity......Page 213
Clarity......Page 214
Controversy......Page 215
Collaboration......Page 216
Emergent Ethical Questions in End-of-Life Care......Page 217
References......Page 219
Appendix A: Missoula–Vitas Quality of Life Index......Page 222
Appendix B: Values History Form......Page 228
12 Ethical Issues in Psychiatric Genetics......Page 232
Informed Consent in Psychiatric Genetics......Page 233
Confidentiality......Page 235
Considerations of Justice......Page 236
Empirical Studies on Ethical Issues in Psychiatric Genetics......Page 238
Genetic Counseling for Psychiatric Disorders......Page 239
Case Scenarios......Page 241
References......Page 242
13 Ethical Issues in Managed and Evolving Systems of Care......Page 244
Ethical Principles in Managed and Evolving Systems of Care......Page 245
Evolving Systems of Care for Mental Illness......Page 249
Resolving Conflicts Between the Needs of Individuals and Populations......Page 251
Case Scenarios......Page 254
References......Page 255
14 Ethical Issues in Clinician Health......Page 258
The Wounded Healer......Page 261
The VIP Syndrome......Page 263
The Impaired Professional......Page 264
Clinician Health and Training......Page 265
Case Scenarios......Page 266
References......Page 267
15 Ethical Issues in Clinical Training......Page 268
Special Ethical Challenges of Clinical Training......Page 270
Empirical Studies on Ethics and Clinical Training......Page 274
Educational Strategies for Ethics Education in Clinical Training......Page 278
References......Page 282
16 Ethical Issues in Psychiatric Research......Page 286
Design, Methods, and the Need for Ethics Safeguards......Page 289
Institutional Review and Data and Safety Monitoring......Page 291
Informed Consent......Page 293
Advance, Alternative, and Collaborative Decision Making......Page 296
Additional Expert and Peer Review Processes......Page 297
Expertise, Integrity, and Conflicts of Interest......Page 298
Special Groups and Potentially Vulnerable Populations......Page 301
Animal Research......Page 305
Practical Efforts Regarding the Ethical Conduct of Research......Page 306
References......Page 307
Appendix: Roberts Research Protocol Ethics Assessment Tool (RePEAT)......Page 310
The Rise of Health Care Ethics Committees......Page 320
Historical Background: Some Notable Faulty Medical Research Practices......Page 321
Early Forms of Hospital Ethics Committees......Page 323
Where Are Ethics Committees Today?......Page 325
Ethics Education......Page 326
Policy Formulation and Review......Page 327
Case Consultation......Page 328
Who Should Be on a Health Care Ethics Committee?......Page 331
Professional Association Ethics Committees......Page 334
Summary......Page 335
References......Page 336
Appendix: Cases for Discussion......Page 338
Appendix A: Glossary......Page 344
Appendix B: Additional Readings......Page 346
A......Page 368
C......Page 369
D......Page 371
E......Page 372
H......Page 373
J......Page 374
N......Page 375
Q......Page 376
S......Page 377
T......Page 378
W......Page 379