Economical Framework of Psychiatric Care

Abstract

In Medicine, autonomy of the patient, beneficence of the physician, Non-maleficence of the physician and justice are four leading ethical principles and several Medical Associations as well as Psychiatric Associations published a Code of Ethics in which the physician–patient relationship is considered to be at the heart of medical and psychiatric practice. In the economical framework, the principle of equity as well as epidemiological, medical and societal consequences of increased welfare and deceleration of mortality influence ethical choices. If ethical decisions would be taken that would inevitably result in an impossibility to sustain the resulting medical treatment because of lack of economic means, this would result in non-ethical injustice in the division of means. Therefore, viability and economic sustainability have ethical implications in themselves. However, ethical decisions should also be based primarily upon sound moral values and their acceptability in a given cultural context. The four models of access to mental health care, the gatekeeper model, the service model, the community-based mental health service, and the managed care model, all pose specific ethical challenges, especially the managed care model, as it intrudes upon the patient–doctor relationship and in equity of division of means. Moral implications of managed care and of the influence of pharmaceutical companies and governmental policies are described and possible solutions on micro-, meso- and macrolevel suggested.