Abstract
Psychiatry is a specialized medical profession, encompassing several roles, all of which require close attention to ethics, a branch of philosophy dealing with the study and linguistic expression of moral principles and actions. When applied to medicine, medical ethics becomes an essential tool to explore and conduct medical practice and research in a morally correct manner. This becomes all the more pertinent for psychiatry, because psychiatric interventions and activities are always value laden, performed under implicit sociocultural constraints. The principles of respect for autonomy, nonmaleficence, beneficence, and justice are considered essential to guiding morality of actions in clinical and research situations, including clinical care, diagnosis, conflicts of interest, informed consent, and personal relationships. At the heart of medical ethics dealing with a patient is the issue of a professional or therapeutic boundary, or simply boundary, which broadly refers to the “edge” or limit of appropriate behavior in clinical and research contexts. While harmful boundary violations such as sexual relationships with a patient have been recognized and denounced since Hippocratic times, more subtly nuanced boundary crossings such as accepting a nonexpensive casual gift from a patient in therapy or accepting an invitation for attending a common cultural also received attention in the past two decades, not only because some of these boundary crossings may follow a slippery slope toward typical boundary violations, but also because they are influenced by context and cultural background. Technological advances and applications in modern digital-age psychiatry have given rise to newer ethical challenges in the practice of our discipline, including boundary issues. These issues also impact the ethics of psychiatric research.
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References
American Psychiatric Association. (2015). APA commentary on ethics in practice. American Psychiatric Association. Available from: https://www.psychiatry.org/psychiatrists/practice/ethics. Last accessed 23 Oct 2020)
Arras, J. D. (1991). Getting down to cases: The revival of casuistry in bioethics. Journal of Medicine and Philosophy, 16, 29–51.
Beauchamp, T. L., & Childress, J. F. (1979). Principles of biomedical ethics (1st ed.). Oxford University Press.
Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.
Bloch, S., Chodoff, P., & Green, S. A. (Eds.). (1999). Psychiatric ethics. Oxford University Press.
Burr, C., Morley, J., Taddeo, M., & Floridi, L. (2020). Digital psychiatry: Risks and opportunities for public health and wellbeing. IEEE Transactions on Technology and Society, 1(1), 21–33.
Crisp, R., & Slote, M. (1997). Virtue ethics (Oxford readings in philosophy). Oxford University Press.
Darwall, S. L. (Ed.). (2002). Deontology. Willey-Blackwell.
FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: A systematic review. BMC Medical Ethics, 18(1), 19. https://doi.org/10.1186/s12910-017-0179-8
Friedman, S. H., & Martinez, R. P. (2019). Boundaries, professionalism, and malpractice in psychiatry. Focus, 17(4), 365–371.
Gabbard, G. O. (2019). Digital professionalism. Academic Psychiatry, 43(3), 259–263.
Gabbard, G. O., Crisp-Han, H., & Hobday, G. S. (2015). Professional boundaries in psychiatric practice. In J. G. Sadler, K. W. M. Fulford, & C. W. van Staden (Eds.), The Oxford handbook of psychiatric ethics. Oxford University Press.
Gilligan, C. (1993). In a different voice. Psychological theory and women’s development. Harvard University Press.
Glass, L. L. (2003). The gray areas of boundary crossings and violations. American Journal of Psychotherapy, 57, 429–444.
Gracia, D. (1991). Procedimientos de Decisión en Ética Clínica (Decision procedures in clinical ethics). Eudema.
Groenhout, R. E. (2004). Connected lives human nature and an ethics of care. Rowman & Littlefield Publishers.
Gutheil, T. G., & Gabbard, G. O. (1993). The concept of boundaries in clinical practice: Theoretical and risk-management dimensions. American Journal of Psychiatry, 150, 188–196.
Gutheil, T. G., & Gabbard, G. O. (1998). Misuses and misunderstandings of boundary theory in clinical and regulatory settings. The American Journal of Psychiatry, 155(3), 409–414.
Hagiwara, N., Kron, F. W., Scerbo, M. W., & Watson, G. S. (2020). A call for grounding implicit bias training in clinical and translational frameworks. Lancet, 395(10234), 1457–1460.
Hook, J., & Devereux, D. (2018). Sexual boundary violations: Victims, perpetrators, and risk reduction. BJPsych Advances, 24, 374–383.
Hoop, J. G., DiPasquale, T., Hernandez, J. M., & Roberts, L. R. (2008). Ethics and culture in mental health care. Ethics and Behavior, 18(4), 353–372.
Jacobson, N. C., Bentley, K. H., Walton, A., Wang, S. B., Fortgang, R. G., Millner, A. J., Coombs, G., III, Rodman, A. M., & Coppersmith, D. (2020). Ethical dilemmas posed by mobile health and machine learning in psychiatry research. Bulletin of the World Health Organization, 98(4), 270–276.
Jonsen, A. R. (1986). Casuistry as methodology in clinical ethics. Theoretical Medicine, 7, 295–307.
Jonsen, A. R., & Toulmin, S. (1998). The abuse of casuistry. A history of moral reasoning. University of California Press.
Kamm, F. M. (2007). Intricate ethics: Rights, responsibilities, and permissible harms. Oxford University Press.
Kant, I. (1785). Groundwork of the metaphysic of morals (trans: Paton, H. J.). Harper and Row, 1964.
Kernberg, O. F. (2016). The four basic components of psychoanalytic technique and derived psychoanalytic psychotherapies. World Psychiatry, 15(3), 287–288.
Lolas, F. (1996). Theoretical medicine: A proposal for reconceptualizing medicine as a science of actions. Journal of Medicine and Philosophy, 21, 659–670.
Lolas, F. (1999). Bioethics: Moral dialogue in the life sciences. Universitaria.
Lolas, F. (2002). Bioethics and psychiatry: A challenging future. World Psychiatry, 1(2), 127–128.
Lolas, F. (2009). The axiological dimension in psychiatric diagnosis. Acta Bioethica, 15(2), 148–150.
Lolas, F. (2010). Psychiatry: Medical specialty or specialized profession? World Psychiatry, 9(1), 34–35.
Lolas, F. (2011). Ethics and the anthropological medicine of the Heidelberg School: Reciprocity and solidarity. Jahr – European Journal of Bioethics, 2(4), 521–523.
Lolas, F. (2015). The basic discipline of psychiatry as metatext. Acta Bioethica, 21, 61–64.
Lolas, F. (2016). Psychiatry ethics. In H. Ten Have (Ed.), Encyclopedia of global bioethics. Springer. https://doi.org/10.1007/978-3-319-05544-2_355-1
Lolas, F. (2018). The hermeneutical dimension of the bioethical enterprise. Notes on the dialogical/narrative foundations of bioethics. Acta Bioethica, 24(2), 153–159.
Lolas, F., & Drumond, J. G. (2007). Fundamentos de umaantropologiabioetica (Foundations for a bioethical anthropology). Edicoes Loyola.
Lustgarten, S. D., Garrison, Y. L., Sinnard, M. T., & Flynn, A. W. (2020). Digital privacy in mental healthcare: Current issues and recommendations for technology use. Current Opinion in Psychology, 36, 25–31.
Merino, Y., Adams, L., & Hall, W. J. (2018). Implicit bias and mental health professionals: Priorities and directions for research. Psychiatric Services, 69(6), 723–725.
Miller, P. M., Bener, A., Ghuloum, S., Commons, M. L., & Burgut, F. T. (2012). Differences and similarities in cross-cultural perceptions of boundaries: A comparison of results from two studies. International Journal of Law and Psychiatry, 35(5–6), 398–405.
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, & Department of Health, Education and Welfare (DHEW). (1978). The Belmont report. NCPHSBBR/DHEW.
Rachels, J. (2003). Elements of moral philosophy (4th ed., pp. 96–121). McGraw-Hill.
Sabin, J. E., & Harland, J. C. (2017). Professional ethics for digital age psychiatry: Boundaries, privacy, and communication. Current Psychiatry Reports, 19(9), 55.
Saenz, S. R. (2020). Diverse patient populations in psychiatry: Ethical and clinical issues. Focus, 18(1), 52–54.
Sarkar, S. P. (2009). Life after therapy: Post-termination boundary violations in psychiatry and psychotherapy. Advances in Psychiatric Treatment, 15, 82–87.
Savin, D., & Martinez, R. (2006). Cross-cultural boundary dilemmas: A graded-risk assessment approach. Transcultural Psychiatry, 43(2), 243–258.
Scher, S., & Kozlowska, K. (2020). Teaching ethics in psychiatry: Time to reset. Harvard Review of Psychiatry, 28(5), 328–333.
Seidel, C. (2019). Consequentialism: New directions, new problems. Oxford University Press.
Shors, M. K., & Kroll, J. (2019). To cross or not to cross: Clinical boundary considerations with persons who are refugees. Transcultural Psychiatry, 2019, 1363461519878289. Advance online publication.
Stoll, J., Müller, J. A., & Trachsel, M. (2020). Ethical issues in online psychotherapy: A narrative review. Frontiers in Psychiatry, 10, 993.
Supreme Court of California. (1976). Tarasoff vs. The Regents of the University of California. Citation: 551 P.2d 334, 131 Cal. Rptr. 14, 17 Cal. 3d 425. Available at: https://www.courtlistener.com/opinion/1175611/tarasoff-v-regents-of-university-of-california/
Van Zyl, L. (2018). Virtue ethics: A contemporary introduction. Routledge.
Veatch, R. M. (2020). Reconciling lists of principles in bioethics. Journal of Medicine and Philosophy, 45, 540–559.
World Health Organization. (2011). Standards and operational guidance for ethics review of health-related research with human participants. WHO.
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Lolas, F., Basu, D. (2023). Professional Ethics and Boundaries. In: Tasman, A., et al. Tasman’s Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-030-42825-9_10-1
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