Ethics Information

As a condition of membership, members of the Maryland Psychiatric Society and the American Psychiatric Association are required to abide by the Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry. If a member is found to have violated any of these principles, he or she can be sanctioned with a reprimand, suspension of membership or expulsion from both organizations.

It is important for even seasoned psychiatrists to regularly review ethical principles to help ensure their practices are in compliance. The APA, which sets nationwide ethical standards for psychiatrists, has online resources available to assist members in this effort. The Opinions of the Ethics Committee on the Principles of Medical Ethics can assist members and district branches in understanding and applying the principles. Another useful resource is the Ethics Primer, a practical compilation of ethical thinking regarding the most frequently encountered problems facing all psychiatrists, including residents.

APA Reaffirms Goldwater Rule

In March 2017, the APA confirmed its support for the ethics guideline commonly known as “The Goldwater Rule,” which asserts that member psychiatrists should not give professional opinions about the mental state of someone they have not personally evaluated.  The APA Ethics Committee issued an opinion that clarifies the ethical principle that was established in 1973, and answers questions that have arisen recently. Three main points form its rationale:

  • When a psychiatrist comments about the behavior, symptoms, diagnosis, etc. of a public figure without consent, that psychiatrist has violated the principle that psychiatric evaluations be conducted with consent or authorization.
  • Offering a professional opinion on an individual that a psychiatrist has not examined is a departure from established methods of examination, which require careful study of medical history and first-hand examination of the patient. Such behavior compromises both the integrity of the psychiatrist and the profession.
  • When psychiatrists offer medical opinions about an individual they have not examined, they have the potential to stigmatize those with mental illness.

For more details, please see the APA Blog on Goldwater Rule.

2013 Ethics Update

The Principles of Medical Ethics are published by the AMA as “standards of conduct that define the essentials of honorable behavior for the physician.” Recognizing that physicians in psychiatric practice may face special ethical problems, the APA publishes The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry.  Complaints charging APA members with unethical behavior or practices are investigated by the district branch and resolved according to procedures approved by the APA Assembly and the APA Board of Trustees. The APA Ethics Committee has also compiled ethical questions and answers to help the practitioner understand some of the complex ethical dilemmas that may arise in psychiatric practice. This is the Opinions of the Ethics Committee on The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry.

The AMA and the APA periodically publish updates to the ethical guidelines. The 165-year-old AMA Code of Medical Ethics is being updated for the first time in four decades to make it easy for physicians to find and interpret guidance on particular topics.  The AMA Council on Ethical and Judicial Affairs (CEJA) is reviewing more than 200 ethical opinions to ensure consistency, while preserving its fundamental guidance. CEJA also is carefully evaluating the opinions for continued relevance, thoroughness of analysis, cogency of recommendations and topical gaps that require additional reports.  AMA members can view a sample of what the updated Code of Medical Ethics might look like via the online CEJA Forum (AMA member login required), and offer feedback on the new format and opinions in a draft chapter on the health of the public.

In 2011, the APA adopted new Procedures for Handling Unethical Complaints, and in 2013, the APA released an updated Principles. The following annotations were added to Section 8 of The Principles:

Section 8

A physician shall, while caring for a patient, regard responsibility to the patient as paramount.
  1. Psychiatrists’ relationships with companies, organizations, the community, or larger society can affect their interactions with patients.
  2. When the psychiatrist’s outside relationships conflict with the clinical needs of the patient, the psychiatrist must always consider the impact of such relationships and strive to resolve conflicts in a manner that the psychiatrist believes is likely to be beneficial to the patient.
  3. When significant relationships exist that may conflict with patients’ clinical needs, it is especially important to inform the patient or decision maker about these relationships and potential conflicts with clinical needs.
  4. In informing a patient of treatment options, the psychiatrist should assist the patient in identifying relevant options that promote an informed treatment decision, including those that are not available from the psychiatrist or from the organization with which the psychiatrist is affiliated

The most up to date documents can be found on the APA ethics page, which includes general information, 2013 Principles (with Procedures), and Opinions.

Joanna D. Brandt, M.D.