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Ethics Consultation Masking Psychiatric Issues in Medicine

Ethics Consultation Masking Psychiatric Issues in Medicine Abstract PHYSICIANS often have turned to psychiatric consultants for "help and guidance with morally troublesome cases," in which the consultant may be "expected to fill a mediating role, often... to persuade the patient or family to act in a certain way." The result may be that the "psychiatric consultation mask[s the] moral dilemmas" so that the ethical dimensions of the case are overlooked by both the primary physician and the psychiatrist.1 In the last decade, ethics consultation programs in hospitals have proliferated.2 The Joint Commission on Accreditation of Health Care Organizations now requires that accredited hospitals in the United States have "a functioning process to address ethical issues."3 Perhaps for these reasons there is now a tendency for ethics consultations to mask psychiatric questions. Three examples will illustrate this problem. All three cases arose within a single week at a single institution, a tertiary care teaching hospital in References 1. Perl M, Shelp EE. Psychiatric consultation masking moral dilemmas in medicine. N Engl J Med . 1982;307:618-620.Crossref 2. Fletcher JC, Hoffman DE. Ethics committees: time to experiment with standards. Ann Intern Med . 1994;120:335-338.Crossref 3. Joint Commission on Accreditation of Health Care Organizations. 1995 Accreditation Manual for Hospitals . Oakbrook Terrace, III: Joint Commission on Accreditation of Health Care Organizations; 1994. 4. Groves JE. Management of the borderline patient on a medical or surgical ward: the psychiatric consultant's role. Int J Psychiatry Med . 1975; 6:337-348.Crossref 5. Groves JE. Taking care of the hateful patient. N Engl J Med . 1978;298:883-887.Crossref 6. Gerrard TJ, Riddell JD. Difficult patients: black holes and secrets. BMJ . 1988;297:530-532.Crossref 7. Appelbaum PS, Grisso T. Assessing patients' capacities to consent to treatment. N Engl J Med . 1988;319:1635-1638.Crossref 8. Lo B. Assessing decision-making capacity. Law Med Health Care . 1990;18:193-201. 9. Lee MA. Depression and refusal of life support in older people: an ethical dilemma. J Am Geriatr Soc . 1990;38:710-714. 10. Lipowski ZJ. Consultation-liaison psychiatry: an overview. Am J Psychiatry . 1974;131:623-630. 11. LaPuma J, Schiedermayer DL. Ethics consultation: skills, roles, and training. Ann Intern Med . 1991;114:155-160.Crossref 12. Fletcher JC. Ethics consultation: a service of clinical ethics. Newslett Soc Bioethics Consult . (Spring) 1991:1-2, 6-7. 13. Moreno JD. Ethics consultation as moral engagement. Bioethics . 1991;5:44-56.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Ethics Consultation Masking Psychiatric Issues in Medicine

Leeman, Cavin P.
Archives of Internal Medicine , Volume 155 (16) – Sep 11, 1995
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References (13)

Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430160026004
Publisher site
See Article on Publisher Site

Abstract

Abstract PHYSICIANS often have turned to psychiatric consultants for "help and guidance with morally troublesome cases," in which the consultant may be "expected to fill a mediating role, often... to persuade the patient or family to act in a certain way." The result may be that the "psychiatric consultation mask[s the] moral dilemmas" so that the ethical dimensions of the case are overlooked by both the primary physician and the psychiatrist.1 In the last decade, ethics consultation programs in hospitals have proliferated.2 The Joint Commission on Accreditation of Health Care Organizations now requires that accredited hospitals in the United States have "a functioning process to address ethical issues."3 Perhaps for these reasons there is now a tendency for ethics consultations to mask psychiatric questions. Three examples will illustrate this problem. All three cases arose within a single week at a single institution, a tertiary care teaching hospital in References 1. Perl M, Shelp EE. Psychiatric consultation masking moral dilemmas in medicine. N Engl J Med . 1982;307:618-620.Crossref 2. Fletcher JC, Hoffman DE. Ethics committees: time to experiment with standards. Ann Intern Med . 1994;120:335-338.Crossref 3. Joint Commission on Accreditation of Health Care Organizations. 1995 Accreditation Manual for Hospitals . Oakbrook Terrace, III: Joint Commission on Accreditation of Health Care Organizations; 1994. 4. Groves JE. Management of the borderline patient on a medical or surgical ward: the psychiatric consultant's role. Int J Psychiatry Med . 1975; 6:337-348.Crossref 5. Groves JE. Taking care of the hateful patient. N Engl J Med . 1978;298:883-887.Crossref 6. Gerrard TJ, Riddell JD. Difficult patients: black holes and secrets. BMJ . 1988;297:530-532.Crossref 7. Appelbaum PS, Grisso T. Assessing patients' capacities to consent to treatment. N Engl J Med . 1988;319:1635-1638.Crossref 8. Lo B. Assessing decision-making capacity. Law Med Health Care . 1990;18:193-201. 9. Lee MA. Depression and refusal of life support in older people: an ethical dilemma. J Am Geriatr Soc . 1990;38:710-714. 10. Lipowski ZJ. Consultation-liaison psychiatry: an overview. Am J Psychiatry . 1974;131:623-630. 11. LaPuma J, Schiedermayer DL. Ethics consultation: skills, roles, and training. Ann Intern Med . 1991;114:155-160.Crossref 12. Fletcher JC. Ethics consultation: a service of clinical ethics. Newslett Soc Bioethics Consult . (Spring) 1991:1-2, 6-7. 13. Moreno JD. Ethics consultation as moral engagement. Bioethics . 1991;5:44-56.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Sep 11, 1995

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