title: Clinical and ethical dilemmas in the psychiatric care of patients who border on the edge of being able to live safely and independently.
abstract: In the current economic environment and era of health care finance reform, mental health budgets have faced cutbacks across the nation, and they may face even deeper reductions in the future. Diminished funding for care of patients with severe psychiatric illness creates significant ethical and clinical dilemmas. Throughout medicine, physicians' professional virtues and obligations of beneficence may conflict with the need to balance respect for patient autonomy and deliver clinically appropriate, humane, and ethical care within a limited budget. This article uses a case presentation to highlight this struggle at the interface of psychiatry, ethics, and the emergency room in the care of people with severe mental illness.
authors.affiliation: Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Stephanie I
authors.initials: SI
authors.lastname: Kwok
authors.forename: Anu A
authors.initials: AA
authors.lastname: Matorin
authors.forename: David A
authors.initials: DA
authors.lastname: Kahn
mesh_terms: D003134:Commitment of Persons with Psychiatric Disorders; D004637:Emergency Services, Psychiatric / Q000941:ethics*; D005260:Female; D006801:Humans; D016743:Mental Competency; D008875:Middle Aged; D010347:Patient Care Planning / Q000941:ethics*; D010349:Patient Compliance; D010817:Physician-Patient Relations / Q000941:ethics*; D011618:Psychotic Disorders / Q000534:rehabilitation*; D012935:Social Justice; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D014481:United States; D028722:Virtues