title: Ethical considerations when making exceptions to "rules" in psychiatry.
abstract: This article explores several contexts in which psychiatrists may face having to decide whether to make exceptions to rules or guidelines when treating their patients. Contexts discussed include paternalistically going against a patient's autonomy, violating professional psychiatric standards of care, and clashing with some kind of institutional policy. The author contends that standard guidelines cannot possibly apply optimally to all patients, and thus there will be times when exceptions to these guidelines must be made by the psychiatrist. In addition to discussing the ethical considerations, the author offers some suggestions when faced with certain conflicting situations.
authors.affiliation: Dr. Howe is Professor, Department of Psychiatry, Director, Programs in Medical Ethics, and Senior Scientist, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors.forename: Edmund
authors.initials: E
authors.lastname: Howe
keywords: Psychiatric treatment; advocacy; anti-suicide contracts; autonomy; coercion; couple therapy; discharging; ethics; exceptions; families; gifts; intimacy; paternalism; persuasion; standards of care