Ethical Issues in Emergency Psychiatry.
The care of patients with a psychiatric emergency is fraught with ethical challenges. Applying ethical reasoning to clinical challenges may help to improve care. Emergency providers should assess decision-making capacity using 4 criteria: communication, understanding, appreciation, and reasoning. Maintaining patient confidentiality is a strong imperative for emergency physicians and should be protected unless compelling additional concerns take precedence. The goal of involuntary treatment should be to protect patients from harm that they would not be exposed to were they capable of autonomous decision making, not dangerous, or not impaired by their psychiatric illness using the least restrictive means possible.
Section of Emergency Medicine, Department of Medicine, Center for Medical Ethics & Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 310D, Houston, TX 77030, USA. Electronic address: Nathan.Allen@bcm.edu.
Nathan Gold
NG
Allen
Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, BCM350, Houston, TX, 77030, USA.
Jeffrey Steven
JS
Khan
Section of Emergency Medicine, Center for Medical Ethics & Health Policy, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; King Saud University, Riyadh 12372, Saudi Arabia.
Mohammad Shami
MS
Alzahri
Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, BCM350, Houston, TX, 77030, USA.
Andrea Gail
AG
Stolar
D003657:Decision Making / Q000941:ethics*; D004630:Emergencies; D004992:Ethics, Medical; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D026684:Personal Autonomy; D011570:Psychiatry / Q000941:ethics*
Confidentiality; Decision-making capacity; Emergency psychiatry; Ethics; Involuntary treatment