In 1977, the World Psychiatric Association approved the Declaration
of Hawaii, setting out ethical guidelines for the practice of psychiatry.
The Declaration was updated in Vienna in 1983. To reflect the impact of
changing social attitudes and new medical developments on the psychiatric
profession, the Word Psychiatric Association has once again examined and
revised some of these ethical standards.
Medicine is both a healing art and a science. The dynamics of this combination
are best reflected in psychiatry, the branch of medicine that specializes
in the care and protection of those who are ill and infirm because of
a mental disorder or impairment. Although there may be cultural, social,
and national differences, the need for ethical conduct and continual review
of ethical standards is universal.
As practitioners of medicine, psychiatrists must be aware of the ethical
implications of being a physician and of the specific ethical demands
of the specialty of psychiatry. As members of society, psychiatrists must
advocate for fair and equal treatment of the mentally ill, for social
justice and equity for all.
Ethical behavior is based on the psychiatristís individual sense of responsibility
towards the patient and their judgement in determining what is correct
and appropriate conduct. External standards and influences such as professional
codes of conduct, the study of ethics, or the rule of law by themselves
will not guarantee the ethical practice of medicine.
Psychiatrists should at all times, keep in mind the boundaries of the
psychiatrist-patient relationship, and be guided primarily by the respect
for patients and concern for their welfare and integrity.
It is in this spirit that the World Psychiatric Association approved by
the General Assembly, on August 25, 1996, the following ethical standards
that should govern the conduct of psychiatrists worldwide.
- Psychiatry is a medical discipline concerned with the provision
of the best treatment for mental disorders; with the rehabilitation
of individuals suffering from mental illness and with the promotion
of mental health. Psychiatrists serve patients by providing the best
therapy available consistent with accepted scientific knowledge and
ethical principles. Psychiatrists should devise therapeutic interventions
that are least restrictive to the freedom of the patient and seek advice
in areas of their work about which they do not have primary expertise.
While doing so, psychiatrists should be aware of and concerned with
the equitable allocation of health resources.
- It is the duty of psychiatrists to keep abreast scientific
developments of the specialty and to convey updated knowledge to others.
Psychiatrists trained in research should seek to advance the scientific
frontiers of psychiatry.
- The patient should be accepted as a partner by right in therapeutic
process. The therapist-patient relationship must be based on mutual
trust and respect to allow the patient to make free and informed decisions.
It is the duty of psychiatrists to provide the patient with relevant
information so as to empower the patient to come to a rational decision
according to his or her personal values and preferences.
- When the patient is incapacitated and/or unable to exercise
proper judgement because of a mental disorder, the psychiatrists should
consult with the family and, if appropriate, seek legal counsel, to
safeguard the human dignity and the legal right of the patient. No treatment
should be provided against the patientís will, unless withholding treatment
would endanger the life of the patient and/or those who surround him
or her. Treatment must always be in the best interest of the patient.
- When psychiatrists are requested to assess a person, it is
their duty first to inform and advice the person being assessed about
the purpose of the intervention, the use of the findings, and the possible
repercussions of the assessment. This isparticularly important when
the psychiatrists are involved in third party situations.
- Information obtained in the therapeutic relationship should
be kept in confidence and used, only and exclusively, for the purpose
of improving the mental health of the patient. Psychiatrists are prohibited
from making use of such information for personal reasons, or financial
or academic benefits. Breach of confidentially may only be appropriate
when serious physical or mental harm to the patient or to the third
person could ensue if confidentiality were maintained; in these circumstances,
psychiatrists should whenever possible, first advice the patient about
the action to be taken.
- Research that is not conducted in accordance with the canons
of science is unethical. Research activities should be approved by an
appropriately constituted ethical committee. Psychiatrists should follow
national and international rules for the conduct of research. Only individuals
properly trained for research should undertake or direct it. Because
psychiatric patients are particularly vulnerable research subjects,
extra caution should be taken to safeguard their autonomy as well as
their mental and physical integrity. Ethical standards should also be
applied in the selection of population groups, in all types of research
including epidemiological and sociological studies and in collaborative
research involving other disciplines or several investigating centers.
Concerning Specific Situations
The World Psychiatric Association Ethics Committee recognizes the need to
develop a number of specific guidelines on a number of specific situations.
Five such specific guidelines are stated below. In the future, the committee
will address other critical issues such as the ethics of psychotherapy,
new therapeutic alliances, relationship with the pharmaceutical industry,
sex change and the ethics of managed care.
- EUTHANASIA: A physicianís duty, first and foremost,
is the promotion of health, the reduction of suffering, and the protection
of life. The psychiatrist, among whose patientare some who are severely
incapacitated and incompetent to reach an informed decision, should
be particularly careful of actions that could lead to the death of those
who cannot protect themselves because of their disability. The psychiatrist
should be aware that the views of a patient may be distorted by mental
illness such as depression. In such situations, the psychiatristís role
is to treat the illness.
- TORTURE: Psychiatrists shall not take part in any process
of mental or physical torture, even when authorities attempt to force
their involvement in such acts.
- DEATH PENALTY: Under no circumstances should psychiatrists
participate in legally authorized executions nor participate in assessments
of competency to be executed.
- SELECTION OF SEX: Under no circumstances should a psychiatrist
participate in decisions to terminate pregnancy for the purpose of sex
- ORGAN TRANSPLANTATION: The role of the psychiatrist
is to clarify the issues surrounding organ donations and to advise on
religious, cultural, social and family factors to ensure that informed
and proper decisions be made by all concerned. The psychiatrists should
not act as a proxy decision maker for patients nor use psychotherapeutic
skills to influence the decision of a patient in these matters. Psychiatrists
should seek to protect their patients and help them exercise self-determination
to the fullest extent possible in situation of organ transplantation.