When most people talk about mental illness, they usually talk about the same things repeatedly: Stigma. Medications. Psychiatrists. Mental hospitals. There’s plenty of talk about disorders, from anorexia to attention deficit hyperactivity to moods and anxiety. Money is always a big topic, and discussions about problems at work (or lack of work) are also frequent.
But what I am obsessed with these days is the subject of ethics in the world of mental health, partly because ethics are one of the least talked about subjects, and in my mind, it’s one of the most important.
Here’s an example. Had America’s doctors opposed the pre-existing condition clause that left millions of Americans without health insurance before the Affordable Care Act was passed in 2012 (including me), perhaps we could have changed that discriminatory law earlier. Why would they do this? Because the pre-existing condition clause was unethical, that’s why. It doesn’t mean it was illegal. That’s a different story. But it was wrong, really wrong, and people like myself were left without any kind of health insurance whatsoever. Our nation’s doctors should have taken a much stronger stance.
Here is an excerpt from the American Medical Association’s Code of Ethics addressing the issue of prejudice in the treatment of individuals.
CHAPTER 8: OPINIONS ON PHYSICIANS & THE HEALTH OF THE COMMUNITY
The medical profession has an ethical responsibility to:
(g) Help increase awareness of health care disparities.
(i) Support research that examines health care disparities, including research on the unique health needs of all genders, ethnic groups and medically disadvantaged populations, and the development of quality measures and resources to help reduce disparities.
Many people don’t realize that it wasn’t that I couldn’t get health insurance to cover my mental health issues: I couldn’t get insurance altogether. Had I been struck by cancer or any other lengthy and expensive illness, I would have been left with a lot of debt and really bad, life-long, credit scores. I lived in constant fear of the ‘big one.”
What does ethics have to do with psychiatrists? We depend on our “P-docs” a lot. Patients with mental health issues often can’t think clearly. We are very mentally vulnerable, relying often on the advice of our mental health providers of how to live our lives. We are not just regular patients.
Our decision-making process is often non-existent, we can be incredibly impulsive, and I for one take sedatives before I go to bed as part of my daily medical routine. They help my brain get adequate rest alongside the rest of my body. If I take them too late, as sometimes happens, (I’m not perfect) the next morning I can be groggy and not in the best frame of mind to make good decisions.
So I trust my psychiatrists a lot to help me think things through, to tell me if I’m overreacting to something, or whether my emotions are indeed real.
In reading the American Psychiatric Association Code of Ethics, one thing becomes clear. Sex can get in a way of what should be a perfectly good doctor-patient relationship.
Seriously?
Seriously.
It spells it out here in Section 2
“A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.”
It then goes on to say: “Further, the necessary intensity of the treatment relationship may tend to activate sexual and other needs and fantasies on the part of both patient and psychiatrist, while weakening the objectivity necessary for control. Additionally, the inherent inequality in the doctor-patient relationship may lead to exploitation of the patient. Sexual activity with a current or former patient is unethical.”
You have to wonder, why should the “inherent inequality in the doctor-patient relationship” lead to exploitation of the patient? And what’s this about a “weakening” of the doctor’s “objectivity necessary for control?” Are they trying to say that male doctors can’t control themselves sexually because they are dealing with a mentally ill patient who is vulnerable? The sad thing is, that they are addressing this issue because it is, indeed, a serious problem in the industry. That’s another story.
I think psychiatrists should sit down with their patients, on day one, and go over the code of ethics, give them a copy, have them sign it, tell them how to contact the American Psychiatric Association if they feel that their rights have been violated. An ethical, honest physician will do this.
Ethics matter.
