Ethical approach in contemporary psychiatry: a pragmatic approach in a psychiatry access center

Medical and legal professionals' attitudes towards confidentiality and disclosure of clinical information in forensic settings: a survey using case vignettes

OBJECTIVE

When potentially dangerous patients reveal criminal fantasies to their therapists, the latter must decide whether this information has to be transmitted to a third person in order to protect potential victims. We were interested in how medical and legal professionals handle such situations in the context of prison medicine and forensic evaluations. We aimed to explore the motives behind their actions and to compare these professional groups.

METHOD

A mail survey was conducted among medical and legal professionals using five fictitious case vignettes. For each vignette, participants were asked to answer questions exploring what the professional should do in the situation and to explain their justification for the chosen response.

RESULTS

A total of 147 questionnaires were analysed. Agreement between participants varied from one scenario to another. Overall, legal professionals tended to disclose information to a third party more easily than medical professionals, the latter tending to privilege confidentiality and patient autonomy over security. Perception of potential danger in a given situation was not consistently associated with actions.

CONCLUSION

Professionals' opinions and attitudes regarding the confidentiality of potentially dangerous patients differ widely and appear to be subjectively determined. Shared discussions about clinical situations could enhance knowledge and competencies and reduce differences between professional groups.

Should a suicidal patient with Huntington's disease be hospitalized against her will? Attitudes among future physicians and lawyers and discussion of ethical issues

The issue of rational suicide of a competent patient suffering from a hopeless but not terminal disease is controversial. Little is known about how psychiatrists, other physicians or judges make decisions about involuntary hospitalization of such patients, or about their ethical reasoning. The objective of this study was to identify future physicians' and lawyers' views on involuntary hospitalization of a suicidal Huntington's disease (HD) patient and to evaluate whether they are ethically defendable. Five-hundred and ninety-nine law students and advanced medical students reported whether they agree or not to involuntary hospitalize a suicidal HD patient (audio/video recording). No significant differences were found between medical and law students. Forty-four percent of students agreed to hospitalization, 49.3% disagreed. The comments indicate that medical and law students had pessimistic views about the quality of life of an HD patient. Medical students referred more often than law students to patients' autonomy rights and less often to benefits to relatives. Involuntary hospitalization of a suicidal but not terminal HD patient is controversial among future physicians and lawyers. Students underestimated the need for careful evaluation. More open discussion and more ethical teaching on the subject of acceptance of rational suicide for hopelessly, but not yet terminally ill patients are needed.