Psychosomatics 47:519, November-December 2006
doi: 10.1176/appi.psy.47.6.519
© 2006 Academy of Psychosomatic Medicine
Issues in Bioethics
Psychosomatic-medicine psychiatrists are frequently asked to evaluate patients for decision-making capacity to consent to or refuse treatment, participate in treatment planning, discharge planning, and to sign out against medical advice. One study found that 55% of all psychiatric consultations requested during 1 year were for decision-making capacity evaluations.1 Despite the plethora of experience in doing consultations for capacity, teaching bioethics, and serving as members or chairs of bioethics committees, many psychosomatic-medicine psychiatrists feel that their training has not adequately prepared them for these tasks.2 The interface between bioethics and psychosomatic medicine presents many challenges. Among these challenges are the myths around decision-making capacity.3 In the "see one; do one; teach one" world of medicine, there may be little time to reflect and carefully consider some of the challenges at the interface of bioethics and psychosomatic medicine. The need to preserve the delicate balance between autonomy and safety, to honor previously-expressed patient wishes, and to understand the needs of caregivers under siege can present complex ethical dilemmas to the psychosomatic-medicine psychiatrist. Also, the delicate balance among legal, ethical, and clinical issues presents major dilemmas in psychosomatic medicine.
The Bioethics Subcommittee of the Academy of Psychosomatic Medicine would like to provide readers with an opportunity to explore issues in bioethics through the publication of complex bioethics case presentations and in-depth analyses. The section will be edited by the Chair and Members of the Bioethics Subcommittee.
Mary Ann Cohen, M.D.
Chair of the Bioethics Subcommittee of The Academy of Psychosomatic Medicine
Rebecca Brendel, M.D., J.D.
Robert Martin, M.D.
Laura W. Roberts, M.D.
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REFERENCES
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- McKegney FP, Schwartz BJ, O’Dowd MA: Reducing unnecessary consultations for informed consent by liaison with administration. Gen Hosp Psychiatry 1992; 14:15–19[CrossRef][Medline]
- Bourgeois JA, Cohen MA, Geppert CMA: The role of psychosomatic-medicine psychiatrists in bioethics: a survey study of members of the Academy of Psychosomatic Medicine. Psychosomatics 2006; 47:520–526[Abstract/Free Full Text]
- Ganzini L, Volicer L, Nelson WA, et al: Ten myths about decision-making capacity. J Am Med Dir Assoc 2004; 5:263–267[CrossRef][Medline]
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