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Professionalism and Ethics: A Q&A Self-Study Guide for Mental Health Professionals

Lucy A. Epstein, M.D.

This book opens with this succinct quote: "Ethics is elegant and earthy." The same could be said for this concise, useful, and insightful book by experts in the field of psychiatry and ethics, Laura Roberts, M.D., and Jinger Hoop, M.D. This book provides a self-study, case-oriented guide to professionalism and ethics in the practice of mental health. It readily accomplishes this goal in a pragmatic fashion that makes the often lofty world of ethics applicable to the challenges of clinical practice. It is particularly applicable to psychiatrists who work in the medical setting, given the frequency and importance of ethical challenges in our work.

The book opens with a treasure trove of introductory remarks by such experts as Paul Appelbaum, M.D., Glen Gabbard, M.D., and Thomas Wise, M.D.; together they set a framework for how ethics can and should be used in clinical and research psychiatry. These remarks emphasize what is unique about this book: that it is not simply a primer of abstract concepts, but rather an overview of how ethics interact with clinical practice and medical professionalism.

The first chapter provides an overview of the core concepts in ethics and professionalism for mental health clinicians, researchers, and trainees. This chapter clearly defines essential ethics skills, such as the ability to identify and anticipate risky or problematic situations. In a series of clearly written tables, the inherent tensions of utilizing ethical principles in clinical practice are explained, and a model of ethical decision-making is provided. Each of these tables could clearly stand on its own; I admit to being tempted to cut the tables out and carry them with me on my daily rounds in the medical hospital. A glossary of ethical terms is also featured, ranging from general terms such as autonomy and beneficence to psychiatric terms, such as therapeutic boundaries. This is followed by a detailed explanation of the core concepts the mental health professional is likely to encounter in practice, such as codes of research ethics, the maintenance of therapeutic boundaries, and informed consent. A second, brief chapter on professionalism follows, which, at times, felt perhaps superfluous to the book as a whole; however, given the importance of the topic, it ultimately serves as a useful addition.

This is followed by four chapters that contain a series of question-and-answer case examples, covering core concepts in ethics, clinical care, medical research, and professionalism. Each answer is explained fully, using the concepts introduced earlier in the book and is followed by an extensive set of references. One of the many strengths of this book is the breadth of topics covered, from interrogation of terrorism suspects to cultural competency to issues regarding end-of-life care.

The intended audience of this book is likely to be trainees in mental health who are preparing for the clinical ethics portion of board examinations. However, this book is a useful, pragmatic, and easily readable addition to any practicing psychiatrist’s library, no matter what his or her level of expertise. The psychiatrist who specializes in psychosomatic medicine would find this book particularly useful when addressing common challenges in consultation psychiatry, such as end-of-life issues, capacity assessments, refusal of care, and working within a multidisciplinary framework. Overall, this elegant and earthy book offers a pragmatic and effective guide to the impact of ethics in daily clinical practice in psychiatry.

FOOTNOTES

 
Dr. Epstein is an attending psychiatrist at Columbia University Medical Center, New York, NY.

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