Professional Ethics and Boundaries

Ethical psychiatrists adhere to a set of professional values based on fostering trust and a commitment to a healing relationship designed solely for the patient's benefit. Professional ethics are embodied in this professional attitude and are effectuated clinically by adherence to coherent treatment boundaries. This chapter summarizes some of the history of medical ethics and its manifestation in the professional approach, along with a synopsis of specific ethical principles developed by the American Psychiatric Association (APA) and the World Psychiatric Association (WPA). Ethical issues pertinent to forensic psychiatry are outlined. The elements of the treatment frame, therapeutic boundaries, and boundary violations, are reviewed in relation to their importance in maintaining ethical and effective psychiatric treatment, and reducing the incidence of medical error. Specific components of the coherent psychiatric frame are discussed, including the importance of psychiatrists maintaining stability, avoiding dual relationships, promoting patient autonomy, avoiding collusive forms of compensation, maintaining relative anonymity, applying the principle of therapeutic abstinence, and protecting themselves from overt or covert exploitation by patients.