European Psychiatric Association policy paper on ethical aspects in communication with patients and their families

Abstract

Background. Establishing a valid communication is not only a basic clinical need to be met but also a relevant ethical commitment. Methods. On the basis of the relevant literature, ethical issues arising from specific, important situations in clinical practice were identified. Results. The main ethical problems regarding communication about the disorder, both in general and in relation to prodromal stages, were described and discussed together with those regarding communication about voluntary and involuntary treatments, “dual roles” enacted in clinical practice, genetic counseling, and end-of-life conditions; on the basis of what emerged, ethically driven indications and suggestions were provided. Conclusions. Several situations put the psychiatrist in front of relevant dilemmas and doubts which are no easy to face with; an ethically driven approach based upon the principle of the best interest of patients may support clinicians in their decisions.

NDIS Participants with Psychosocial Disabilities and Life-Limiting Diagnoses: A Scoping Review

“…“Improving quality of life…as well as reducing physical and mental stress” [ 78 ] (p. 4) is fundamental to palliative care. People with SPMI often have a reduced quality of life throughout their lifetime, further compounded by a life-limiting diagnosis [ 25 , 36 , 79 ]. Many people with SPMI have struggled with service systems that do not respect their autonomy.…”

“…As a result, they can be discharged from mental health services without notice or have supports reduced. The literature shows that this leaves people with SPMI and life-limiting conditions feeling abandoned and dying alone in unfamiliar environments [ 22 , 79 ]. The literature also highlights the need for continuity of care and continued support from a multidisciplinary team where pre-existing therapeutic relationships are maintained and fostered, and medication management responsibilities are shared [ 22 , 24 , 53 , 79 , 94 ].…”

“…The literature shows that this leaves people with SPMI and life-limiting conditions feeling abandoned and dying alone in unfamiliar environments [ 22 , 79 ]. The literature also highlights the need for continuity of care and continued support from a multidisciplinary team where pre-existing therapeutic relationships are maintained and fostered, and medication management responsibilities are shared [ 22 , 24 , 53 , 79 , 94 ]. However, the research indicates that the mental health workforce often finds working with dying patients/clients challenging [ 5 , 16 , 28 ].…”

Clinical practice guidelines on breaking bad news

“…As the team reaches a confirmed diagnosis over a period of time, the team may sit down with the caregivers as well as the patient who may have settled down by that time. [ 24 ] In the case of Alzheimer’s disease, there is general consensus about disclosure. However, one has to determine when and how to disclose.…”

Ethical dilemmas in contemporary psychiatry: Findings from a survey of National Psychiatric Associations in Europe

“…This and further guidance papers are freely available on the EPA website (www.europsy.net). The EPA Council of National Psychiatric Associations (NPAs) has also addressed ethical aspects of communication in psychiatric practice, by publishing basic and specific principles of communication with respect to informing about the disorder in prodromal stages, recommended treatments, involuntary treatments, communication in case of competing obligations ("dual roles"), genetic counseling, and communication in case of end-of-life conditions [10]. In parallel, the World Psychiatric Association (WPA) developed and released a code of ethics for psychiatry in 2021 [11].…”