Download PDF
Psychiatr Prax 2014; 41(07): 355-363
DOI: 10.1055/s-0034-1370058
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Klinische Ethik in der Psychiatrie: State of the Art

Clinical Ethics in Psychiatry: State of the Art
Stella Reiter-Theil
1   Abteilung Klinische Ethik, Universitäre Psychiatrische Kliniken, Universitätsspital Basel, IBMB, Universität Basel, Schweiz
,
Jan Schürmann
1   Abteilung Klinische Ethik, Universitäre Psychiatrische Kliniken, Universitätsspital Basel, IBMB, Universität Basel, Schweiz
,
Klaus Schmeck
2   Kinder- und Jugendpsychiatrische Klinik, Universitäre Psychiatrische Kliniken, Basel, Schweiz
› Author Affiliations
Further Information

Publication History

Publication Date:
28 July 2014 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Ziel: Überblick zur klinischen Ethik (Konsultation) in der Psychiatrie.

Methode: Systematische Literaturrecherche in Datenbanken vor dem Hintergrund der modellhaften Implementierung von Ethikkonsultation in einer psychiatrischen Universitätsklinik.

Ergebnisse: Berichte zur Ethikkonsultation in der Psychiatrie wurden nur sporadisch publiziert; dem stehen aktuelle Erfahrungen gegenüber, die erheblichen Bedarf belegen.

Schlussfolgerungen: Bedarf an Erprobung und Begleitforschung zur ethischen Unterstützung in der Psychiatrie. Bisher bewährt: patienten- sowie teamorientierte ethische Unterstützung.

Abstract

Aim: Overview on Clinical Ethics Consultation in Psychiatry.

Method: Systematic literature search in data bases (PubMed, Web of Knowledge, SpringerLink, PubPsych, PsychSpider und PsycINFO) against the background of practical experiences with pilot model of implementation of Ethics Consultation in one psychiatric university hospital.

Results: Reports on Ethics Consultation in Psychiatry were published only sporadically. This is contrasted by recent experiences showing considerable needs for ethics support in Child and Adolescent Psychiatry, Adult as well as Forensic Psychiatry.

Discussion: This somewhat “late” development of Ethics Consultation in Psychiatry (compared with somatic medicine) might have structural reasons (lacking resources), be related to strong compensatory competencies of psychiatric staff, esp. regarding communication or legal knowledge, but could also relate to an under-estimation (“under-diagnostic”) of ethical problems in psychiatric patient care – both, in the eyes of psychiatric insiders, as well as seen from the outside.

Conclusions: Needs for model projects and accompanying research on Ethics Consultation in Psychiatry. Proved in practice: patient- as well as team-oriented ethics support.

Schlüsselwörter

klinische Ethikkonsultation - ethische Unterstützung - Psychiatrie - Literaturrecherche

Keywords

clinical ethics consultation - ethics support - psychiatry - literature search
 

  • Literatur

  • 1 Reiter-Theil S. Ethics consultation on demand: concepts, practical experiences and a case study. J Med Ethics 2000; 26: 198-203
    CrossrefPubMedGoogle Scholar
  • 2 American Society for Bioethics and Humanities (ASBH). Core Competencies for Health Care Ethics Consultation. 2nd. Edition. Glenview: ASBH; 2011
    Google Scholar
  • 3 Moher D, Liberati A, Tetzlaff J et al. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLos Med 2009; 6 DOI: 10.1371/journal.pmed1000097.
    PubMedGoogle Scholar
  • 4 Hayes JR. Consultation-liaison psychiatry and clinical ethics: a model for consultation and teaching. Gen Hosp Psychiatry 1986; 8: 415-418
    CrossrefPubMedGoogle Scholar
  • 5 Höger C, Reiter-Theil S, Reiter L et al. Fallbezogene ethische Reflexion. Syst Fam 1997; 10: 174-179
    PubMedGoogle Scholar
  • 6 Liegeois A, Eneman M. Ethics of deliberation, consent and coercion in psychiatry. J Med Ethics 2008; 34: 73-76
    CrossrefPubMedGoogle Scholar
  • 7 Pargiter R, Bloch S. The ethics committee of a psychiatric college: its procedures and themes. Aust N Z J Psychiatry 1997; 31: 76-82
    CrossrefPubMedGoogle Scholar
  • 8 Reiter-Theil S. Kompetenz durch Ethik-Konsultation: ein Modell – dargestellt am Problem der Sterilisation einer geistig behinderten Frau. systeme 1998; 12: 22-36
    PubMedGoogle Scholar
  • 9 Trinh NH, Moore D, Brendel DH. Ethics consultation to PACT teams: balancing client autonomy and clinical necessity. Harvard review of psychiatry 2008; 16: 365-372
    CrossrefPubMedGoogle Scholar
  • 10 Wilson DR, Steibelt P. Patients’ Rights and Ethics Committee, Douglas Hospital Centre. Canada’s mental health 1985; 33: 24-27
    PubMedGoogle Scholar
  • 11 Abma T, Molewijk B, Widdershoven GM. Good Care in Ongoing Dialogue. Improving the Quality of Care Through Moral Deliberation and Responsive Evaluation. Health Care Anal 2009; 17: 217-235
    CrossrefPubMedGoogle Scholar
  • 12 Abma TA, Widdershoven GA. Moral deliberation in psychiatric nursing practice. Nurs Ethics 2006; 13: 546-557
    CrossrefPubMedGoogle Scholar
  • 13 Dauwerse L, Weidema F, Abma T et al. Implicit and Explicit Clinical Ethics Support in The Netherlands: A Mixed Methods Overview Study. HEC Forum 2013; DOI: 10.1007/s10730-013-9224-2.
    PubMedGoogle Scholar
  • 14 Landeweer EG, Abma TA, Widdershoven GA. Moral margins concerning the use of coercion in psychiatry. Nurs Ethics 2011; 18: 304-316
    CrossrefPubMedGoogle Scholar
  • 15 Landeweer EGM, Abma TA, Widdershoven GAM. The Essence of Psychiatric Nursing Redefining Nurses’ Identity Through Moral Dialogue About Reducing the Use of Coercion and Restraint. Adv Nurs Sci 2010; 33: E31-E42
    CrossrefPubMedGoogle Scholar
  • 16 Molewijk AC, Abma T, Stolper M et al. Teaching ethics in the clinic. The theory and practice of moral case deliberation. J Med Ethics 2008; 34: 120-124
    CrossrefPubMedGoogle Scholar
  • 17 Molewijk B, Verkerk M, Milius H et al. Implementing moral case deliberation in a psychiatric hospital: process and outcome. Medicine, Health Care and Philosophy 2008; 11: 43-56
    CrossrefPubMedGoogle Scholar
  • 18 van der Ham AJ, Kupper F, Bodewes A et al. Stimulating client involvement and client-provider dialog through participatory video: deliberations on long-term care in a psychiatric hospital. Patient Educ Couns 2013; 91: 44-49
    CrossrefPubMedGoogle Scholar
  • 19 Artnak KE. Ethics consultation in dual diagnosis of mental illness and mental retardation: medical decisionmaking for community-dwelling persons. Camb Q Healthc Ethics 2008; 17: 239-246
    PubMedGoogle Scholar
  • 20 Backlar P, McFarland B. A national survey of ethics committees in state mental hospitals. HEC Forum 1993; 5: 272-288
    CrossrefPubMedGoogle Scholar
  • 21 Horn P. Psychiatric ethics consultation in the light of DSM-V. HEC Forum 2008; 20: 315-324
    CrossrefPubMedGoogle Scholar
  • 22 Primeau F. Basic Principles of Ethics for Psychiatry. CPA Bulletin de l’APC 2002; 2: 7-8
    PubMedGoogle Scholar
  • 23 Vollmann J. Clinical Ethics Committees and Ethics Consultation in Psychiatry. In: Helmchen H, Sartorius N, eds. Ethics in Psychiatry. Netherlands: Springer; 2010: 109-125
    CrossrefGoogle Scholar
  • 24 Hoy J, Feigenbaum E. Ethics In Community Care Making the Case for Ethics Consults in Community Mental Health Centers. Community Mental Health Journal 2005; 41: 235-250
    CrossrefPubMedGoogle Scholar
  • 25 Roberts LW, Battaglia J, Epstein RS. Frontier ethics: mental health care needs and ethical dilemmas in rural communities. Psychiatr Serv 1999; 50: 497-503
    CrossrefPubMedGoogle Scholar
  • 26 Su L, Huang J, Yang W et al. Ethics, patient rights and staff attitudes in Shanghai's psychiatric hospitals. BMC Med Ethics 2012; 13: 1472-6939
    PubMedGoogle Scholar
  • 27 Zacchia C, Tremblay J. [Clinical ethics in psychiatry: the experience at Douglas Hospital]. Sante Ment Que 2006; 31: 95-105
    CrossrefPubMedGoogle Scholar
  • 28 Pargiter R, Bloch S. Developing a code of ethics for psychiatry: the Australasian experience. Aust N Z J Psychiatry 1994; 28: 188-196
    CrossrefPubMedGoogle Scholar
  • 29 Sondheimer AN, Klykylo WM. The Ethics Committees of the American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association: history, process, education, and advocacy. Child Adolesc Psychiatr Clin N Am 2008; 17: 225-236
    CrossrefPubMedGoogle Scholar
  • 30 Reiter-Theil S. Klinische Ethikkonsultation – eine methodische Orientierung zur ethischen Beratung am Krankenbett. Schweizerische Ärztezeitung 2005; 86: 346-351
    PubMedGoogle Scholar
  • 31 Beauchamp TL, Childress JF. Principles of biomedical ethics. 6th. Aufl. New York: Oxford University Press; 2009
    Google Scholar
  • 32 Medau I, Jox R, Dittmann V et al. Eine Pilotstudie zum Umgang mit Fehlern in der Psychotherapie – Therapeuten berichten aus der Praxis. Psychiat Prax 2012; 39: 326-331
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Lang U. Innovative Psychiatrie mit Offenen Türen: Deeskalation und Partizipation in der Akutpsychiatrie. Berlin, Heidelberg: Springer; 2013
    CrossrefGoogle Scholar
  • 34 Swetz KM, Crowley ME, Hook C et al. Report of 255 clinical ethics consultations and review of the literature. Mayo Clin Proc 2007; 82: 686-691
    CrossrefPubMedGoogle Scholar
  • 35 Reiter-Theil S, Mertz M. Was ist ein moralisches Problem – Medizinethik?. In: Zichy M, Ostheimer J, Grimm H, Hrsg. Was ist ein moralisches Problem. Zur Frage des Gegenstands angewandter Ethik. Freiburg: Verlag Karl Alber; 2012: 293-321
    Google Scholar
  • 36 Mehta N, Thornicroft G. Stigmatisation of People with mental Illness and of Psychiatric Institutions. In: Helmchen H, Sartorius N, eds. Ethics in Psychiatry. European Contributions. Heidelberg: Springer; 2010: 11-32
    CrossrefGoogle Scholar
  • 37 DuVal G, Clarridge B, Gensler G et al. A national survey of U.S. internists’ experiences with ethical dilemmas and ethics consultation. J Gen Intern Med 2004; 19: 251-258
    CrossrefPubMedGoogle Scholar
  • 38 Stutzki R, Ohnsorge K, Reiter-Theil S Hrsg. Ethikkonsultation heute – vom Modell zur Praxis. Münster: LIT Verlag; 2011
    Google Scholar
  • 39 Bloch S, Green SA eds. Psychiatric Ethics. 4th. Edition. New York: Oxford University Press; 2009
    CrossrefGoogle Scholar