Ethics Committees Reimagined

The APA and district branch (DB) ethics committees used to stay busy processing complaints from patients, their family members, and colleagues about members who allegedly engaged in ethically compromised behavior. Most complaints now are directed to state licensing boards, giving ethics committees more time to engage in proactive contemplation of emerging ethical dilemmas as our field adapts to changes in practice such as physician aid in dying and psychedelic-assisted psychotherapy.

APA has gradually shifted its ethics focus away from adjudication of ethics complaints and enforcement of sanctions for violations of APA’s Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry toward educating members about the Principles and how to think ethically about dilemmas that arise in psychiatric practice. The goal is to help psychiatrists recognize and deliberate about dilemmas before they act, support ethical decision-making, and prevent ethics infractions. The APA Ethics Committee regularly issues and updates “The Opinions of the Ethics Committee on the Principles of Medical Ethics,” a compilation of responses to questions posed by psychiatrists about dilemmas that arise in education, research, clinical practice, and the business of psychiatry. The committee also issues opinions and prepares resource materials for members discussing the ethical implications of current issues in medicine. At every Annual Meeting, the committee hosts a forum during which panelists respond to questions submitted in advance at [email protected] as well as from psychiatrists in the audience to receive on-the-spot guidance.

District branch ethics committees have also experienced a shift in focus over the last two decades. A question that a number of DBs are contemplating is what their role should be going forward. The Ethics Committee of the Colorado Psychiatric Society (CPS) has occasionally met to discuss dilemmas arising as a result of changing laws. For example, when Colorado’s legislature considered physician aid in dying in 2015, our ethics committee met to discuss what guidance to offer members should the legislation pass. Although the bill died in the legislature, in 2016 a similar law was approved by voters. The CPS Ethics Committee wrote a newsletter article to educate members about the nuances of participation in a patient’s request for aid in dying, offering guidance to avoid an ethical misstep. CPS devoted its Spring Dinner Meeting that year to a panel discussion on the topic, deepening members’ understanding about the law, the ways in which psychiatrists might be asked to participate, and alternatives to physician aid in dying such as palliative care. This issue invigorated the committee toward its new role as an educational resource.

Ethics columns in Psychiatric News and DB newsletters are important, but we shouldn’t stop there. Ethics committees can become more proactive, responding to legislative and emerging practice issues with guidance for psychiatrists. For example, there has been a wealth of professional and lay literature in the last few years about psilocybin, LSD, and ayahuasca in mental health treatment, which raises intriguing ethical questions surrounding psychiatrists’ participation in this new practice. Several scholarly articles have wrestled with this topic, and ethics committees need to provide guidance. Dr. Charles Grob has called for the establishment of ethical structures around this new psychiatric practice, and Dr. Brian Holoyda advocates for psychiatrist involvement in informed consent discussions about the risks and potential benefits of psychedelic treatments. APA is now working on a resource document that will be released in the near future.

The APA and DB ethics committees collectively comprise a remarkable resource for ethical deliberation. If you have not done so recently, take time to review ethics opinions that have been issued by APA’s committee in the last few years and to submit any questions you might have to [email protected]. Our ethics committees represent collectives of psychiatric ethical wisdom that can proactively issue guidance to members about how to best navigate the dilemmas encountered in new areas of psychiatric research and practice.

On a personal note, this is my last column for Psychiatric News. I have enjoyed communicating with you these last five years and pondering the ethics issues we all face, big and small, as we meet our professional and ethical obligations with the utmost respect for our patients, colleagues, and communities. It is in so doing that we are not only helping people heal, but also decreasing stigma and instilling confidence in our profession. ■

Claire Zilber, M.D., is a psychiatrist in private practice in Denver and a faculty member of the PROBE (Professional Problem Based Ethics) Program. She has served as a member of the APA Ethics Committee and chair of the Ethics Committee of the Colorado Psychiatric Society and is currently its immediate past president. She is the co-author of Living in Limbo: Creating Structure and Peace When Someone You Love Is Ill.