In this chapter, I will be discussing some of the ethical challenges that occur while working as a psychiatrist or therapist in the emergency department (ED) of a hospital. To that end, I will be covering such topics as capacity and consent, autonomy, beneficence, non-maleficence, free will, paternalism, when to initiate a Tarasoff or refrain from initiating a Tarasoff, confidentiality, legal detainment against one’s will, and physical and chemical restraints.
The topics themselves are not that difficult to comprehend, although navigating through some of the gray areas may require a bit of self-reflection and self-examination (it’s ok, it’s good for you). The challenge on my part will not be to convey the content in an understandable and accurate way
(that’s the easy part), but to present this material in a manner that’s just a little more interesting to those in the mental health arena, than say, for example, a wordy tome on the behavior of gases at low temperatures (now if that’s your thing, if that’s what gets you all worked up and passionate, my apologies, or rather, my sympathies). What I am trying to say, in a polite academic way, is that I will try my very best not to make this topic as boring as it can be.
All kidding aside, ethics in psychiatry is all but boring, as in many ways it represents and embodies the very heart and soul, the essence of what we strive to accomplish in the mental health field, and for many of us, it’s what drew us into this field in the first place. I am speaking of our innate sense of fairness and compassion, embodied in our desire and wish to alleviate pain and suffering while treating all patients with the utmost respect, decency, and dignity that we know we all deserve. This becomes all the more important and pressing as we work with the most vulnerable and wounded among us, that is, patients in the throes of a mental health crisis.