Principles of M - PDF document

1 Ameri c an P s y c h iat r ic Asso c i
Ameri c an P s y c h iat r ic Asso c iation The P ri nc i p les of Medic a l Eth i cs Wi t h An n o t a t i o ns Espe c i a l ly Applicab l e t o P s y c hiatry 2 0 1 3 E d it io n Co p y r i ght © 2 0 1 0 Ame r i c a n P sy c h ia t r i c A s so c ia t i on ALL RI G H TS RES E R V ED M a nu f a c tu r ed i n the U n i t ed St a tes of Am e r i c a 0 8 0 7 0 6 3 2 1 The P r i n c i p l es of M e d i c a l Eth i c s 20 1 3 E d i t i on (P r ev i ous edit i ons 1 9 73 , 19 7 8 , 19 8 1 , 1 9 8 4 , 19 8 5 , 1 98 9 , 1 99 2 , 1 9 9 3 , 1 99 5 , 1 99 5 Rev i se d , 19 9 8 , 20 0 1 , 20 0 1 Rev i se d , 2 0 0 6 , 2 00 8 , 2 0 09 . 2 0 0 9 Re v i s e d , and 2010 Ame r i c a n P sych ia t r i c A s so c ia t i on 10 0 0 W i l son Bou l ev a r d #18 2 5 A r li ngton, VA 2 22 0 9 1 THE PRI N C I PLES O F MED I C A L ETHICS W it h A n n o t a t io n s E s p e c i a l l y A p p li c a b l e t o P s y c h i a t ry 2 01 3 E d it i o n I n 1973, t h e Am e ri c a n P s y c h i a tric A ssoci a t i on ( A P A) publ i shed the f irst e di t i o n of T he Principles of M e dical Ethi c s with Ann o ta t ions E s p ec ia l ly A p pl i c able to P s yc hia t r y . S ubse q u e nt l y , r e vis i ons w e re publ i shed a s the A P A B o a rd of T r ust e e s and the A P A A ssemb l y a ppro ve d a ddi t ional a nn o tations. I n J u l y of 1 9 80, t he Am e ri c a n M e di c a l As s o c iat i on ( A MA) a ppro ve d a n e w v e rsion of the Principles of M e d i c al Ethics (the f irst r e vis i on sin c e 1957 ) , a nd the A P A Ethics Comm i t te e 1 inco r por a ted m a n y o f i t s an n otations in t o the n e w Principles , whi c h r e sul t e d in t he 1981 e di t ion and subs e qu e nt r e vi s ions. This ve r sion i n c ludes c h a n g e s to t he Principles a ppro ve d b y t he AMA in 2001. F o re w o rd A L L P HY S I C I A NS should pr a c t i c e in acc o rd a n c e w i th t he medi ca l code o f e t hics s e t fo r th i n the Principles of M e dical Ethi c s of the A me r i c a n M e dic a l Associ a t i o n . An up - to - d a te e x p re ss i on a nd e labo ra t i on of the s e stat e ments is found in the O pin i ons a nd Repo r ts of the Coun c il on Et h ic a l a nd J udici a l Af fa irs of t h e Am e ri c a n M e di c a l Associ a t i on . 2 P s y c hi a tris t s a r e stron g l y a dvised to be fa m i l i a r w i t h these d o c umen t s. 3 Ho we v e r, th e se g e n e r a l guidelines h a ve som e t i m e s be e n dif f icult t o in t e rp r e t for p s y c hiat r y , so fu r ther a nno t

2 a t i ons to the b a sic p r inciples
a t i ons to the b a sic p r inciples a re o f f e r e d in t his do c ument. W h i le p s y c h i a tris t s ha v e the s a me g o a ls as a ll p h y sici a ns, th e re a re sp e c ial e th i ca l problems in p s y c hiatric pra c t i c e that dif fe r in c olori n g a nd d e g re e f rom e th i ca l proble m s in other br a n c h e s of m e dic a l pr ac t ic e , e v e n 1 T h e c o m m i t tee i n c l ud e d H e r b e rt Kl e m m e r, M .D., C h a ir p e rs on , M i l t i a d e s Za p h ir o p o u l o s, M .D., E w a ld B u s se , M .D., J oh n R. S a und e rs, M .D . , an d R ob e rt M c D ev i t t, M .D. J. Br an d Bric k m a n , M .D . , W i l l i a m P . C a m p , M .D., a n d R o b e rt A . M o o r e , M .D . , s e r ve d a s c on s u l t a n ts t o t h e A P A E th ics C o mm i t t e e . 2 C u r re n t O p i n i o n s wi t h A n n o t a t i on s o f t h e C o un c il o n E t h ic a l a n d J ud ic i a l A f f a irs , C h ic ag o , A me ric a n M e d ic a l A s s o c iati on , 20 0 2 – 2 0 0 3 . 3 C h a p ter 7 , S ec t i o n 1 o f t h e B y l a w s o f t h e A me ric a n P s y c h iatric A s s o c iati o n ( M a y 20 0 3 e d i t i on ) st a te s , “ A ll m e m b e rs o f t h e A s s o c iati o n s h a ll b e b o u n d b y t h e e t h ic a l c od e o f t h e m e d ic a l p r o f e s s i on , s p ec i f ic a l l y d e f i n e d in t h e Pri n c i p les o f Me d ic a l E th ics o f t h e A me ric a n M e d ic a l A s s o c iati o n an d i n t h e A s s o c iati on ’s Pri n c i p les o f Me dic a l E th ics W i t h A n no t a t i on s E s p ec i a l l y A pp l i c ab le t o Ps yc h i a tr y .” In i n t e r p r e t i n g t h e B y l a w s, it is t h e op i n i o n o f t h e A P A B o a rd o f T r u s t ee s t h a t i n ac t i v e st a t u s in n o w a y r e m ov e s a ph y si c i a n m e m b e r f r o m r e s pon s i b i l i ty to a b i d e b y t h e Prin c i p les o f Me d ic a l E t h ics . 2 thou g h the b a sic p rin c ip l e s a r e t h e sam e . T h e a n n otations a re not des i g n e d a s absolutes a nd will be re vised f rom time to t i m e so as to be a ppl i ca b l e to cu r r e nt p r ac t i ce s a nd p r o b lems. F ol l owing a re the AMA Principles of M e dical Ethi c s , printed in their e nt ir e t y , a nd then e ac h p r inciple p r in t e d se p a r a t e l y a lo n g with an a n notat i on e spe c ial l y a ppl ic a ble t o p s y c hia t r y . P r i nc i p l e s o f M ed i c a l E t h i c s A m er i c a n M ed i c a l A s s o c i a t i o n P re a m b l e The medi ca l pr o f e ss i on h a s long

3 subs c rib e d to a b o d y of e th
subs c rib e d to a b o d y of e th i ca l s t a t e ments d e v e loped p r i ma ri l y for the b e n e fit of the p a t i e nt. As a memb e r o f this pro fe ss i on, a p h y sici a n m ust r ec o g n i z e r e spons i bi l i t y to p a t i e nts first and f o re mos t , a s w e l l as to soci e t y , to o t h e r h ea l t h pr o f e ss i on a ls, a nd to s e lf. The f ol l owi n g Principles a dop t e d b y the A me r i c a n M e di c a l Associ a t i on a re not l a ws, but s t a nd a rds of c ond u c t which d e fine the e ssenti a ls of hono ra ble b e h a vior for the p h y sici a n. S ec t i on 1 A p h y sic i a n sh a ll be d e d i ca ted to p r ovid i n g c omp e tent medi ca l c a r e , with c ompassion and r e spe c t f o r hum a n d i g ni t y a nd rights. S ec t i on 2 A p h y sic i a n sh a ll uphold t he stand a rds of p ro fe ss i on a l i sm, be hon e st i n a ll pro fe ss i on a l in t e r a c t i ons, a nd strive to re port p h y sici a ns d e fi c i e nt i n c h a r a c t e r or c ompe t e n ce , or e n g a g i n g in f ra ud or d ece pt i on, to a p p r opri a te e nt i t i e s. S ec t i on 3 A p h y sic i a n sh a ll re sp e c t the l a w a nd a lso r ec o g n i z e a re spons i bi l i t y to se e k c h a n g e s in t hose r e quir e ments whi c h a r e c ontr a r y to t he b e st i n te re sts of the p a t i e nt. S ec t i on 4 A p h y sic i a n sh a ll re sp e c t the r i g hts of p a t i e nts, co l le a g u e s, and oth e r he a l t h pr o f e ss i on a ls, and shall sa f e g u a rd p a t i e nt c o n f iden ce s a nd p r iva c y with i n the c o n str a in t s of the la w . S ec t i on 5 A p h y sic i a n sh a ll c ont i nue to s t u d y , a pp l y , a nd a d v a n c e sc i e nt i fic know l e d g e , m a in t a in a c om m i t ment to m e dic a l edu ca t i on, make r e lev a nt i n f o r mation av a i l a ble to p a t i e nts, coll e a g u e s, a nd the public, obt a in c o nsultation, a n d use the t a lents of oth e r he a l t h pr o f e ss i on a ls wh e n ind i ca ted. 3 S ec t i on 6 A p h y sic i a n sh a l l , in t he pro v is i on of a ppro p ri a te p a t i e nt c a r e , e x ce pt i n e me r g e n c ies, b e f r e e to c hoose whom to se r v e , w i t h whom to asso c iat e , a n d the e nvironme n t i n whi c h to p r ovide medi ca l c a r e . S ec t i on 7 A p h y sic i a n sh a ll rec o g n i z e a re spons i bi l i t y to pa r t icip a te in ac t i vi t ies c ontr i but i ng to t he i m p r ov e ment of the c o m mun i t y a nd the b e t te rm e nt of public h ea l t h. S ec t i on 8 A p h y sic i a n sh a l l , while ca ri n g f or a p a t i e nt, r e g a r d r e spons i bi l i t y to t he p a t ient a s pa ra moun t . S ec t i on 9

4 A p h y sic i a n sh a ll support
A p h y sic i a n sh a ll support ac c e ss t o medi ca l c a re f or a ll p e ople. Principles with A nn o tati o ns F ol l owing a re eac h o f the AMA Principles of M e d ical Ethi c s p r in t e d se p a rate l y a lo n g with a nnotations e spe c ial l y a p pl i ca ble to p s y c hiat r y . P r e a m b le The medi ca l pr o f e ss i on h a s long subs c rib e d to a b o d y of e th i ca l s t a t e ments d e v e loped p r i ma ri l y for the b e n e fit of the p a t i e nt. As a memb e r o f this pro fe ss i on, a p h y sici a n m ust r ec o g ni z e r e spons i bi l i t y to p a t i e nts first and f o re mos t , a s w e l l as to soci e t y , to o t h e r h ea l t h pr o f e ss i on a ls, a nd to s e lf. The f ol l owi n g P rin c ip l e s ad o p t e d b y the A me r i c a n M e di c a l Associ a t i on a re not l a ws, but s t a nd a rds of c ond u c t which d e fine the e ssenti a ls of hono r a ble b e h a vior for t h e p h y sici a n . 4 S ec t i on 1 A ph y sician sha l l be d e dicat e d to pro v id i ng c omp e tent m e dical c are wi t h c o mpassion and r e spe c t f or human dignity and rights. 1. A p s y c hiatrist sh a ll not gr a t i f y his or h e r o wn n e e ds b y e x plo i t i ng the p a t ie nt. The p s y c hia t rist shall be e v e r vi g i l a nt about the impa c t that his or h e r c ondu c t h a s upon the bound a ri e s of the d o c to r – p a t i e nt r e lationship, and thus upon the w e l l - b e i n g of the p a t i e nt. Th e se r e quir e ments b ec ome p ar t i c ula r l y i m port a nt b e ca u se of the e ssential l y priv a te, hi g h l y p e rso n a l, a nd som e t i mes int e nse l y e mo t ional n a ture of the r e lationship established w i t h the p s y c hiatrist. 2. A p s y c hiatrist should not be a p a r t y to a n y t y p e of pol ic y that e x c ludes, s e g r e g a tes, or d e me a ns the d i g ni t y o f a n y p a t i e nt b eca u s e of e t h nic o r i g in, r a c e , se x , c r e e d, a g e , socio e c onom i c status, or s e x u a l ori e ntation. 4 S tat eme n ts in i t a l i c s are ta k e n d i r ec t l y f r o m t h e A m e ri c a n M e d ic a l A s s o c i a t ion ' s Pri n c i p les o f Me d i c a l E t h ic s . 4 3. I n acc o rd w i t h the re qu i r e ments of l a w a nd a c ce p t e d medi ca l p r ac t i ce , it is e th i ca l for a p h y sici a n to subm i t h i s or h e r w o rk to p ee r r e view a nd to t he ul t i m a te a uthori t y of the m e dic a l sta f f e x ec ut i ve bo d y a nd the hospit a l admin i str a t i on a nd i t s g ov e rning bo d y . I n ca se o f di s pute, the e th i ca l p s y c hiatrist h a s the f ol l owing steps a v a i labl e :

5 a . S ee k a pp e a l f r om t he
a . S ee k a pp e a l f r om t he m e dic a l s t a ff d e c is i on to a joint c onf e r e n c e c om m i t te e , includ i ng memb e rs o f the medi ca l s t a f f e x ec ut i ve c om m i t tee a nd the e x ec u t i ve c om m i t tee of the g ov e rn i ng bo a rd. A t t his app ea l, the e th i ca l p s y c hiatrist c o uld r e qu e st t h a t ou t side opinions be c onsid e r e d. b. App ea l t o the g ov e rni n g bo d y i t s e lf. c . App ea l t o state a g e n c ies re g ulating l ic e nsure o f h ospitals if, in the p a rticul a r st a te, th e y c on c e rn th e mselv e s with m a t t e rs of pro fe ss i o n a l comp e ten c y a nd qu a l i t y of ca r e . d. Attempt t o e du ca te c ol le a g u e s thro u g h d e v e lop m e nt of r e s ea r c h pr o je c ts a nd d a ta a nd p re s e n t a t i ons a t pro f e ss i on a l m ee t i n g s a nd in pro fe ss i on a l j ourn a ls. e . S ee k r e d r e ss i n loc a l co u rts, p e rh a ps th r o u g h a n e njo i ning i n junction ag a inst the g ov e rni n g bo d y . f . P ubl i c e du ca t i on a s car r i e d out b y a n e th i ca l p s y c hiatrist would not ut i l i z e a pp ea ls b a s e d sol e l y upon e mo t ion, but would be pr e s e nt e d in a p r o fe ss i on a l w a y a nd without a n y p o tential e x p lo i tation of p a t i e nts t h r ou g h testimon i a ls. 4. A p s y c hiatrist should not be a p a rtici p a nt i n a l e g a l l y a uthori z e d e x ec ut i on. S ec t i on 2 A ph y sician shall uphold t he standards of prof e ss i onal i sm, be hon e st i n all prof e ss i onal in t e ractions and s t rive to report physi c ians d e f i c i e nt i n c hara c ter or c omp e t e n ce , or e ng a ging i n fraud or d ece pt i on to appropriate e nt i t i e s. 1. The re qui r e ment that the p h y sici a n c ondu c t h i mse l f/h e rs e lf with pro p ri e t y in h i s or h e r p r o fe ss i on a nd in all t he ac t i ons of his or h e r li f e is esp ec ial l y i m port a nt i n the ca se o f the p s y c hia t rist be ca u s e the p a t i e nt t e nds to model his or h e r b e h a vior a ft e r t h a t of his or h e r p s y c hia t rist b y identifi c a t i on. F u r the r , the n e c e ssa r y in t e nsi t y o f the tr e a t me nt r e l a t i onship m a y tend to ac t i v a te s e x u a l a n d other n ee ds a nd f a ntas i e s on the p a rt of both pat i e nt and p s y c hiatrist, while wea k e ning t h e obje c t iv i t y n e ce ss a r y f or c o ntrol. Additional l y , t h e inhe re nt i n e qu a l i t y in t he do c tor - p a t i e nt r e lationship ma y l e a d to e x plo i tati o n of the p a t i e nt. S e x u a l a c t i vi t y with a c u r r e nt or f o r mer p a t i e nt i s un e th

6 i ca l. 5 2. The p s y c hiat
i ca l. 5 2. The p s y c hiatrist should d i l i g e nt l y g u a rd ag a inst e x plo i t i ng info r mation fu r nished b y t h e p a t i e nt and should not use the unique position of pow e r af f o r d e d hi m /her b y the p s y c hot h e r a p e ut i c si t u a t i on to i n f l u e n c e the p a t i e n t i n a n y w a y not d i r e c t l y r e lev a nt t o the tr ea t m e nt g o a ls. 3. A p s y c hiatrist who r e g u l a r l y p ra c t i ce s outside his or h e r a r e a o f p r o f e ss i on a l comp e ten c e should be c onsid e r e d u n e th i ca l. D e te r m i n a t i on of pro fe ss i on a l comp e t e n c e should be made b y p ee r r e view b o a rds or ot h e r a ppro p ri a te bodi e s. 4. S p ec ial c onsid e r a t i on should be g iven to those p s y c hiatrists who, b eca u s e o f m e n t a l i l lness, jeop a rdi z e the w e lf a re of t h e ir p a t i e nts and their own re putations a n d pr a c t i ce s. I t i s e th i ca l, ev e n e n c ou ra g e d, f or a nother p s y c hiatrist t o in t e r c e de in s u c h situations. 5. P s y c hiatric s e rvi c e s, l i ke a ll medi ca l se r vi c e s, a r e dispens e d in t h e c onte x t of a c ontr ac tual a r r a n g e ment b e tw ee n the p a t i e nt and t he p h y sic i a n. The pro v is i ons of the c ontr a c tual a r ra n g e ment, whi c h a re b ind i ng on the p h y sici a n a s w e ll a s on the p a t i e nt, s hould be e x pl i c i t l y e stablished. 6. I t i s ethi c a l for the p s y c h i a t r ist to m a ke a c h a r g e f o r a m i ssed a p poin t ment wh e n th i s f a l l s with i n the t e rms of the sp ec ific c on t r a c tual a g re e m e nt wi t h the p a t i e nt. C h a r g i n g f or a m i ssed a ppoin t ment or f or one n ot c a n ce l e d 24 hou r s in a dv a n c e n ee d not, i n i t s e l f , be c onsid e r e d un e th i ca l i f a p a t i e nt i s f u l l y a dvised th a t t he p h y s i c ian w i l l m a ke such a c h a r g e . T h e pra c t i ce , how e v e r, should be r e so r ted to inf re qu e nt l y a nd a lw a y s with the ut m ost conside ra t i on f o r the p a t i e nt and his or h e r c i r c ums t a n ce s. 7. An a r r a n g e ment in which a p s y c hiatrist provid e s s up e rvision or a dm i nis t r a t i on to o t h e r p h y sici a ns o r no n medi ca l p e rsons f or a p e r ce nt a ge of th e ir f e e s or g ross in c ome is not ac c e ptabl e ; t his would c o n st i tu t e fe e spli t t i n g . I n a te a m of p r a c t i t i on e rs, or a mu l t i disciplina r y te a m, i t is ethi ca l for the p s y c hia t rist t o r e ce i v e income f or a dm i nis t r a t i on, r e s e a r c h, e d u ca t i on, or c onsultation. This shou l

7 d be b a s e d on a mu t u a l l y
d be b a s e d on a mu t u a l l y a g r ee d - upon a nd s e t f e e or sal a r y , op e n to r e n e g ot i a t i on wh e n a c h a n g e in t he t i me d e mand o cc u r s. (S e e a lso S ec t ion 5, Annot a t i ons 2, 3, a nd 4.) S ec t i on 3 A ph y sician sha l l resp ec t the law and also re c ognize a responsibil i ty to s ee k c hang e s in t hose r e quire me nts w hich are c ontrary to t he b e st i nte r e sts of t he pat i e nt. 1. I t would s e e m sel f - e vid e nt t h a t a p s y c h i atrist who is a law - b r e a k e r mi g ht b e e th i ca l l y unsuited to p rac t i c e his o r h e r p r o f e ss i on. W h e n su c h i l leg a l a c t i vi t ies b ea r dir ec t l y upon his or h e r p r a c t i ce , th i s would o bviou s l y be the c a s e . H o w e v e r, in oth e r instan ce s, i l le g a l a c t i vi t ies su c h a s tho s e c on c e rni n g the r i g ht t o pr o test soci a l i nju s t i ce s m i g ht not b e a r on e i ther the im a g e of t h e p s y c hia t rist or the a bi l i t y of the sp ec ific p s y c h i a trist to t r e a t h i s or h e r p a t ie nt ethic a l l y a n d w e l l . W hi l e no c om m i t tee or b oa rd c ould of f e r p rior a s s u ra n c e t h a t a n y i l l e g a l a c t i vi t y would not be c onsid e r e d u n e th i ca l, i t i s co nce ivab l e that a n ind i vidual c ould v i olate a l a w w i t hout being g ui l t y 6 of pro fe ss i on a l l y un e th ic a l beh a vior. P h y sici a ns l ose n o ri g ht o f c i t i z e nship on e nt r y in t o the p r o fe ss i on of medi c ine. 2. W h e re not sp ec ifi c a l l y p r ohib i ted b y loc a l la ws g o v e rning m e d i ca l p r ac t i ce , the p rac t ic e of ac upun c t u re b y a p s y c hiatrist i s not un e thic a l p e r s e . The p s y c hiatrist should have pro f e ss i on a l c ompet e n c e in t he use o f ac upun c tu r e . O r , if h e or she is s u p e rvising the u s e of a c upun c t u re b y nonmedi ca l i ndiv i du a ls, he or she should p r ovide p r op e r m e di c a l s u p e rvis i on. (See a lso S ec t i on 5, Annot a t i ons 3 a nd 4.) S ec t i on 4 A ph y sician sha l l resp ec t the rig h ts of pat i e nts, co l leagu e s, and other h e al t h prof e s s iona l s, and shall safeguard pat i e nt confiden ce s and pri v a c y wi t hin t he c onstrain t s of t h e la w . 1. P s y c hiatric r e c o rds, in c l u ding e v e n the id e nt i fi ca t i on of a p e rson a s a p a t i e n t, m ust be p r ote c ted w i t h e x tr e me c a r e . Confid e nt i a l i t y is e s s e nt i a l t o p s y c h i a t ric tr e a t m e nt. This is b a s e d in p a rt on the sp ec i a l n a ture of p s y c hiatric th e r a p y a s w e ll

8 a s on the tr a di t ional e th i c
a s on the tr a di t ional e th i ca l r e lationship b e tw ee n p h y sici a n a nd p a t i e nt. G r owi n g c on c e rn re g a r d ing the c iv i l ri g hts of p a t i e nts and the poss i ble a dv e rse e f f ec ts of c o m pute r i z a t i on, dupl i ca t i on e quip m e nt, and d a ta b a nks m a k e s the dis s e m i n a t i on of c onfid e nt i a l i n f o r mation an in c re a sing h a za rd. B e ca use o f the s e nsi t ive a nd p r ivate n a tu r e of the inf o rm a t i on with which the p s y c hia t rist de a ls, he or s h e must be c ir c u m sp e c t in t he info r mation t h a t he or she c hoos e s to disclo s e to o t h e rs a bout a p a t i e n t. The w e lf a re of t h e p a t i e nt m ust be a c ont i nuing c onsid e r a t i on. 2. A p s y c hiatrist ma y r e l e a s e c onfid e nt i a l i n f o r m a t i on on l y with t he a uthori za t i on of the p a t i e nt or und e r p r o p e r l e g a l c ompu l sion. The c o n t i nuing du t y o f the p s y c h i a trist to prot ec t t he p a t i e nt i n c ludes f ul l y a p p r is i ng hi m /her of the c o n notations of wa iv i ng the p r iv i le g e o f p r iv a c y . This ma y b e c ome a n is s u e wh e n the p a t i e nt i s being invest i g a ted b y a g ov e r nment a g e n c y , is a pp l y i n g f o r a posit i on, or is i nvolved in le g a l a c t i on. The same prin c ip l e s a pp l y to t he r e le a s e of info r mation con c e rning t r e a t m e nt t o medi ca l d e p a rtme n ts of g o v e rnm e nt a g e n c ies, business o r - g a ni z a t i ons, l a bor u nion s , a nd insu ra n c e c om p a ni e s. I n fo r mation g a ined in c onfid e n c e a bout p a t i e nts s ee n in student h ea l t h se r vi c e s shou l d not be re l e a s e d without the stude n ts’ e x pl i c it p e rmission. 3. Cl i nic a l and oth e r m a te r i a ls u s e d in t eac hi n g a nd w r i t ing must be a d e qu a t e l y di s g uised in o r d e r to p re s e rve t h e a n on y m i t y o f the ind i viduals involved. 4. The e th i ca l r e spons i bi l i t y of m a in t a in i ng c o n fid e n t iali t y holds e qu a l l y f or t h e c onsultations in which the p a t i e nt m a y not have b ee n pr e s e nt and in whi c h the c onsultee w a s not a p h y sic i a n. I n su c h i n st a nc e s, the p h y sici a n c onsultant should a le r t t he c o n sul t e e to h i s or h e r du t y of confid e nt i a l i t y . 5. Ethi ca l l y , the p s y c hiatrist ma y disclose on l y that i n f o r mation which is r e l e v a nt t o a g i v e n si t u a t i on. He or she should a void of fe ri n g s p ec ula t ion as f ac t. S e nsi t ive in f o rm a t i on su c h a s an ind i vidual ’ s se x u a l or

9 i e ntation or fa nta s y mat e ri a
i e ntation or fa nta s y mat e ri a l is u s u a l l y unn e c e ssa r y . 7 6. P s y c hiatrists a r e oft e n a sked to e x a m i ne ind i viduals for se c u r i t y pur p o s e s, to d e te r m i ne sui t a bi l i t y f o r v a rious jo b s, and to det e rmine l e g a l comp e ten c e . The p s y c h i a trist must f ul l y d e s c ribe the n a ture a nd p u r pose a nd l a c k of c o n fid e nt i a l i t y of the e x a m i n a t i on to t he e x a m i n e e a t the b e g inn i ng of t h e e x a m i n a t i on. 7. C a r e ful ju d g ment must be e x e r c ised b y the p s y c h i a trist in ord e r to in c lude, wh e n a ppro p ri a te, t h e p a r e nts or g u a rdi a n in t he t r ea t me nt of a m i nor. A t t he sa m e t i me, the p s y c hia t rist m ust assure the minor p r op e r c onfid e n t i a l i t y . 8. W h e n, in t he c l i nic a l j ud g ment of the t r e a t i n g p s y c hiatrist, t he r isk of d a n g e r is d ee med to be si g nifi c a nt, t he p s y c h i a trist m a y r e v e a l con f id e nt i a l i n f o r mation d i s c losed b y the p a t i e nt.” 9. W h e n the p s y c hia t rist i s ord e r e d b y t h e c ourt to r e v ea l t he c o n fid e n ce s e nt r usted to hi m /her b y p a t i e nts, h e o r she m a y c omp l y or h e / she m a y e th i ca l l y hold t he ri g ht t o dis s e nt with i n the f r a me w o r k o f the l a w. W h e n the p s y c h i a trist is i n doubt, t he r i g h t of the p a t i e nt t o c onfid e nt i a l i t y a nd, b y e x tension, to uni m p a ir e d tr ea t m e nt should be g iven p r iori t y . The p s y c hia t rist should r e s e r v e the r i g ht t o r a ise the q u e st i on of a d e qu a t e n ee d f or disclosur e . I n the e v e nt t h a t t he n e c e ss i t y f or leg a l d i s c losure is de m onstr a ted b y the c ourt, t h e p s y c hiatrist m a y r e qu e st t he r i g ht t o discl o sure of o n l y that info r ma t ion which is r e lev a nt t o t he l e g a l question a t h a nd. 10. W i t h r eg a rd for the p e rs o n ’ s di g ni t y a nd p r iv a c y a nd with t ru l y info r med c onse n t, i t i s e th i ca l t o pr e s e nt a p a t i e n t t o a sci e nt i fic g a t h e ring if the c onfid e nt i a l i t y o f t he pr e s e n t a t i on is und e rstood a nd a c ce pted b y the a udien c e . 11. I t i s ethi c a l t o pr e s e nt a p a t i e nt or f o r m e r p a t i e nt t o a publ i c g a the r i n g or to the n e ws media on l y if the p a t i e nt is ful l y info r med of e nd u ring loss of c o n fid e nt i a l i t y , is compet e nt, a nd c onse n ts i n w r i t ing with o ut co e r c ion. 12. W h e n invo l v

10 e d in fund e d r e s e a r c h, the
e d in fund e d r e s e a r c h, the e th i c a l p s y c hiatrist wi l l advise human subje c ts of the f unding so u r c e , r e tain his or h e r f r ee dom t o r e v ea l data a nd r e sul t s, and f ol l ow a ll a ppro p ri a te a nd c u r r e nt g uid e l i n e s r e lative to human subj ec t p r ote c t i on. 13. Ethi ca l conside ra t i ons in medi ca l pr a c t i c e p r ec lu d e the p s y c h i a tric e v a luat i on of a n y p e rson c h ar g e d with c rimin a l a c ts prior to a c ce ss t o, or a v a i l a bi l i t y o f, l e g a l c ouns e l. The on l y e x ce pt i on is the re nd e ri n g of ca r e to t he p e rson f o r the sole pur p ose o f m e d ic a l t r e a t m e nt. 14. S e x u a l i nvolvem e n t betw ee n a f ac ul t y memb e r or supe r visor a nd a t r a inee or student, in those si t u a t i ons in whi c h a n a buse of p o w e r ca n o c c u r , oft e n ta k e s ad va n t a ge of in e qu a l i t i e s in the w o r ki n g re lationship a nd m a y be un e th ic a l be c a use: a . A n y t r ea t m e nt of a p a t i e n t bei n g sup e rvis e d m a y b e d e let e r i ous l y a f f e c ted. b. I t m a y d a m a g e the t rust r e lationship betw ee n t e a c h e r a nd stud e nt. c . T eac h e rs a re i m port a nt p ro fe ss i on a l role models f or their tr a in e e s and a f f ec t t h e ir tr a ine e s’ futu r e pr o f e ss i o n a l beh a vior. 8 S ec t i on 5 A ph y sician sha l l continue to stud y , apply, and ad v an c e sc i e nt i f i c k now l e dg e , mainta i n a c om m i t m e nt t o m e dical e du c at i on, ma k e rel e v ant i nformation availab l e to p at i e nts, coll e agu e s, and the public, obtain consultat i on, and use the t a lents of other h e al t h p r o f e ssionals w h e n ind i c ated. 1. P s y c hiatrists a r e re spons i ble f or their own c ont i nuing e d u ca t i on a nd should be m i ndful of the fac t t h a t t h e irs must b e a l i f e t i me of l e a rni n g . 2. I n the p ra c t i c e of his or h e r sp ec i a l t y , the p s y c hiat r ist c onsults, a s soci a tes, c ol l a bor a tes, or in t e g r a tes his or h e r wo r k with t h a t of m a n y p r o f e ss i on a ls, i n c lud i ng p s y c h o lo g is t s, p s y c ho m e trici a ns, soci a l wo r k e rs, a lcoholism couns e lors, ma r ri a ge c ouns e l o r s, public h ea l t h nurs e s, and the like. F u r t h e rmo re , the n a ture o f mod e rn p s y c hiatric p ra c t ic e e x tends his or h e r c onta c ts t o su c h p e ople a s te ac h e rs, juv e ni l e a nd a dult pro ba t i on o f fi ce rs, a t t o r n e y s, w e lf a re wo r k e rs, a g e n c y volun te e rs, a nd n e i g hb o rhood a i d e s. I n ref e r ring p

11 a t i e nts for tr ea t m e nt, c ou
a t i e nts for tr ea t m e nt, c ouns e l i n g , o r re h a bi l i t a t i on t o a n y of th e s e pra c t i t i on e rs, the p s y c hiatrist s h ould e n sure that the a l l ied p r o fe ss i on a l or p a r a p r o fe ss i on a l wi t h whom he or she is d e a l i ng is a r ec o g ni z e d memb e r of his or h e r o w n discipline a nd is c o m p e tent to c a r r y out t he the ra p e ut i c task r e quir e d. The p s y c hia t rist should have the s a me a t t i t ude tow a rd memb e rs of the m e di c a l p r o fe s sion t o whom he or she r e f e rs p a t i e nts. W h e n e v e r h e or she h a s r e a son to doubt t he tr a in i n g , skil l , or e th i ca l qu a l i fi ca t i ons of the a l l i e d pr o f e s sional, the p s y c h i a trist should not r e f e r ca s e s to hi m /he r . 3. W h e n the p s y c hia t rist assumes a c ol l a bo r a t i ve or s up e rviso r y r ole w i t h a no t h e r m e ntal h ea l t h wo r k e r, he or s h e must e x p e nd suf f ici e nt t i m e to assu r e that p r o p e r ca re is g iven. I t i s c ontr a r y to t he in t e r e sts of the p a t i e nt and to p a t i e n t c a re if t h e p s y c hiatrist a l l ows hims e lf/he r s e lf to be us e d a s a fi g u r e h ea d. 4. I n r e lationships b e tw e e n p s y c hia t rists and p rac t i c i ng l i ce n s e d p s y c hol o g is t s, the p h y sici a n should not del e g a t e to t he p s y c hol o g ist or, in fac t, to a n y n o nmed i ca l pe r s o n a n y m a t t e r r e quiring the e x e r c ise of pr o f e ss i o n a l m e dic a l j u d g ment. 5. The p s y c hiatrist should a g r e e to t he r e qu e st of a p a t i e nt for c o n sul t a t i on or to su c h a r e qu e st fr o m t he f a m i l y o f a n incomp e tent or m i nor pa t i e nt. The p s y c hia t rist m a y s u gg e st poss i ble c onsultants, but the p a t i e nt or fa m i l y sh o uld be g iven f r e e c hoi c e of the c onsultant. I f the p s y c hia t rist d i s a ppro ve s of the p r o fe ss i o n a l quali f ic a t i ons of the c o n sul t a nt or if th e re is a dif fe r e n c e o f opinion th a t t he prim a r y the r a pi s t c a n not r e solve, he or s h e m a y , a ft e r suitable not i ce , withdr a w f rom the c a s e . I f this d i s a g re e m e nt oc c u r s within an insti t ut i on or a g e n c y f ra m e wo r k, the di f f e r e n c e s shou l d be re solved b y the m e diation or a rbitr a t i on of hi g h e r p r o fe ss i on a l autho r i t y w i t h in t he ins t i t u t ion or a g e n c y . S ec t i on 6 A ph y sician sha l l, i n the pro v is i on of appropriate pat i e nt car e , e x ce pt i n e m e rgen c ies, b e free to c hoose whom to s e r ve , w i t h

12 whom to associate, and the e n v ironm
whom to associate, and the e n v ironm e nt i n wh i c h to pro v ide me dical c are. 9 1. P h y sici a ns g e n e r a l l y a g r e e that the do c to r - p a t i e nt r e lationship i s such a vi t a l f ac tor in e f f e c t i ve tr e a t m e nt of the p a t i e nt t h a t pr e s e r v a t i on of opt i mal c ondi t ions for d e v e lop m e nt of a sound wo r king r e latio n ship b e tw ee n a d o c tor a nd his or h e r p a t i e nt should t a ke p r e ce d e n c e o v e r a ll other c onsid e r a t i ons. P ro fe ss i on a l cou r te s y m a y l e a d to poor p s y c h i a tric c a re for p h y sici a ns a nd their fa m i l i e s b e ca u s e of e mb a r ra ss m e nt ov e r the l ac k of a c omp l e te g i v e - a n d - t a ke c ont r ac t. 2. An e th i ca l p s y c hiatrist m a y r e fu s e to pro v ide p s y c hiatric tr ea t ment to a p e r s on who, in the p s y c h i a tris t ’s opinion, c a nnot be di ag nosed a s h a ving a ment a l i l l n e ss a men a ble to p s y c hia t ric tr e a t m e nt. S ec t i on 7 A ph y sician sha l l re c ognize a responsibil i ty to par t icipate in a c t i v i t ies c ontr i but i ng to t he impro ve m e nt of the c om munity and the b e t t e rm e n t of publ i c h e al t h. 1. P s y c hiatrists should fost e r the c oop e r a t i on of those le g i t i m a te l y c on c e r n e d with t he medi ca l, p s y c hol o g ic a l, s o c ial, a nd l e g a l as p ec ts o f m e ntal h ea l t h a nd i l lne s s. P s y c hiatrists a r e e n c ourag e d to s e r v e soc i e t y b y a dvis i ng a nd c on s ul t ing with t he e x ec ut i v e , le g is l a t i v e , a nd jud i c ia r y b r a n c h e s of the g ov e rnm e nt. A p s y c hiatr i st s hould cl a ri f y wh e ther h e / she sp ea ks a s an ind i vidual or a s a re p r e s e ntative of a n o r g a ni z a t i on. F u r the r m o r e , p s y c hiat r is t s shou l d a void c loaking t h e ir public statements with the a uthori t y of the pro fe ss i on ( e . g ., “P s y c hiatrists know that ” ). 2. P s y c hiatrists m a y in t e rp r e t and sh a r e with t he pu b l i c their e x p e rtise in the v a rious p s y c hos o c ial is s u e s that m a y a f f ec t m e ntal h e a l t h a nd i l lness. P s y c hiatrists should a lw a y s b e m i ndful of their sep a r a te rol e s as d e di c a ted c i t i z e ns a n d a s e x p e rts in p s y c h olo g ic a l m e d i c ine. 3. On o cca sion p s y c h i a tris t s a r e a s k e d for a n opin i on a bout an i n div i du a l who is in t he l i g ht of publ i c a t t e nt i on or w h o h a s dis c losed info r mat i on a bout h i mself/h e rs e lf throu g h publ i c medi a . I n s u c h c i r c ums t a n ce s, a p s y c hia t rist ma y s h a re

13 w i th t he publ i c his or h e r
w i th t he publ i c his or h e r e x p e rtise a bout p s y c hia t ric is s u e s in g e n e r a l. How e v e r, it is un e th i ca l for a p s y c h i a trist to o f fe r a pro f e ss i on a l opin i on unless he or she h a s co n du c ted a n e x a m i n a t i on a nd h a s be e n g ra nt e d pr o p e r a uthori z a t i on f o r su c h a s tat e ment. 4. The p s y c hiatrist m a y p e r m i t h i s or h e r c e rtifi c a t i on to be us e d for the invo l unta r y tr ea t m e nt of a n y p e rson o n l y f ol l owi n g his or h e r p e rson a l e x a m i n a t i on of that p e rson. T o do so, he or she must f ind t h a t t he p e rson, b e ca u s e of m e ntal i l lness, ca nnot fo r m a jud g ment a s to wh a t is i n his/ h e r o w n b e st i nte re sts a nd that, without s u c h tr ea t m e nt, substa n t ia l i mpai r ment is l i k e l y to oc c ur to t he p e rson or othe r s. 5. P s y c hiatrists shall not p a rticip a te in tortur e . 10 S ec t i on 8 A ph y sician sha l l, w hi l e c aring for a pat i e nt, regard r e spons i bi l i t y to t he p at i e nt as paramount. 1. Psychiatrists’ relationships with companies, organizations, the community, or larger society can affect their interactions with patients. 2. When the psychiatrist’s outside relationships conflict with the clinical needs of the patient, the psychiatrist m ust always consider the impact of such relationships and strive to resolve conflicts in a manner that the psychiatrist believes is likely to be beneficial to the patient. 3. When significant relationships exist that may conflict with patients’ clinical needs, it is especially important to inform the patient or decision maker about these relationships and potential conflicts with clinical needs. 4. In informing a patient of treatment options, the psychiatrist should assist the patient in identifying rele vant options that promote an informed treatment decision, including those that are not available from the psychiatrist or from the organization with which the psychiatrist is affiliated. S ec t i on 9 A ph y sician sha l l sup p ort ac ce ss t o m e d i c al care f or all peopl e . 11 PR O C E DUR ES F O R H A ND L I N G C O MP L A I N TS OF U N ETH I CA L C O NDUC T IN TR ODU C T IO N The medical pr o f e s si on has l ong s u b s c rib ed to a b o d y of eth i c a l statemen t s d eve l o p ed pr i m a r il y f or the b ene f i t of the p a t i ent. As a m em b er of th i s pr o f e s sion, a p hys i c ia n mu s t r e c o g n i ze r e sp o n si bi l i ty n o t on l y to p a t i ents b ut al so to so c i et y , the pr o f e s sion, other health pr o f e s sion al s, a nd to self. The P r i nc i p l e s of Me d i

14 c a l E t h i c s with A nno t a t
c a l E t h i c s with A nno t a t i o n s E s pe c i a l ly A p p l i c a b le to P s y c h i a t r y ( he r e a ft e r r e f e rr e d to a s the ” P r i nc i p le s ”) , a d o p ted f r om the Ame r i c a n M e d i c a l A s so c ia t i on, a r e not la ws b u t stan d a rd s of c o n d u c t th a t d e f i ne the e s se n t ial s of hono r a bl e b eha v i or for the p hys i c ia n. Com p lai nts c harg i ng mem b e r s of the Ame r i c a n Psy c h ia t r i c A s s o c ia t i on ( A PA) w i t h uneth i c a l b e h a v i or o r pr a c t i c es s h al l b e i nvest i g a ted a nd r e s o l ved i n a cc o rd a n c e w i th pr o c e d u r e s a pp r oved b y the APA A s semb l y a nd the APA Board of T r u s tees. The s e pr o c e d u r es a r e c ongr u ent w i th the m i n i mum r e q u i r ements un d er the H e al th Care Qu ali t y I m pr ovement A c t. A D i st r i c t B r a n c h (D B ) of t h e APA m a y a d o p t a dd i t i onal r e q u i r e m ents to c omply w i t h a ny a dd i t i on a l o r more st r i ngent r e q u i r ements of sta t e la w . A D i st r i c t B ra n c h s h ou l d not i fy t h e APA i f a dd i t i on a l r e q u i r ements a r e a d o p te d . E th i c s c a ses a r e c on fi d ent ia l . The a l l e g a t i on s , the na m es of t h e p a r t i es a nd other i n f o r m a t i on a r e m a d e a v ai l abl e on l y to p e r so n s d i r e c t l y pa r t i c i p a t i ng i n the pr o c e e d i ngs. Info r m a t i on r eg a rd i ng a n e th i c s c a se i s m a d e p ub l i c i n l i m i ted c i rc um s t a n c e a s set f o r th i n the s e pr o c e d u r es a nd on l y a fter a fi nal d etermina t i on has b een r e a c hed w hen r e q u i r ed b y law or ne c e s sa r y to pr otect t he p ub l i c . P A RT I: INITIAL P R OCED U RES A. T h e Co m p la in t 1. An e th i c s c omp l a int ca n be filed b y a p a t i e nt or guardian , a fam i l y memb e r of a p a t i e n t, a n APA memb e r or ot h e r ind i v idual with p e rson a l k n owl e dge of the a l le g e d un e th i ca l c ondu c t. 2. The ind i vidual submi t t i n g the c omp l a int is the “ Comp l a inant” a nd the APA memb e r c h a r g e d with ethics viol a t i ons is the “ A cc used M e mbe r .” 3. Comp l a in t s ch a r g i n g a n A P A m e mber with unet h ic a l beh a vior s h a ll b e : a . I n w r i t in g ; b. S i g n e d b y the Complain a nt and 12 c . Add re ssed to the D B o f the A cc u s e d M e mbe r . I f a dd r e ssed to the A P

15 A, the c omp l a int shall be re
A, the c omp l a int shall be re f e r r e d b y t h e APA to t he A c c used Memb e r ’ s D B . B . P r o c e e d i n g on Ex tr i n sic Evi d e n ce : 1. A c omp l a int m a y b e b a s e d on e x trins i c e vid e n ce , includi n g a n y do c uments a t t ac h e d to t he c omp l a in t . 2. A DB m a y in i t i a te a n e th i ca l p r o cee di n g wi t hout a Comp l a int b a s e d upon e x trins i c e viden c e whi c h it re ce ives or ot h e r w ise b ec omes a w a r e that a memb e r h a s potential l y a c ted un e th i ca l l y in vio l a t i on of the Principles. In such p r o cee di n g , th e re is no C omp l a inant. 3. E x trins i c e viden c e inc l ud e s fo r mal jud i c ial o r a dm i nis t r a t i ve r e ports, swo r n d e posit i on or trial testi m o n y , medi c a l or hosp i tal r e c o rds, a nd s i m i lar r e l i a ble do c uments. C. R e view f or J u r is d ic t ion 1. On c e a c omp l a int is r ec e ived, the D B shall r e vi e w the c omp l a int to d e t e r m i ne if the DB h a s jurisd i c t i on ov e r the matte r . This r e view shall take pla c e b e fo r e the A cc used M e mber is not if ied th a t a c omp l a i nt w a s filed. 2. This r e view will c onsid e r : a . I s t h e A cc used M e mber a memb e r of the APA a nd the D B ? On l y c omp l a in t s a g a inst APA memb e rs c a n be in v e st i g a ted. I f t h e A c c used M e mber is n ot a memb e r, the DB s h a ll not if y the Comp l a inant that it ca nnot pursue the c omp l a int b eca use the A cc used Memb e r is not a memb e r of the APA a nd no fu r ther a c t i on ca n b e tak e n. b. I s the A cc used Mem b e r a memb e r of the D B ? I f not, the c omp l a int shall be fo r w a rd e d to t he APA O f fi c e of E th i c s. c . Do e s the c omp l a int a l le g e u n e th i ca l c ond u c t that took pla c e ov e r ten ( 10) y ea rs a g o? A c omp l a int a l l e g i n g u n e th i ca l c on d u c t must be r e c e ived w i th i n ten (10) y e a rs of the a l l e g e d c ond u c t. I n t h e c a s e of a m i nor p a t i e nt, t h e ten (10) y e a r l i m i t will not b e g in unt i l the p a t i e nt re ac h e s t h e a ge of 18. I f the a l l e g e d c ondu c t took pl a c e outs i de of the ten y ea r l i m i t, the DB shall no t i f y the Complain a nt i n w r i t i ng that no f u rth e r a c t i on ca n be ta k e n. 3. I f t h e

16 c omp l a int me e ts these jurisd
c omp l a int me e ts these jurisd i c t i on a l stand a rds, the DB shall e v a l u a te the c omp l a int a s s e t fo r th i n P a rt II b e low to d e te r m i n e wh e ther it a l le g e s c on d u c t that vio l a tes the Principles . 13 4. The D B ’s d e t e rmin a t i on that a c omp l a int do e s not me e t these juris d ictional stand a rds is fin a l a nd the r e is no r e v i e w b y the Ch a ir of the APA Ethi c s Com m i t te e . D. No t ic e : A n y " Notic e " r e quir e d in these p r o c e d u r e s should be s e nt b y a d e l i v e r y s y stem that re quir e s a v e ri f y i n g of re c e ip t , such a s c e rtif i e d or o v e rn i g ht m a i l . PA R T II : R E V I EW O F ALLE G AT I ON S The DB Ethi c s Com m i t tee ( D B EC) shall r e vi e w the c omp l a int to d e te r m i ne wh e ther it a l le g e s a r e c o g ni z e d e th i c s violation of the Principles . A. P r e l i m i n a r y D e t e r m i n a tions 1 . The DBEC s h al l d etermine whether the c ompl ai nt a ll e ges on i ts face a n eth i c s v i o l a t i o n ( s) a s s et fo r th i n the P r i nc ipl e s . 2 . Th i s i s not a d etermina ti on on the merits of the c o m p lai nt. Ra t he r , i t i s a d etermina ti on of w hether a r e c ogn i zed eth i c s v i o l a t i on i s a l l eged a s s um i ng the facts i n the c ompl ai nt a r e t r ue. Th i s r ev i ew i s li m i ted to r ev i ew i ng the a ll e g a t i ons i n the c o m p lai nt a nd a dete r m i na ti on of whe t her tho s e all eg a t i ons a s s e r t a r e c ogn i zed eth i c s v i o la t i on a s set fo r th i n the P r i nc i p l e s . 3 . If the c ompl ai nt a l l e ges c on d u c t th a t d o e s not v i o la te the P r i n c i p l e s , the DBEC s h al l not i fy the Com p lai n a nt i n w r i t i ng (w i th a c o p y to the APA Ethics Of f i c e) th a t n o f ur ther a c t i on w i l l b e t a k en a nd al so i n f o r m the Com p lai nant th a t h e /she m a y r e q ue s t w i th i n 3 0 d a ys a r ev i e w of th i s d e c i sion b y the Ch a i r of the APA Ethics Comm i ttee a s set fo rt h i n P a r t I I .C. 1 . 4 . Be f o r e i n i t ia t i n g th i s b e l ow Rev i ew p h a se, a si g ned Con f i d ent ial i ty Ag r eement s h al l b e o b t ai ned f r om the Com p lai nant (including any attorney representing the Complainant) b y wh i c h the Com p lai nant a g r ees th a t al l i n f o r m a t i on a nd d o c umen t s c o n c e r n i

17 ng the eth i c a l pr o c e d u r e
ng the eth i c a l pr o c e d u r es a nd al l c ommun i c a t i ons f r om the APA a nd DB, i n c l u d i ng the i r eth i c s c omm i ttees a nd H e a r i ng P a n e l s, a r e c on f i d ent ia l a nd sha l l b e used so l e l y i n co n ne c t i on wi th the eth i c a l p r o c ee d i ngs a nd not for other p u rp o s e s o r l eg a l pr o c ee d i ngs. B. R e vi e w of Al le gatio n s 1 . Th i s p hase i s the p e r i od d u r i ng wh i c h t h e DBEC b eg i ns to l o ok a t the 14 merits of the c a se. The p u r p o s e of th i s pr o c e s s i s to a s s e s s al l i n f o r m a t i on pr ov i d ed b y the Com p l a i nant a nd then ev al ua t e whether the r e i s a ba s i s for the all eg a t i on of uneth i c a l c on d u c t. The DBEC c a n c ho o se whether or not to c ont a c t a nd ad v i se the A cc u s ed M em b er of the eth i c s c ompl ai nt d u r i ng th i s s t a ge. 2 . The DB eth i c s c h a i r s h al l a pp o i nt a member ( s ) to r ev i ew t h e all e g a t i ons i n the c o m p lai nt. The i n d i v i d ua l ( s ) s h al l s u b m i t a wr i tten or o r a l re p o r t t o the DBE C . 3 . To he l p en s u r e fa i r n e s s, it is desirable that the DBEC a rr a nge for tho s e who d o the r ev i ew a nd tho s e w h o se r ve on the hear i ng p a nel to b e se p a r a te te a m s. Somet i mes wh a t s ur faces d u r i ng th i s r ev i ew i s not a l w a ys r e l ev a nt to o r a d m i s s ibl e a t the he a r i ng, a nd thus th i s s e p a r a t i on of f u n c t i ons m i n i m i zes the c hances th a t the hear i ng p a nel w i l l h a ve b een i n f l uen c ed b y a n e a r li er p hase of the c a se. 4 . The r ev i ew i s a cc ompl i s h ed b y r e v i ew i n g t he a l l eg a t i ons a nd a n y r e la ted m a teri a l s pr ov i d ed t o them b y the Co m p lai nant. During t he r ev i ew p hase, the r ev i ewer ( s) m a y se e k a d di t i on a l i n f o r m a t i on f r om the Com p lai nant. The add i t i onal i n f o r m a t i o n c a n b e o b t ai ned b y wr i tt e n r e q ue s t, p hone c on f e r en c e or i n p e r son i nte r v i ew. 5 . During th i s Rev i ew of Al l eg a t i ons p hase, the DBEC m a y, b ut i s not r e q u i r ed to, not i fy t he A cc u s e d M em b er of the c ompl ai nt a nd i nv i te a dd i t i onal i n f o r m a t i o n f r om h i m or h e r . The a dd i t i onal i n f o r m a t i on c a n b e o b t a i ned b y w r i

18 tt e n reque s t, p hone c on f e
tt e n reque s t, p hone c on f e r en c e or i n p e r son i n terv i ew. 6 . If the DBEC fin d s t h e c ompl ai nt d oes sta t e a p otent i a l eth i c s v i o la t i o n , i t s h al l not i fy the A cc u sed M em b er a nd i nv i te a dd i t i onal i n f o r m a t i on f r om h i m or her b e f o r e pr o c ee d i ng w i th a fo r m a l i nves t i g a t i on of the mem b er p u r s u a nt to Pa r t I I I . 7 . If the DBEC fin d s the c ompl ai nt d oes not s t a te a p otent ia l et h i c s v i o l a t i on un d er the eth i c a l st a n d a rd s e s t abli s h ed b y the P r i nc i p l e s a nd thus the r e i s no ba sis to pr o c ee d , i t s h al l no t i fy the Com p l ai nant i n wr i t i ng of the c on c l u s i on. Th i s N ot i c e s h al l a l so i n f o r m the Com p lai nant th a t he/s h e has 3 0 d a ys to r e q u e st a r e v i ew of t h i s d e c i sion b y the Ch a i r of the APA Ethics Comm i ttee a s set f o r th i n Pa r t I I . C . 1 . 8 . If the DBEC det e r m i nes there i s a ba sis to p r o c e e d , i t m u s t not if y the APA Se cr et a r y a s we l l a s the Com p lai nant a nd the A c c u s ed M e m b er a nd pr o c e e d to the e x c han g e of i n f o r m a t i on p h a se. 15 9 . DBE C s s h ou l d p o st p one a d j u d i c a t i on of e th i c s c ompl ai nts unt i l a l l other p en d i ng a c t i ons s uc h a s c i v i l , cr i m i n a l or l ic en s i ng b o a r d pr o c ee di ngs ha v e b een r e s o l ve d . C. R e view b y the Cha i r of the A P A Eth i c s C o m m i t te e 1. I f t h e D B EC d e t e rmin e s the c omp l a int do e s not a l l e g e a n e th i c s vio l a t i on of the Principles, the Comp l a i n a nt m a y r e qu e st a r e view of a D B ’s d ec is i on b y t h e Ch a ir o f the APA Ethi c s Com m i t t ee . The r e qu e st f o r a r e v iew must be s e nt to the DB a nd the Ch a ir of the APA Ethi c s Com m i t tee with i n 30 d a y s of the d a te of the N ot i c e b y the DB not t o pr o c ee d. 2. I f the Ch a ir of the APA Ethi c s Com m i t tee d e te r m i n e s that the c omp l a int identifi e s a potential vio l a t i on, h e /she will r e q u e st that the DB p r o c ee d with p r o c e ss i ng t h e c omp l a in t , a nd will pro v ide the D B with a w ritten e x plan a t i on f o r this de c is i on. 3. I f t h e Ch a ir of the APA Ethi c s Com m i t t e e d e te r m i n e s that the c omp l a int do e s n o t w a r r

19 a nt fu r ther ac t i on, then
a nt fu r ther ac t i on, then h e /she will not if y the Comp l a inant a nd DB of th i s d ec is i on a nd that the c a se is closed. P A RT III: EX C HANGE OF I N F OR M ATI O N A. No t ice t o A cc u s e d Me m b e r 1. I f the D B EC d ec ides to p r o cee d, the D B EC must not if y the A cc used M e mber of the e th i c s c omp l a int a nd th a t the D B EC will p r o c e e d to d e te r m i ne wh e th e r the A cc u s e d Memb e r violat e d the Pr i n c ip l e s . The Notice shou l d includ e : a . A c o p y of the c omp l a in t ; b. All do c uments that w e r e a t t ac h e d to the c omp l a i nt or obtain e d duri n g the in i t i a l r e view ph a s e ; and c . Copies of the P rin c ip l e s a nd P ro c e dur e s for H a ndl i ng Comp l a in t s of U n e th i ca l Condu c t; d. The e th i ca l prin c ip le (s) t he A cc u s e d M e mb e r is a cc used of vio l a t i n g . 2. The D B EC should a lso not if y the A cc used M e mber of his or h e r due p r o ce ss r i g ht s . Th e se include the ri g ht: a . To re qu e st a h ea ri n g ; b. To be r e p re s e nted b y a n a t t o r n e y o r other p e rson of the A cc used Mem b e r ’ s c hoice (h e re a ft e r r e f e r r e d to as “ Couns e l” ) ; c . To h a ve a re c o r d made of the p r o cee di n g s ( b ut not the Ethi c s Com m i t te e ’s subsequ e nt de l ibe ra t i ons, whi c h will not have b e e n pr e s e r v e d ) , c op i e s of w hich 16 m a y b e obtain e d b y t h e A c c used Memb e r u p on p a y m e nt of a n y re a sona b le c h a r g e s; d. To ca l l , e x a m i n e , a nd c r o s s - e x a m i ne witness e s; e . To p re s e nt e vi d e n c e d e t e rmin e d to be r e le v a nt b y the h ea ri n g p a n e l, reg a r d less of i t s admissib i l i t y in a c ou r t of l a w; f . To submit a w r i t ten st a tem e nt or make a n o ra l stat e ment a t the c lose of the h ea ri n g ; g . To re c e ive a w ritten d ec i sion; a nd h. To a pp ea l a n y a dv e rse d e c is i on to t he APA Ethi c s C om m i t te e . 3. W h e n a ppl i ca ble, t h e D BEC shall obtain a nd p r o v ide the A c c used M e mber with v a l i d w r i t ten a uthori z a t i on(s) f r om the p a t i e nt(s) in v olved to p r ovide r e le v a nt medi ca l r e c o r ds a nd oth e r info r mation a bout the p a t i e n t, a nd, if a ppl i ca ble, p s y c hot h e r a p y notes. B . Accused Member’s Response 1.

20 The A c c used Memb e r s h a l
The A c c used Memb e r s h a ll p r ovide a w ritten r e s p onse to the c omp l a in t , including c opies of a ll do c uments a nd a l i st of a ll w i tness e s he or she in t e nds to p r e s e nt a t the h ea ri n g . The A cc u s e d Memb e r is not l i m i ted a t the h ea ring to the e viden c e a nd witnesses identifi e d i n his or h e r re spon s e . 2. The D B EC m a y a lso c onsid e r a ddi t ional info r mation p r ior to a n y s c h e duled h ea ri n g . On the b a sis of i n f o r mation in the A cc us e d Memb e r ' s r e sponse, o r other info r mation that sur face s during the E x c h a n g e of I n fo r mation ph a se but p r ior to the h ea ri n g , the D B EC m a y d e c ide to dis m iss t h e ca s e . A d e c is i on b y the D B EC to dis m iss in th i s ph a se r e quir e s r e vi e w b y the APA Ethi c s Com m i t t e e a s s e t fo r th i n P a rt V I . 3. The n a me of a n y m e mber who r e s i g ns f r om the APA a ft e r a n e th i c s c o mp l a int a g a inst hi m /her is r e c e ived a nd b e f o re it is r e solved shall be r e p o r t e d in Ps yc hia t ric N e ws a nd in the dis t ri c t b ra n c h n e w sletter or oth e r usual m e a ns of c om m unic a t i on with i ts memb e rship. C. Ap p oi n t m e n t of Hea r i n g P a n e l The D B EC shall a ppoint a p a n e l of no less than t h r e e memb e rs to h ea r t h e c omp l a in t . All memb e rs should be e th i c s c om m i t tee memb e rs w h e n poss i ble, a nd a t le a s t one must b e . One memb e r of the p a n e l shall be s e le c ted to c h a ir the H e a ring P a n e l ( H ea ri n g P a n e l Ch a ir) a nd s h a ll be a v o t ing memb e r of the p a n e l. The A c c used M e mb e r m a y r e qu e st those with whom h e /she h a s a c onfli c t of in t e rest be e x c used, a nd r e a s o n a ble r e qu e sts should be hono re d. 17 D . N oti c e of Heari n g 1 . N o l e s s t h a n 3 0 da ys b e f o r e the s c he d u l ed hear i ng, the D B E C s h al l pr ov i d e a N ot i c e t o the Com p lai nant a nd the A cc u sed M e m b e r . The N ot i c e sho u l d su pp l y the fol l o w i ng i n f o r m a t i on: a . The p la c e, d a te a nd time of the he a r i ng; b. The na m es of the H e a r i ng P a n e l Cha i r a n d the other p a nel m e m b e r s who w i l l h e a r the c a se; a nd c . A li st of w i t ne s ses e x p e c ted to test i fy. 2. A n y r e a so

21 n a ble r e qu e s t s b y the
n a ble r e qu e s t s b y the p a rties for a l t e rn a t i ve h e a ri n g d a t e s should be hono re d. E . E du c a t ion O p tion 1. At a n y t i me b e fo r e a fin a l d e te r m i n a t i on of wh e ther the A cc u s e d Memb e r vio l a ted the e th i ca l stand a rds e s t a bl i shed b y t he Principles , a nd with the a g r e e m e nt of the A cc used M e mbe r , t h e c o mp l a int m a y be r e solved in acc o rd a n c e with the Edu ca t i on a l Option r a ther than d e t e r m i ne wh e ther the A cc u s e d Memb e r vio l a ted the Principles . I n d ec id i n g wh e ther to u se th i s a ppro a c h, the D B E C shall c onsid e r such f ac tors a s the n a ture a nd s e riousn e ss o f the a l le g e d m i s c ond u c t a nd a n y p rior findin g s o r a l l e g a t i ons of un e th i ca l cond u c t. 2. I f the DBEC d ec i d e s to a t t e mpt to r e solve the c omp l a int b y using the Edu ca t i on a l Option as d e s c rib e d in p a ra g r a ph 1 a bov e , it shall p r o cee d on l y a ft e r: a . A cc used Mem b e r h a s b e e n info r med (1) that h e / she is e nt i t l e d to p r o cee d und e r e n f o r c e ment p r o c e dur e s, a nd (2) that the D B EC r e s e r v e s the ri g ht to p r o cee d on the c omp l a int to d e te r m i ne wh e ther the A cc used Memb e r v io l a ted the Principles if, in i t s sole d i s c r e t i on, it d e te r m i n e s that t he A cc used Memb e r h a s not s a t i sf ac tori l y c oop e r a ted. b. A cc used M e mber a g re e s to pro cee d un d e r the Ed u ca t i on a l Opt i on; c . Th e re a r e a p p rop r iate e du ca t i on oppo r tun i t i e s a v a i l a ble a nd the D B EC h a s the r e sour c e s to m oni t or c omp l ian ce ; d. The A cc used M e mber w i l l h a ve the oppo r tun i t y to r e spond to the su g g e st i on to use the Edu c a t i on Option. The D B EC s h a ll d e t e rmine the p ro c e d u r e s to be used to obtain the r e sponses, including w r i t ten submis s ions a n d /or me e t i ng with the p a rties s e p a r a te l y or t o g e the r . Ho we v e r, in d e t e r m i ning the p r o c e dure it will use, the D B EC shall s ee k to p rovide a fo r mat that will fac i l i t a te the A cc us e d Memb e r ' s und e rst a ndi n g of the e th i ca l is s u e s r a ised b y the c omp l a in t , includi n g the r e a sons for or sou r ce s of t h e Comp l a inant ' s c o n ce rn, a nd to p e rmit the DB to a ssess

22 the A cc used M e mbe r ' s und er
the A cc used M e mbe r ' s und er standing of th e s e matte r s. 18 3. The DBEC shall identify a s p ec ific e du c a t i on a l p r ogr a m includi n g c our s e s, r e a di n g a nd/or c onsultation for t he A cc used Memb e r to c omp l e te with i n a sp e c i f ied p e riod a nd shall not if y the A cc u s e d Memb e r a nd the APA Ethi c s Com m i t t e e of the r e quir e d p r ogr a m. The D B EC w i ll mon i tor the A cc used Memb e r ’ s c omp l ia n c e w i t h a n y such e du ca t i on a l r e quir e ment s . The A c c used Mem b e r ’ s f a i l u r e to c omp l e t e the spe c ified e du ca t i on a l p r o g r a m may r e sult in the p r o cee d i n g s b e i n g r e o p e n e d to d e te r m i ne wh e ther the A c c used Memb e r vio l a ted the P rincipl e s . I t is p r e f e r a b le, but not r e quir e d, that the subsequ e nt p r o cee di n g be c on d u c ted b y D B EC mem b e r s other than those w ho p a rticip a ted in the p r o ce ss p r e vious l y . 4. The D B EC shall r e tain r ec o r ds o f c omp l a in t s c o n side re d purs u a nt to th i s P a rt a nd of a n y e d u ca t i on the r ea f t e r r e quir e d of an A cc used M e mbe r . T h e D B m a y c o n sider such info r mation in c onn ec t i o n with a d ec is i on a s to how to h a ndle a n y lat e r c omp l a in t s invo l ving the A c c used M e mbe r . 5. On c e the D B EC d ec ides to r e solve the c omp l a int b y using the Ed u ca t i on a l Option, i t shall noti f y both t he Comp l a inant a nd A c c used M e mbe r . 6. Upon c omp l e t i on of a n Edu ca t i on Option r e q u ir e ments, the p r o c ee di n g shall be te r m i n a ted. P A RT IV: T H E H E A R ING A. Basic R e q u ir e m e nt s 1 . Wh il e the s p i r i t of t h i s pr o c e ss i s a c o ll eg i a l one ba sed on mut u a l r e sp e c t a mong pr o f e s sion a l c o ll e a gues - - a nd not a c ou r t of la w - - pr o c e d u r a l safegu a rd s a r e a n i n te g r a l a s p e c t i n o rd er to pr e s e r ve the r i ghts of the A cc u s e d M em b er a nd pr ov i d e fa i r ne s s a nd r e sp e c t for b oth the A cc u s e d M em b er a nd the Com p lai nant. 2 . If d eemed u s e f ul a nd not li k e l y to pr e j u dic e the p a ne l , the H e ar i ng P a n e l Cha i r m a y a l l ow t h e i n d i v i d ua l ( s ) who d i d t he r ev i ew of a ll e g a t i o ns un d er P a r t II to pr e s ent o ra l or wr i tten d o c um e nt a r y a nd test i mony ev i d

23 en c e, s u bj e c t to cr o ss e
en c e, s u bj e c t to cr o ss ex a m i na ti on b y the A cc u s ed M em b er or h i s or her c oun s e l , for the p a ne l ’ s c o n s id e r a t i on. T h i s r ev i ewe r ( s ) o f the all eg a t i ons sho u l d not p a r t i c i p a te a ny f ur t her i n the hear i ng or b e p a r t of the p a ne l ’ s d e lib e r a t i ons or vot i n g. 3 . Cou n sel’s p a r t i c i p a t i on i s s u bj e c t to the c ont i nuing d i r e c t i on a nd cont r ol of the H e a r i ng P a nel Cha i r . The H e a r i ng P a nel Cha i r s ha l l exe rc i se h i s o r her d i s c r et i on so a s to pr event the i nt i m i d a t i on or haras s m ent of the Com p lai nant a n d /or other w i tne s ses g i ven the p e e r r ev i ew na t u r e of the pr o c e e d i ngs. P a nel m em b e r s m a y a sk q ue s t i ons of the A cc u s ed M em b e r . 4 . The A cc u s ed M em b e r ’ s vo l unta r y w ai ver of a he a r i ng s ha l l not pr event the H e a r i ng P a n e l f r om meet i ng w i th, a nd hear i ng the e v i d e n c e o f , the 19 Com p lai nant a nd o t her w i tne s se s , a nd r e a c h i ng a d e c i sion i n the c a se. The A cc u s e d M em b er m a y c hoo s e not to b e pr e s ent a t the hear i ng a nd to pr e s ent h i s/her d e fe n se th r ough o t her wi tne s ses a n d /or Co u n s e l . 5 . The Com p l a i nant m u s t b e pr e s ent i n p e r son a t the hear i ng to test i fy r eg a rd i ng h i s/her all e g a t i ons un l e s s ex c u s ed b y the H e a r i ng P a n e l Cha i r , a nd th i s s h ou l d o c c ur on l y when, i n the j u d gment of t h e H e a r i ng P a nel Ch a i r , p a r t i cip a t i on wou l d b e h a r mful to h i m/her or ext r i n s i c ev i d en c e se r ves a s t h e Com p lai nant. Co m p lai nants m a y b r i ng a s upp o r t p e r son to the hear i ng i f a ppr oved b y the H e a r i ng P a n e l Cha i r . Com p lai nants gene ra ll y d o not r em ai n i n the hear i ng o n c e they ha v e pr e s ent e d the i r test i mony a nd ev i d en c e a nd b een cr o s s ex a m i ne d . The H e a r i ng P a n e l Cha i r m a y ha v e them w a i t outside d u r i ng the r e m ai n d er of the hear i ng i n the event f ur ther i n f o r m a t i on f r om the C o m p lai na n t b e c omes nee d e d . B. The He a ri n g 1 . The he a r i ng m a y con s i st o f : a An o r a l o p en i ng statement b y the Com p lai nant, a nd the A cc u s e d M em b er or h i s/her Cou

24 n s e l ; b Te s t i mony b y
n s e l ; b Te s t i mony b y the C o m p lai nant a nd a ny w i tne s se s , a nd a ny wr i tten or o r a l c r o s s ex a m i na t i o n b y A cc u s ed Member or h i s/her Coun s e l ; c Te s t i mony b y the A cc u s ed Membe r ; d Quest i ons b y the H e ar i ng P a n e l mem b e r s; a nd e P r e s ent a t i on of a n y e v i d en c e d etermined to b e r e l e v a nt b y the H e a r i ng P a nel Ch a i r , r eg a rd l e ss of i ts a d m i s s ib i li t y i n a cou r t of l a w. 2 . The A cc u s ed M em b er or h i s Cou n sel s h al l b e p e r m i tted to m a k e a n o ra l c l o s i ng statement a n d /or s u b m i t a wr i tten statement a t the cl o s e of the hear i ng or wi t h i n a reasona bl e t i me the r e a f ter. PA R T V: D I STR I CT BR ANCH D E C I S I O N A f ter the hear i ng, the H e a r i ng P a nel s h a l l meet a nd r e a c h a d e c i sion ba sed on the i n f o r m a t i on p r e s ented a t the hear i ng, i n cl u d i ng the test i mony f r om the p a r t i es a nd a ny other w i tne s se s , the d o c uments s u b m i tted a nd a ny other e v i d en c e pr ov i d ed a s p a r t of the hear i ng. The d e c i sion s h al l c on s i st of ( A ) a d etermi n a t i on of whether the A cc u s e d M em b er v i ol a ted the eth i c a l sta n d a rd s e s t abli s h ed b y t he P r i nc ipl e s , a nd ( B ) i f s o, then w hat s a n c t i on, i f an y , i s a pp r o pr ia te. 20 A. De t e rmination 1 . A f ter the c on c l u s i on of the hear i ng, the p a nel s h al l i s s ue a wr i tten d etermina ti on th a t sets fo r th the H e a r i ng P a ne l ’ s fin d i ngs, r e c ommen d a t i on s , a nd reasonin g . 2 . In m a k i ng i ts d e c i si o n, t he Hearing P a nel s h ou l d con s i d e r : a . The n a tu r e a nd se r i ou s ne s s of the all eged c on d u c t; b . Whether or not the r e i s a r e a so n a b l e b e l i ef th a t a n eth i c s v i o la t i on o cc u r r e d . c . The cr e d ibili t y of the A cc u s e d M em b e r , Com p lai nant a nd t h e other w i tne s se s ; d . Any do c uments sub m i tted th a t t he p a n e l f i n d s cr e d ibl e; a nd 3 . The DB exe c ut i ve c o un c i l (or the DB ’ s g o ve r n i ng b o d y) mu s t r ev i ew the p a ne l ’ s d etermina ti on. The DB exe c ut i ve c oun c i l c a n a cc e p t o r modify the p a ne l ’ s fin d i ngs. In al l c a se s , the DB s h al l se e k to r e a c h a d e c i sion a s

25 ex p e d i t i ou s l y po s si b l
ex p e d i t i ou s l y po s si b l e. 4 . Be f o r e not i fy i ng t he Com p lai nant a nd A cc u s e d M e m b e r , a l l d etermina ti ons mu s t b e fo r w a rd e d to t h e APA Ethics Co m m i ttee for r ev i ew p u r s u a nt to the pr o c e d u r es set f o r th i n P a r t V I . 5 . U n l e s s the DBEC pr o c ee d s un d e r the E d u c a t i on Opt i on, the r e a r e two ba sic fin d i ngs: a . The A cc u s ed M em b er did not a c t uneth i c a ll y; or b . The A cc u s ed M em b er a c ted uneth i c all y . 6 . N o Eth i c a l V i o l a t i on a . If the H e a r i ng P a nel d e c i d es a fter a hear i ng th a t no et h i c a l v i o la t i o n o cc u r r e d , i t s h al l p r e p a r e a wr i tten ex p la na ti on th a t sets fo r th the r e a so n s f o r the d et e r m i na ti o n . Th i s d etermina ti on s ha l l b e s ub m i tted to the DB e xe c ut i ve c oun c i l a nd the APA Ethics Comm i ttee for r ev i e w a s s et fo r th i n Pa r t V I . b . I f a ppr oved b y the DB exe c ut i ve c o u n c i l a nd the APA Ethics Comm i ttee a s set fo r th i n P a r t VI, t he DBEC s h al l no t i fy the Com p lai nant a nd A c c u s ed Member i n wr i t i ng of the d etermina t i on. c . The r e i s no a pp e a l f r om th i s d etermina ti o n . 21 7 . Ethical V i o la t i on a . If the p an el d e c i d es a fter a hear i ng th a t A cc u s ed M em b er a c ted uneth i c al l y, i t s h a l l p r e p a r e a wr i tten ex pl a na ti on t h a t sets fo r th the r e a so n s f o r the d ete r m i na ti o n . It s h al l then pr o c eed to d et e r m i ne the a ppr o p r ia te san c t i on. Th i s d etermina t i on s ha l l b e s u b m i tted to t he DB exe c ut i ve c omm i ttee a nd the APA Ethics Comm i ttee for r ev i ew a s set fo r th i n Pa r t V I . b . If a ppr oved b y b oth the DB exe c ut i ve c omm i ttee a nd APA Ethics Comm i ttee, on l y the A cc u s e d Member sha l l b e not i f i ed i n wr i t i n g of the d etermina ti on sett i ng fo r th the r e a so n s f o r the d et e r m i na ti on a nd the san c t i on. Th i s N o t i c e s h ou l d b e c o p i ed to the APA Ethics Of f ic e. Th i s N ot i c e s h a l l a l so i n f o r m the A cc u s e d M e m b er of h i s or her r i ght to a pp e a l the d etermi n a t i on to the APA E th i c s Comm i ttee w i th i n 3 0 d a ys. T he ap p e a l r i g ht a pp li es to a l l a d ve r se

26 f i n d i ngs. c . The Com p
f i n d i ngs. c . The Com p lai n a nt i s not not i fied of the d etermina ti on un t i l a l l app e al s ha v e b een c on c l u d ed or the t i me for the A c c u s ed M em b er to a p p e a l h a s ex p i r e d . B. Sa nct i o n s If the p a nel fin d s th a t a n et h i c a l v i o l a t i o n has o cc u rr e d , i t mu s t d etermine the a ppr o p r ia te san c t i on. Th i s d etermina ti o n m a y i n c l u d e c on s i d e r a t i on of a ny m i t i g a t i n g or a gg ra v a t i ng c i rc um s t a n c es s uc h a s ill ne s s or pr i or fin d i ngs of uneth i c a l c on d u c t th a t a r e r e l e v a nt to the c u rr ent v i o la t i on. The th r ee (3) san c t i ons i n i n cr e a sing o rd er of seve r i ty a r e: ( 1 ) Re p r i m a n d ; (2) Su sp en s i on; a nd (3) Ex p u l sion. 1 . Re p r i m a nd a . A r e pr i m a nd i s a n o f fi c i a l a d mon i s h ment b y the APA. The r e pr i m a nd s h al l i d ent i fy the c on d u c t c o n side r ed u n eth i c a l a nd the ba sis of the d etermina ti o n . b . The r e pr i m a nd i s c on f i d ent ia l a nd i s n o t p ub l i s h ed to the g ene r a l mem b e r s h i p of the D B or the APA, or to the g ene r a l p u b l i c . c . A d d i t i onal c on d i t i ons m a y b e i n c l u d ed w i t h the r e pr i m a nd a s set fo r th P a r t V.C.) 2 . Su sp en s i on a . Su sp en s i on i s a se r i ous san c t i on th a t w il l b e m a d e p ub l i c . An A cc u s e d M em b er m a y b e su sp en d ed for a pe r i od not to ex c eed f i ve (5) y e a r s. 22 b . A s u s p en d e d mem b er s h al l p a y d ues a nd i s e li g i b l e for APA b e ne f i ts, ex c e p t th a t s u c h a m em b er w il l l o s e h i s/ h er r i ghts to ho l d o f fice, vote, nom i na t e c a n d i d a tes, pr o p o se r e f e r e n d a or a men d ments to the By la w s , a nd se r ve on a ny APA c omm i ttee or c ompo n ent, i n c l u d i ng t he APA Board of T r u s tees a nd the APA A s semb l y. If the s u s p en d ed m e m b er i s a Fe l l ow, L i fe Fe l l o w, D i sti n gu i s h ed Fe ll ow or D i s t i ngu i s h e d L i fe Fe ll o w , the F e ll o wsh i p wi l l b e su sp en d ed f o r the same p e r i od of t i me. c . Each DBEC s h al l d e c i d e wh i c h, i f a ny, DB pr i v il eges a nd b ene f i t s s h al l b e de n i ed the A cc u s ed Member d ur i ng the pe r i od of s u s p e n sion. d . A d d i t i onal c on d i t i ons

27 m a y b e i n c l u d ed w i th
m a y b e i n c l u d ed w i th the s u s p en s i o n a s set fo r th i n Pa r t V.C. e. The na m e of a ny m e m b er who i s s u s p e n d ed for a n eth i c s v i o la t i o n , al ong w i th a n ex pla na ti on of the n a tu r e of the v i o la t i on, s h al l b e r e p o r t e d b y the APA Of f i c e of Eth i c s: i . In P s y c h ia t r ic N e w s ; ii . To the DB to b e i n c l u d ed i n the DB n ews l e tter or other us u a l me a ns of commun i c a t i on wi t h i ts mem b e r s h i p ; i i i . To the medical li c e n s i ng a utho r i ty i n al l states i n w h i c h the mem b er i s l i c en s e d : i v. To the N a t i on a l P r a c t i t i oner Da t a B a n k . f . The DB s h ou l d al so c on s u l t a pp li c abl e state l a w to a s s u r e t hat i t a d he r es to a ny r e q u i r ements. 3 . Ex p u l sion a . Ex p u l sion i s the most se r i ous san c t i on. As a r e s u l t, a l l d etermi n a t i ons to ex p el a n A cc u s ed M em b er mu s t b e a f fir med b y the APA B o a r d of T r u s tees. b . Once a d e c i sion to ex p el a me m b er has b een a ppr oved b y t he DB exe c ut i ve c oun c i l a nd the APA Ethics Comm i ttee, a nd the a pp e a l pr o c e ss un d er P a r t VII has b een e xhaust e d or ex p i r ed the APA Ethics Comm i ttee Ch a i r (or h i s/her d e s i gnee) s h al l pr e s ent the m a t t er a nd the d o c ument a r y r e c o r d to the APA Boa r d of T r u s tees a t the Boa r d' s next meet i n g . T he A PA Board of T r u s tees m a y: i . A f firm the san c t i on; ii . I m p o s e a l e s ser san c t i on; 23 i i i . Remand to the APA Ethics Comm i ttee or DBEC for f u r ther a c t i on or c on s i d e r a t i on i n w h i c h c a se the s e p r o c e d u r es s h al l a pp l y to t ho s e a c t i on s ; or i v. Request f ur ther i n f o r m a t i on f r om the D B EC b e f o r e vot i ng on the d e c i sion to e x p e l . c . A d e c i sion to a f f i r m a n ex p u l sion mu s t b e b y a vote of tw o - th i rd s (2/ 3 ) of tho s e T r u s tees p r e s ent a nd vot i ng. A d e c i sion to i m p o s e a l e s ser san c t i on s h al l b e b y a m aj o r i t y v ote. d . If the A P A Board of T r u s tees a f f i r ms ex p u l sion, the APA Se cr et a r y s h al l not i fy the D B E C , a nd the DBEC s h al l i n tu r n not i fy the Com p lai nant a nd A c c u s ed M em b er of the

28 d e c i sion a nd th a t i t i
d e c i sion a nd th a t i t i s fin al . . The A cc u s e d M em b er s h al l a l so b e pr ov i d ed c o p i es o f the DBEC a n d /or p a nel re c ommen d a t i on ( s) a nd reasonin g . e. The na m e of a ny m e m b er who i s ex p e l l ed f r om the APA for a n eth i c s v i o l a t i on, al ong w i th a n e x p la na t i on of the n a tu r e of the vi o la t i o n, sha l l b e re p o r ted b y the APA O f f i c e of Eth i c s: i . In P s y c h ia t r ic N e w s : ii . To the DB to b e i n c l u d ed i n the DB newsl e tter ( A PA Of f i c e of E t h i c s w i l l pr ov i d e DBEC w i th la ng u a ge) or other u s ual me a ns of c ommun i c a t i on w i th i ts mem b e r s h i p ; i i i . To the medical li c e n s i ng a utho r i ty i n al l states i n w h i c h the mem b er i s l i c en s e d : i v. To the N a t i on a l P r a c t i t i o n er Da t a B a n k . f. The DB s h ou l d al so c on s u l t a pp li c abl e state l a w to a s s u r e t hat i t a d he r es to a ny state r e q u i r ements. C. A d di s t io n al Co n d i t i o n s Con c u r r ent w i th the i m p o s i t i on of the san c t i ons of r e p r i m a nd a nd s u s p en s i on, a dd i t i onal c on d i t i ons c a n b e i m p o s e d . T h e s e c on d i t i ons a r e d e si g ned to r e i n f o rc e a nd fac ili t a te e t h i c a l b eha vi o r . 1 . Su p e r v i sion a . The DBEC m a y i m p o s e s u p e r v i so r y r e q u i r ements on a s us p en d ed mem b e r . When s uc h c on d i t i ons a r e i m p o s e d , the fol l ow i ng pr o c e d u r es s h al l a pp l y: 24 i . If the DBEC i m p o s es c on d i t i o n s, i t s h al l en s u r e th a t the DB mon i tors com p lia n c e; ii . If a mem b er fa il s to sa t i s f y the c on d i t i on s , the DBEC m a y d e c id e to r e c ommend a new san c t i on; a nd i i i . If the DBEC d eter m i nes th a t a mem b er s h ou l d b e ex p e ll ed for non c ompl ia n c e w i th c on d i t i on s , the APA Board o f T r u s te e s s ha l l r ev i ew the ex p u l sion i n a cc o rd a n c e w i th the pr ov i sions set fo r th i n P a r t V I I. E. of these pr o c e d u r e s . b . In d etermin i ng whe t her to r e q u i r e s u p e r v i sion, the H e a r i ng P a nel a n d /or the DBEC s h ou l d c on s i d er the a v ai l a b l e r e s ou rc es to c on d u c t a nd m on i tor s u c h s u p e r v i sion. 2 . E d u c a t i on Requ i r ement a . The

29 DBEC m a y i m p o s e a n E d
DBEC m a y i m p o s e a n E d u c a t i on R e q u i r ement a s p a r t of the san c t i ons of r e pr i m a nd or s u sp e n s i on. b . If the DBEC d e c i d es to i m p o s e a n E d u c a t i on Requ i r ement, the DBEC s h al l i d ent i fy a s p e c i fic e d u c a t i onal pr og r a m i n c l u d i ng c ou r se s , r e a d i ng a n d /or c on s u l t a t i on for the A cc u sed M e m b er to c omplete w i th i n a s p e c i fied p e r i od a nd s h al l not i fy the A cc u sed M em b er a nd the APA Ethics Comm i ttee of the r e q u i r ed p r og r a m. The DB w i l l mon i tor the A cc u s e d M em b e r’ s c ompl ia n c e w i th a ny s uc h e d u ca t i on a l r e q u i r ements. The A cc u s ed M em b e r’ s fa il u r e to c omplete the spe c i fied e d u c a t i onal r e q u i r ement( s ) m a y r e s u l t i n the p r o c e e d i ngs b e i ng r eo p ened (e. g ., to d etermine i f a g r e a ter s a n c t i on i s i n d i c a te d ). 3 . Pe r so n a l T r e a tment a . As p a r t o f a ny sa n c t i on, p e r so n a l t r e a tment m a y b e r e c ommen d e d , b ut not r e q u i r e d , a nd a n y s uc h r e c ommen d a t i on s h a l l b e c a rr i ed out i n a cc o rd a n c e w i th the eth i c a l r e q u i r ements gove r n i ng c on f i d ent i a li ty a s set fo r th i n the P r i nc i p l e s . In a ppr o pr ia te c a se s , the DBEC m a y a l so r e f er the p s y c h ia t r i st i n q ue s t i on to a pr og r a m r e sp on s i bl e for c on s i d e r i ng i m p ai r ed or p hys i c all y i l l p h ys i c ia n s . PA R T VI: R EVIEW BY THE A P A ETH I CS C O MM I T T EE A. APA E t h i c s Com m i tt e e R e vi e w 1 . A f ter the DBEC d e c i sion i s c on f i r med b y i ts DB exe c ut i ve c oun c i l ( o r the 25 DB ’ s gove r n i ng b o d y), the d e c i sion a nd a ny p e r t i nent i n fo r m a t i on c on c e r n i ng the pr o c e d u r es fol l owed or r e la t i ng to the a c t i on t a k en s h al l b e fo r w a rd ed to the APA Ethics Comm i ttee for r ev i ew. Th i s r ev i ew a pp li es to al l d e c i sions, i n c l u di ng tho s e whe r e the DBEC fin d s th a t a n eth i c s v i o l a t i on h a s not o cc u rr e d . 2 . The APA Ethics C o mm i ttee w i l l a pp o i nt a p a nel c omp o sed o f a t l e a st th r ee (3) vot i ng mem b e r s of the APA Eth i c s Comm i ttee to un d e r t a k e these r ev i ew f u n c t i ons on b eha l f of the f u l l APA Ethics Comm i tt e e. The r ev i

30 ew s h al l a s s u r e th a t:
ew s h al l a s s u r e th a t: a . The c ompl ai nt re c e i v e d a com pr ehen s i ve a nd fa i r rev i ew; b . That the r ev i e w w a s i n a cc o rd a n c e wi th the a pp li c a b l e p r o c e d u r e s; a nd c . The san c t i on i m p o s ed wa s a ppr o pr ia te. 3 . If the APA Ethics s ub c omm i ttee c on c l u d es th a t the s e r e q u i r e m ents were not sat i s f i e d , i t s h al l so a d v i se the DB E C, a nd the DB E C s h al l r emedy the d e f i c i en c i es a nd s h al l m a k e f ur ther r e p o r ts to the APA Et h i c s Comm i ttee unt i l s uc h t i me a s t he APA Ethics Co m m i ttee i s sa t i s f i ed th a t the s e r e q u i r ements ha v e b e en met. 4 . If the APA Ethi c s s ubcomm i ttee c on c l u d es th a t the san c t i on s h ou l d b e r e c on s i d e r e d b y the DBE C , i t s h al l pr ov i d e a statement o f r e a so n s ex p lai n i ng the ba sis for i ts o p i n i on, a nd t he DBEC s h al l r e c o n sider the san c t i on. A f ter r e c o n side r a t i on, the d e c i s i on of the DBEC s h a l l b e fi n a l w i th the ex c e p t i on t hat Ex p u l sions mu s t al so b e a ppr oved b y the APA Board of T r u s tees. 5 . The Com p lai n a nt a nd A cc u sed M em b er s h al l not b e not i f i ed of a ny d e c i sion unt i l t h i s r ev i ew i s c omplete d . B. N otifi c ation of D e c ision 1 . A f ter the A P A Ethics Comm i ttee or s u b c omm i ttee c ompletes t he r ev i e w pr o c e s s , the fo ll ow i ng N ot i c es w i l l b e sent: a . If the d etermina ti on i s th a t no et h i c s v i o l a t i on has o cc u rr e d , the DB s h al l pr ov i d e wr i tten N ot i c e to the Com p l a i nant a nd A cc u s ed M em b er of the d e c i sion. b . I f the d etermina ti on i s th a t a n eth i ca l v i o la t i on d i d o cc u r , the DBEC s h al l p r ov i d e w r i tten N ot i c e to the A c c u s ed Member o f the de c i s i on a nd the san c t i on. The A cc u s ed M em b er s h al l b e pr ov i d e d : (1) c o p i es of the DBEC a n d /or p a nel r e c ommen d a t i on ( s ) , (2) the D B E C d e c i sion, a nd (3) 26 not i c e of h i s/her r i ght to A p p e a l the d e c i si o n w i th i n 3 0 d a ys of r e c e i p t of the l etter. The C o m p lai nant s h a l l not b e not i fied unt i l al l a p p e al s or the t i me for a l l a pp e al s has e x p i r e d . c . If the d e c i sion i s to ex p el the m

31 em b e r , t he DBEC s h al l no
em b e r , t he DBEC s h al l not pr ov i d e N ot i c e unt i l the APA Board of T r u stees h a s a ppr oved the ex p u l sion p u r s u a nt to P a r t V.B. 4 . Once a ppr ov e d b y the Boar d , the D B EC s h al l pr ov i d e wr i tten N o t i c e to the Com p l a i nant a nd A cc u s ed M em b e r , w i th a c o p y to APA, th a t Ex p u l sion has b e e n a ppr oved b y the B o a r d of T r u s tees a nd th a t t he d e c i sion i s f i n a l . P A RT VII: A P P EAL S A. Ap p e al P a n e l 1. All a pp ea ls shall be c o n side re d a nd d ec ided b y a p a n e l of thr e e (3) m e mbe r s of the APA Ethi c s Com m i t tee who h a ve not b e e n invo l v e d in a r e view o f the c a se pursu a nt to P a rt V I . 2. The Ch a ir of the APA E th i c s Com m i t t e e m a y a p point a r e pla ce ment if the r e a r e not thr e e memb e rs of the Com m i t tee who h a ve not b ee n invo l v e d in the ca se who a re a ble to s e rv e . B . G r o und s f or Ap p e al All app ea ls s h a ll be b a s e d on one ( 1) or mo r e of t he f ol l owing g r ounds: 1. Th a t t h e re h a ve b e e n signifi ca nt pro c e dur a l i r re g u la r i t ies or d e fi c ie n c ies in the ca s e ; 2. Th a t T he Principles of Me dical Ethi c s wi t h A n nota t ions Esp ec ia l ly A p pl i c able to Ps yc hia t ry h a s b e e n i m p r op e r l y a ppl i e d; 3. Th a t the find i n g s of or s a n c t i on i m posed b y the DB a r e not support e d b y subs t a nt i a l e viden ce ; 4. Th a t sub s tantial n e w e v i d e n c e h a s c a l l e d in t o qu e st i on the f ind i n g s and c o n c lus i ons of the distri c t br a n c h. C. A cc us e d M e m b er ’s R e qu e st F or App e al 1. The A c c used Memb e r ’ s r e qu e st f o r a n a p p ea l m u st be r e c e ived with i n 30 d a y s o f the d a te the A c c used Mem b e r is not i fi e d of the dis tr ict b ra n c h d e c is i on. Up o n re ce ipt of the A cc used M e mbe r ’s r e qu e st for a n a pp ea l, the APA Ethi c s Co m m i t t e e shall r e qu e st a nd the DB shall p r ovide to the APA E th i c s Com m i t t e e a c o p y of the DB file, including the re c o r di n g of the h e a ri n g . The APA Ethi c s Com m i t tee shall make a c o p y the D B file a v a i l a b l e to the A cc used Memb e r upon r e qu e st a nd c omp l ian c e with a n y c ondi t ions s e t b y the APA Ethi c s C om m i t te e . 27 2. I n a p

32 p e als h ea rd b y a n APA Et
p e als h ea rd b y a n APA Ethi c s Com m i t tee a pp ea ls p a n e l, t h e p a n e l will r e view a nd d ec ide the a pp ea l s ole l y on the b a sis of t h e DB’s do c ument a r y re c o r d of i t s ac t i ons a nd d ec is i on a nd a n y w ritten a pp ea l stat e ments filed b y the A c c used Memb e r a nd the dis t ri c t b r a n c h. The A cc used Memb e r ’ s stat e ment will be p r ovided to the D B , whi c h m a y file a w ritten r e sponse. A n y DB r e sponse will be fo r w a r d e d to the A cc used M e mbe r , who will h a ve the oppo r tun i ty to r e spond in w r i t ing p r ior to the Ethi c s Com m i t te e ’s c o nside ra t i on of t h e a p p ea l. F i l ing d ea dl i n e s a nd other p r o ce du r e s g ov e rni n g the a pp ea l shall be e stablished b y t h e APA Ethi c s C om m i t te e . D. D ec is i on b y A P A Eth i c s C o m m it t e e Ap p e al P a n e l 1. A f ter r e vie w i n g a ll do c u ments, the APA Ethi c s Com m i t tee a pp ea ls p a n e l m a y t a ke a n y o f the f ol l owi n g a c t i ons: a . A f fi r m t he d e c is i on, including the s a n c t i on i m posed b y t h e dis t ri c t br a n c h; b. A f fi r m t he d e c is i on, but alter the s a n c t i on i m posed b y the distri c t b r a n c h; c . R e v e rse the d ec is i on of t he dis t ri c t br a n c h a nd te r m i n a te the ca s e ; o r d. R e mand the c a se to the d is t ri c t b ra n c h with sp e c if i c ins t ru c t i ons a s to wh a t fu r ther info r mation or ac t i on is n ece ss a r y . R e mands will be e mp l o y e d on l y in r a r e ca s e s, such a s w h e n n e w info r mation h a s b ee n p re s e nted on a p p ea l or wh e n t h e re is a n ind i ca t i on that i m port a nt info r mation is a v a i l a ble a nd h a s not b ee n c ons i d e r e d. A f ter the dis t ri c t b r a n c h or p a n e l h a s c omp l e ted r e mand p roc ee di n g s, t h e ca s e shall be h a ndled in a c c o r d a n c e with pr o ce du r e s in P a rt V I a nd V I I . 2. A f ter t h e APA Ethi c s Com m i t tee a pp ea ls p a n e l r e ac h e s a d e c is i on, if the d ec is i on is a n y th i n g oth e r than to e x p e l a memb e r or r e m a nd, the Ch a ir of the A P A Ethi c s Com m i t tee shall provide Notice to t he D B of the d ec is i on. T h e D B s h a ll then p r ovi d e Notice to the A cc used Memb e r a nd t h e Comp l a inant of the d ec is i o n a nd that it is fin a l. 3

33 . I f the d e c is i on is to
. I f the d e c is i on is to e x p e l the memb e r, the d ec is i on would be fo r w a r d e d t o the APA B o a rd o f T rust e e s as outl i n e d in P a rt V. B .4. 30 Index A Abuse of power, 7 Accused member, 11, 12, 14 appointment of hearing panel with, 16 notice to, 15 – 16 request for appeal, 26 – 27 response to notice, 16 Acupuncture, 6 Adjudication, 15 Age, 3 Allegations, review of, 13 – 15 AMA. See American Medical Association American Medical Association (AMA), 1, 11 Opinions a nd Reports of the Council on Ethical and Judicial Affairs, 1 preamble, 2 – 3 principles with annotations, 3 – 10 American Psychiatric Association (APA), 1, 11 Assembly, 1, 11 Board of Trustees, 1, 1n3 bylaws, 1n3 District Branch (DB), 11 Ethics Committe e, 1, 1n1 Ethics Committee Review, 24 – 25 APA. See American Psychiatric Association Appeals, 3, 26 – 27 accused member's request for, 26 – 27 Appeal Panel, 26 decision by APA Ethics Committee Appeal Panel, 27 to governing body, 4 grounds for, 26 to state agencies, 4 Appointments, 5 Attorney, 15. See also Law B Brickman, J. Brand, M.D., 1n1 Busse, Ewald, M.D., 1n1 C Camp, William P., M.D., 1n1 Certification, 9 Chair of the APA Ethics Committee, 15 Civil rights, of the patient, 6 Community, psychi atrist participation in, 9 Competence, 7 Complainant, 11, 12, 18 – 19 Complaints of unethical conduct, 11 – 27 adjudication, 15 appeals, 26 – 27 district branch decision, 19 – 24 exchange of information, 15 – 18 extrinsic evidence, 12 the hearing, 18 – 19 initial procedures, 11 – 13 overview, 11 review of allegations, 13 – 15 review by the APA Ethics Committee, 24 – 26 review for jurisdiction, 12 – 13 review process, 29 31 Computerization, 6 Conduct, of physician, 4 Confidentiality, 6 – 7 dissemination of, 6 ethi cal responsibility of, 6 – 7 of ethics cases, 11 lack of, 7 sensitivity of, 6 Confidentiality agreement, 13 Conflicts of interest, 10 Court, 7 redress in local, 4 Creed, 3 Criminal acts, 7 D DBEC. See EB Ethics Committee DB Ethics Committee (DBEC), 13 – 15 Deception, 2 Decision affirmation of, 27 appeals, 26 by APA Ethics Committee Appeal Panel, 27 notification of, 25 – 26 remand of the case, 27 reversal of, 27 written, 16 Determinations after conclusion of the hearing, 20 – 21 preliminary, 13 Dignity, 7 Disclosure, 7 Discrimination, 3 Disputes procedures, 4 District Branch (DB), American Psychiatric Association, 11 decision of, 19 – 24 Doctor – patient relationship, 9 contractual arrangement of, 5 in effective treatment, 8 – 9 professionalism of, 4 refusal of treatment, 9 E Education a

34 dvancement of, 8 of colleagues, 4
dvancement of, 8 of colleagues, 4 continuing, 8 option, 17 – 18 of the public, 4 requirement as sanction, 24 training materials for, 6 Ethical violation, 21 Ethics AMA and, 3 confidentiality of cases, 11 disclosure of information and, 6 patients and, 3 psychiatrists and, 1 – 2 Ethnicity, 3 Evidence, 16 Exchange of information, 15 – 18 accused member's response, 16 32 appointment of Hearing Panel, 16 education option, 17 – 18 notice to accused member, 15 – 16 n otice of hearing, 17 Execution, 4 Expulsion, 22 – 23 Extrinsic evidence, 12 F Family, patient’s, 8 Fee splitting, 5 Financial arrangements, 29 Fraud, 2 Freedom of choice, of physicians, 3 G Governing body, 4 Government, psychiatrist and, 6 Guardians, 7 H Health Care Quality Improvement Act, 11 Hearing Panels appointment of, 16 basic requirements of, 18 – 19 Chair of, 17, 18 – 19 determination of, 20 district branch decision of, 19 education option, 17 – 18 notice of, 17 request of, 15 written and/or oral statements at close of, 16 Human dignity, 3 Human rights, 3 I Information availability to patients, 8 disclosure of, 6 exchange of, 15 – 18 Informed consent, 7 Insurance companies, releasing information to, 6 J Jurisdiction, 12 – 13 K Klemmer, Herbert, M.D., 1n1 L Labor unions, releasing information to, 6 Law, court ordered treatment, 7 changes to, 5 – 6 redress in local courts, 4 respect of, 2, 5 violations to, 5 – 6 Legislation, Health Care Quality Improvement Act, 11 33 M McDevitt, Robert, M .D., 1n1 Medical care access to, 3 for everyone, 10 Medical code of ethics, 1 dedication to medical care by physician, 2 overview of, 1 Mental health care workers, 8 Mental illness, of psychiatrist, 5 Minors, treatment of, 7 Moore, Robert A., M.D., 1n1 N National Practitioner Data Bank, 22, 23 News media, 7 Notice, 13, 14 to accused member, 15 – 16 of hearing, 17 notification of decision, 25 – 26 O Opinions and Reports of the Council on Ethical and Judicial Affairs of the American Medical Association, 1 P Parents, 7 Patient Attitude of physician toward, 3 behavior of, 4 best interests of, 5 civil rights of, 6 confidentiality, 6 contractual arrangement with psychiatrist, 5 dignity, 7 doctor – patient relationship, 9 exploitation of family of, 8 identification of, 6 information availability, 8 missed appointment, 5 privacy, 2, 6 psychiatrist and, 3 recognition of responsibility by physician, 3 records of, 6 release of information about, 6 request for consultation, 8 respect by physicians , 6 responsibility from physician, 3, 10 sexual activity with physician, 3, 4 welfare of, 5,

35 6 well - being, 3 Peer review, 4
6 well - being, 3 Peer review, 4 Physicians access to medical care for all people, 3, 10 attitude toward patient, 3 behavior of, 3 – 10 citizenship, 6 commitm ent to medical education, 2 conduct of, 4 dedication to medical care, 2, 3 delegation to psychologists, 8 exploitation of patient by, 5 freedom of choice, 3 34 medical code of ethics of, 1 objectivity of, 4 participation in improvement of community and public health, 3 professionalism of, 2, 4 – 5 recognition of responsibility to patient, 3 respect of rights of patients, colleagues, and other health professionals, 2, 6 respect of the law, 2, 5 responsibility to patient , 3 sexual activity with patient, 4 standards of professionalism, 2 Preamble, 2 Preliminary determinations, 13 Principles of medical ethics, 1 with annotations, 3 – 10 Privacy, 2, 6 – 7 Professionalism, 2 of the physician, 4 – 5 Psychiatric News, 22, 23 Psyc hiatric records, 6 Psychiatrists certification of, 9 collaborative role of, 8 competence of, 5 conduct of, 4 conflicts of interest, 10 continuing education of, 8 consultation with colleagues, 8 contractual arrangement with patient, 6 disclosure of patient information, 6 ethics and, 5 expertise of, 9 government and, 9 mental illness of, 5 participation in the community, 9 – 10 personal treatment, 24 practicing outside of professional competence, 5 professional opinion of, 9 public statemen ts of, 9 referral to other professionals, 8 refusal to provide psychiatric treatment, 9 relationships, 10 release of confidential information of patient, 6 separate roles as citizens, 9 suitability to practice, 5 – 6 supervision of other physicians or nonmedical persons, 5 treatment goals, 5 Psychiatry. See also Opinions and Reports of the Council on Ethical and Judicial Affairs of the American Medical Association Public education, 4 Public health, 3 Public media, 9 R Race, 3 Records, patient, 1 Redress, 4 Remand, 27 Reprimand, 21 Research, funded, 7 Review of allegations, 13 – 15 S Sanctions, 21 – 23 35 education requirement, 24 expulsion, 22 – 23 personal treatment, 24 reprimand, 21 supervision, 23 – 24 suspension, 21 – 22 Saunders, John R., M.D., 1n 1 Scientific knowledge, advancement of, 2, 8 Security, 7 Sexual activity between faculty member or supervisor and trainee or student, 7 with patient, 4 Sexual orientation, 3, 7 Social injustices, 5 – 6 Socioeconomic status, 3 Standards of conduct, 2, 3 Students, permission to release information about, 6 Supervision, 23 – 24 Suspension, 21 – 22 T Teacher – student relationship, 7 Testimony, 19 Torture, 9 Treatment and treatment options, 10 V Violations ethical, 21 no