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This chapter is by no means exhaustive. The goal here is to provide a framework where ethical principles can be called upon to help deliver the best possible care for patients that are commonly seen by psychiatrists in the emergency room setting, an environment where it can be especially challenging to deliver ethical care to difficult patients.

A grasp of the salient ethical principles discussed in this chapter is meant to provide a foundation for the consulting psychiatrist to help navigate the tensions between competing ethical principles, and to readily be aware of ethical issues as they come up. Knowing what questions to ask oneself is a key first step in understanding how one’s personal values or strongly held beliefs, if not examined consciously, can impact and sometimes impede appropriate ethical clinical decisions made on behalf of patients whose values may differ from our own.


Allen, R S, and J L Jr. Shuster. 2002. The role of proxies in treatment decisions:evaluating functional capacity to consent to end-of-life treatments within a family context. Behavioral Sciences and the Law 20 (3): 235-252.

Appelbaum, P. 1988. The new preventative detention: psychiatry’s problematic responsibility for the conrol of violence. American Journal of Psychiatry 7 (145): 799-785.

Pellegrino, E D. 1994. Patient and physician autonomy: Conflicting rights and obligations in the physician- patient relationship. Journal of Contemporary Health Law and Policy 10: 47-68.

Reznek, L. 1991. The Philosophical Defense of Psychiatry. New York: Routledge.

Shuman, A G, and A R Barnosky. 2011. Exploring the limits of autonomy. Journal of Emergency Medicine 40 (2): 229-232. doi:10.1016/j.jemermed.2009.02.029.


Appelbaum, P S, and T Grisso. 1988. Assessing patient’s capacities to consent to treatment. The New England Journal of Medicine 319: 1635-1638. doi:10.1056/NEJM198812223192504.

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