Ratner Richard A
Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine, 5028 Wisconsin Avenue NW, Washington, DC 20037, USA.
Child Adolesc Psychiatr Clin N Am. 2002 Oct;11(4):887-904, ix. doi: 10.1016/s1056-4993(02)00023-8.
Ethical concerns are ever present in the practice of all branches of psychiatry. They are likely to be more acute and commonplace in the practice of child and adolescent psychiatry because of the complication introduced by the immaturity of the patient. Children, depending on their age and developmental stage, may be incapable of giving meaningful consent, and situations in which breaking confidentiality must be considered arise more often. The field of forensic psychiatry is fundamentally different from clinical psychiatry because of the universal involvement of third parties and because interactions with evaluees do not occur within the context of a doctor patient relationship. Arguably, these conditions compel the forensic psychiatrist to function as a double agent. According to Appelbaum, an influential psychiatric ethicist, forensic practice calls for a different set of ethical guidelines that, while humane, do not either imply or derive from the existence of a doctor patient relationship. Others argue that a mix of forensic and clinical ethics is more appropriate. New developments in psychiatry, including the use of the Internet for E-mail and telepsychiatry, require continuing vigilance by the profession so that ethical standards can evolve to cover new circumstances at the frontiers of psychiatric practice.
伦理问题在精神病学各分支的实践中一直存在。由于患者不成熟所带来的复杂性，这些问题在儿童和青少年精神病学实践中可能更为尖锐和常见。根据年龄和发育阶段的不同，儿童可能无法给出有意义的同意，而且必须考虑打破保密原则的情况更经常出现。法医精神病学领域与临床精神病学有着根本的不同，因为普遍涉及第三方，并且与被评估者的互动并非发生在医患关系的背景下。可以说，这些情况迫使法医精神病医生扮演双重角色。有影响力的精神病学伦理学家阿佩尔鲍姆认为，法医实践需要一套不同的伦理准则，这些准则虽然人道，但并不意味着存在医患关系，也不是从医患关系中衍生出来的。其他人则认为，混合使用法医伦理和临床伦理更为合适。精神病学的新发展，包括使用互联网进行电子邮件和远程精神病学服务，要求该行业持续保持警惕，以便伦理标准能够不断演变，以涵盖精神病学实践前沿的新情况。
