Global Health Center, Icahn School of Medicine at Mount Sinai, New York, NY.
Dartmouth Hitchcock Medical Center, Lebanon, NH.
Ann Glob Health. 2014 Mar-Apr;80(2):146-51. doi: 10.1016/j.aogh.2014.04.002.
Existing literature addresses the ethical considerations of global health work and how medical school curricula can help prepare students for them, but little has been written regarding an ethical approach to global psychiatry. In this paper we summarize prominent ethical issues that arise in global health psychiatry in order to provide a foundation for a framework in global health psychiatry. These issues include obtaining informed consent in the face of language barriers, diagnosing and treating for mental illnesses while navigating communities where such conditions are heavily stigmatized, and justifying the cessation of proving care to current patients for the sake of providing care to new patients abroad. To help prepare psychiatrists and students for work that engages these issues, we propose a multi-step process to assist the practicing global psychiatrist in recognizing ethical dilemmas and evaluating potential courses of action based on their respective ethical merits.
现有文献探讨了全球健康工作的伦理考量以及医学院课程如何帮助学生为此做好准备,但关于全球精神病学的伦理方法却鲜有论述。本文总结了全球精神卫生工作中出现的突出伦理问题,为全球精神卫生工作框架奠定基础。这些问题包括在语言障碍的情况下获取知情同意、在精神疾病的诊断和治疗中,在面对此类疾病被严重污名化的社区时进行导航,以及为了向国外的新患者提供护理而停止为现有患者提供护理的合理性。为了帮助精神科医生和学生为解决这些问题做好准备,我们提出了一个多步骤的流程,以协助实践中的全球精神科医生识别伦理困境,并根据各自的伦理价值评估潜在的行动方案。