Dr. Darby is Director, UCLA Forensic Psychiatry Fellowship Program, Health Sciences Clinical Assistant Professor, Dr. MacIntyre is Health Sciences Clinical Instructor, and Dr. Weinstock is Health Sciences Clinical Professor of Psychiatry, Department of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine, University of California, Los Angeles, CA.
J Am Acad Psychiatry Law. 2022 Dec;50(4):566-576. doi: 10.29158/JAAPL.210152-21. Epub 2022 Oct 11.
Psychiatrists face complex ethics dilemmas in the COVID-19 pandemic era when assessing dangerousness in patients or forensic evaluees who threaten to purposely infect others or spread the virus. Understanding local public health and medical quarantine laws for their jurisdictions can help guide treating psychiatrists in how to handle some of these situations; however, challenges occur when what is ethically best conflicts with the action that will confer the greatest protection against legal liability. Additionally, the calculus of weighing competing ethics considerations changes based on how relevant it is to the duties of a particular role (e.g., treatment, forensic, research, managed care, etc.) as well as the contextual factors of the situation. We present dialectical principlism as a framework to help psychiatrists resolve such ethics dilemmas related to the COVID-19 and future pandemics, illustrating how it can be applied in different roles (i.e., treatment versus forensic) and situations (i.e., when it is clear the danger of viral transmission is secondary to a delusion versus a delusion-like belief) to come to the best outcome that balances patient welfare, legal considerations, and societal safety. Occasionally, the most ethical action may entail small liability risks.
精神科医生在评估有故意感染他人或传播病毒风险的患者或法医评估对象时，会在新冠疫情时代面临复杂的伦理困境。了解其管辖范围内的当地公共卫生和医疗隔离法律，可以帮助指导治疗精神科医生如何处理这些情况；然而，当道德上的最佳选择与能够最大程度地保护其免受法律责任的行动相冲突时，就会出现挑战。此外，基于特定角色（例如治疗、法医、研究、管理式医疗等）的相关职责以及情况的背景因素，权衡相互竞争的伦理考虑因素的计算方法也会发生变化。我们提出辩证原则论作为一种框架，帮助精神科医生解决与新冠疫情和未来大流行相关的此类伦理困境，并举例说明如何在不同角色（即治疗与法医）和情况下（即当病毒传播的危险明显次于妄想而非类似妄想的信念时）应用它，以达到平衡患者福利、法律考虑和社会安全的最佳结果。偶尔，最符合伦理的行动可能需要承担较小的法律责任风险。
