Clinical assistant professor of psychiatry at Case Western Reserve University in Cleveland.
AMA J Ethics. 2023 Sep 1;25(9):E710-717. doi: 10.1001/amajethics.2023.710.
The nature and scope of palliative psychiatry and associated ethical implications are debated in the literature. This article examines conceptual limitations of extant accounts of palliative psychiatry, with a focus on psychopharmacological practice, and suggests that modifiable and unmodifiable psychiatric illnesses exist on a spectrum along which broader or narrower palliative psychiatric care approaches can be outlined. The article also discusses how these approaches intersect with questions about whether and to what extent psychiatric medications have symptom-reducing or disease-modifying effects. The discussion leads to the conclusion that clinicians are ethically obliged to distinguish among and clearly formulate goals of care in a dynamic and ongoing process of shared decision making with patients.
姑息精神病学的性质和范围及其相关的伦理含义在文献中存在争议。本文探讨了现有姑息精神病学理论的概念局限性，重点是精神药理学实践，并认为可改变和不可改变的精神疾病沿着一个范围存在，在这个范围内可以概述更广泛或更狭义的姑息精神病学治疗方法。本文还讨论了这些方法如何与关于精神药物是否以及在何种程度上具有减轻症状或改变疾病的问题相交织。讨论的结论是，临床医生在与患者进行的动态和持续的共同决策过程中，有道德义务区分和明确制定护理目标。
