Making a situational diagnosis. Psychiatrists at the interface of psychiatry and ethics in the consultation-liaison setting.

Psychiatrists bring a unique understanding to clinical ethics, but psychiatrists need a precise awareness of the difference between exercising their clinical expertise and facilitating ethical decisionmaking. The author outlines a schema for recognizing and honoring that distinction and illustrates "pseudoethics," "pseudopsychiatry," and "psychiatry/ethics" consultations. The author describes how to make a "situational diagnosis" that includes patient/family issues, staff issues, joint issues, legal/regulatory issues, and ethical issues, thus enabling the psychiatrist to institute an appropriate "hierarchy of interventions": educational, psychological, and ethical. The literature on ethics education for psychiatric practitioners is reviewed and a program is suggested.