Rebecca Weintraub Brendel, MD, JD, Editor
Michelle Hume, MD, PhD, Editor
This issue of Psychiatric Clinics of North America was conceived in May of 2019 at the gracious invitation of the series editor, Harsh K. Trivedi, MD, MBA, to whom we are indebted. Amid the collegiality, learning, and intellectual fervor of the American Psychiatric Association (APA) Annual Meeting that year in San Francisco, and in the ensuing months, many of our colleagues on the APA Ethics Committee were delighted to come along on this journey with us by contributing to this exploration of the evolution of psychiatric ethics. When the two of us sat down together, in person, in February of 2020 at the American College of Psychiatrists meeting and finalized the submission invitations and timeline, little did we know that the world as we knew it was about to be upended by the COVID-19 pandemic.
We are indebted to the editorial and production staff at Elsevier for working with us to bring this project to completion amid the substantial disruptions and delays occasioned by the global pandemic. Yet as we reckon with the changes and challenges posed by the pandemic and bring this issue to publication, we have also observed that many of the submissions—conceived prepandemic—have captured essential elements of psychiatric ethics to lead us into the future as we begin to forge the contours of our postpandemic profession.
This issue engages head-on the many ethical challenges ahead for our profession. As psychiatrists and other physicians are increasingly employed by institutions and health care delivery becomes increasingly complex, this ethics compilation begins by interrogating the competing obligations that arise for psychiatrists working in systems of care—often between responsibilities to patients and expectations of institutions. The articles in this issue entitled “Ethical Considerations in Trauma-Informed Care” and “Ethical Challenges in Considerations of Cultural Practices and Traditions: Autonomy and Multiculturalism” squarely return us to the care of the patient with a focus on patient well-being, the patient experience of care, trauma-informed care, and considerations of culture and lived experience.
The exploration continues with an unpacking of challenges in psychiatric research, critical to generating knowledge and treatment of mental illness. It next reviews an empirical study of organizational ethics, asking how psychiatry self-regulates in addressing departures from professional norms of ethics and practice. Taken together, these two topics lead us to ask critical questions about our responsibility for generating ethically conducted and scientifically sound research to guide progress in psychiatry in an age of increasing public skepticism about science and about how our profession can meet its responsibility for self-regulation and integrity.
The next seven articles focus attention on emerging ethical challenges across a broad range of psychiatric subspecialty areas and practice. These contributions specifically interrogate ethical challenges in forensic psychiatry, addiction psychiatry, consultation-liaison psychiatry, eating disorders, child and adolescent psychiatry, psychiatric emergencies, and geriatric psychiatry. The careful analysis and wisdom of these articles assure us that, as the cumulative stress, loss, and uncertainty of the COVID-19 pandemic is becoming more fully apparent in our collective psyche, our ethics can help lead the way in addressing the many challenges before us.
Finally, as we bring this project to press, we thank our colleagues for authoring their important contributions to this issue and for their industriousness and commitment to the success of this project amid countless competing obligations of substantial urgency over the past 18 months. We are confident that your work will support countless psychiatrists in never having to worry alone when the inevitable ethical dilemmas arise.