A Look at Professional Ethics in the Psychiatry

Professional Ethics Opinion #2 in the righ sibly theints as Prisoners can give informed consent freely depending on the imprisonment they are serving. If they are imprisoned in a psychiatric facility, then they should not be able to give informed consent because they are not in the right mind to give the consent. However, if they were imprisoned criminally, which I will assume, then possibly they would be in the right mind to make this kind of judgment. Looking at the fact that they have no rights as citizens and have been confined, it may be possible for them not to.

For this discussion, I will assume they are in the right mind. Dictionary.com defines informed consent as “Consent by a patient to a surgical or medical procedure or participation in a clinical study after achieving an understanding of the relevant medical facts and the risks involved.” According to the text, informed consent originates from the legal and ethical right the patient has to direct what happens to her body and from the ethical duty of the physician to involve the patient in her health care.

The most important goal of informed consent is that the patient has an opportunity to be an informed participant in his health care decisions. It is generally accepted that complete informed consent includes a discussion of the following elements:

1. the nature of the decision/procedure
2. reasonable alternatives to the proposed intervention
3. the relevant risks, benefits, and uncertainties related to each alternative
4. assessment of patient understanding
5. the acceptance of the intervention by the patient

In order for the patient’s consent to be valid, he must be considered competent to make the decision at hand and his consent must be voluntary.

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It is easy for coercive situations to arise in medicine. Patients often feel powerless and vulnerable. To encourage the patient to volunteer, the physician can make clear that he is participating in a decision, not merely signing a form. With this understanding, the informed consent process should be seen as an invitation to him to participate in his health care decisions. The physician is also generally obligated to provide a recommendation and share her reasoning process with the patient. Comprehension on the part of the patient is equally as important as the information provided. This is where it may become difficult to a psychiatric patient.

Consequently, the discussion should be carried on in layperson’s terms and the patient’s understanding should be assessed along the way. Basic consent entails letting the patient know what you would like to do and asking them if that will be all right. Basic consent is appropriate, for example, when drawing blood. Decisions that merit this sort of basic informed consent process require a low-level of patient involvement because there is a high-level of community consensus. The opposite side of the spectrum says that because of this person being denied rights based on their imprisonment, then they shouldn’t be allowed to make this kind of decision. I think that when rights are denied in this manner, it does not apply to information.

All people have the right to be informed. If this prisoner wants to subject himself to medical experimentation after knowing the risks, then so be it. It is not going to change the fact that he is being punished. For this person it would probably be something to do to pass time while rotting away in prison. We certainly shouldn’t deny them that. There was a case study done on this matter. In 1971, Philip Zimbardo conducted an experiment for the U.S. House of Representatives Committee on the Judiciary (Hearings on Prison Reform) on whether innate dispositions or situational factors influence prison behavior. He constructed a “prison” in the basement of the Stanford psychology building and chose a group of “decent, intelligent” college men as his subject group. Their roles as either “prisoners” or “guards” were decided by the toss of a coin. The “guards” were given uniforms, Billy clubs and whistles while the “prisoners” were made to wear humiliating outfits resembling hospital gowns. This experiment was to be two weeks long, 24 hours a day, 7 days a week.

Within a single day the “guards” developed degrading routines in which they forcefully made the “prisoners” carry out. Reality and illusion began to blur, as the majority “were no longer able to differentiate between role-playing and self.” (Zimbardo, 1971) Some “prisoners” broke down, others rebelled and still others became apathetic and resigned to their fate. Some “guards” became increasingly brutal and cruel, taking pleasure in the power of their positions. The experiment had to be stopped after just 6 days because of the increasing brutality displayed by some of the “guards”. The six days the experiment ran produced dramatic changes in virtually every aspect of behavior, thinking and feeling. Being an ethical researcher, Zimbardo made all but the most brutal “guards” participate in encounter groups to confront issues the experiment created. This experiment was not meant to be a recreation of what happens in an actual prison. Rather it was meant to show that roles that were artificially created could evolve into those that were real.

Although informed consent is a must for any reputable psychological experiment, too much information can skew any effect the experiment might create. This experiment was predicated upon the artificial removal of the prisoners consent. The subjects were not given “safe words” and after the initial agreement to participate in the experiment they were unable to easily withdraw their consent. They were not fully aware of the implications of life in “prison” and therefore they could not truly give informed consent. Obviously, a major distinction between Zimbardo’s artificially created prison and real life scheming is that we consciously choose our roles. Because we start from the foundation of communication and consensually we define limits.

The clothes we wear, the flags we show, and the behaviors we exhibit can all define our roles externally. Internally, our roles are defined by the power exchange we are willing to accept. Additionally, unlike Zimbardo’s subjects we are drawn to our roles and choose them as our own. Most of us experience a prison journey in our lives. It brings us through the fires of selfdiscovery into a realm of intense awareness and spirituality. We are being defined by our roles at the same time we are defining the roles we choose. It is an intellectual as well as an emotional process that allows us to fully explore the nuances of our chosen role. Due to the intellectual exploration of our role, we are able to more fully integrate our tendencies into our personality, thereby circumventing the cognitive dissonance the experiment subjects experienced.