S-1995-02-1995_OVE

L’ASSOClAnON MIDICALE MONDIALE, INC ASOCIACION MEDICA MUNDlAL, INC
Telephone: 50 40 75 75
Fax: 50 40 S9 37
THE WORLD MEDICAL ASSOCIATION, INC.
B. P. 63 • 01212 FERNEY-VOLTAIRE Cede., France
28, avenue des Alpes – 01210 FERNEY-VOLTAIRE, France
Cable Address:
WOMEDAS, ferney-Voltaire
September 1995
WORLD MEDICAL ASSOCIATION STATEMENT
.QD.
ETHICAL ISSUES CONCERNING PATIENTS WITH
MENTAL ILLNESS
Adopted by the 47th General Assembly
Bali, Indonesia, September 1995
PREAMBLE
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Original: English
Historically, society has regarded patients with mental illness as a threat to those
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Historically, society has regarded patients with mental illness as a threat to those
around them rather than a sick person in need of support and care. Therefore, in the
absence of efficient treatment many patients with mental illness were confined to
asylums for all or part of their lives. The aim of such treatment in these cases was to
prevent self-destructive behaviour and aggressive behaviour toward others.
At the present time, progress in psychiatric therapy allows better careotpatients with
mental illness. Efficiemtdrugs and other treatments are capable of curing mild cases
and bringing about long remissions for patients whose conditions are more serious.
Patients with mental illness should be viewed, treated and have the same access to
care as any other patient.
The psychiatrist is a physician with the same obligations towards his/her patient as
any other specialist
Thus, the role, sometimes imposed upon the psychiatrist, as society’s agent, should
not be allowed to undermine or erode their primary role as healers.
ETHICAL PRINCIPLES
1. The WMA believes that the discrimination associated with psychiatry and the
mentally ill should be eradicated. This stigma often discourages people in need
from seeking psychiatric help, therefore aggravating their situation.
2. The psychiatrist aspires for a therapeutic relationship founded on mutual trust
He/she should inform the patient of the nature of the condition, therapeutic
procedures (inclUding possible alternatives and the risk of each)t and the
expected outcome.
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The condition of a patient with mental illness incapable of exercizing hlslher
autonomy does not differ from that of any other legally incompetent patient.
He/she should be treated like any other patient who is temporarily or
permanently incompetent. A patient with mental illness, including psychosis,
should not automatically be considered to be legally incompetent. Hls/her
judgement should be respected in areas where he/she is capable of making
decisions. If the patient lacks the capacity to make a decision as to hlslher
medical care, surrogate consent should be sought from an authorized
representative In accordancewith applicable law.
3. Involuntary treatments should be used In the treatment of a patient with mental
illness only when he/she is in an acute state and may pose a threat to
himself/herself or others. Physicians should consider compulsory hospitalization
to be exceptional and, therefore, should utilize it only when and as long it is
medically necessary.
4. Every psychiatrist should offer to the patient the best available therapy to hlslher
knowledge, and should treat him/her with the solicitude and respect due the
dignity of all human beings. The psychiatrist practicing in an institution, the _
military, or prison, can be faced with a conflict between hislher responsibilities to …
society and his/her obligation to the patient. Hlslher primary loyalty must be to
the patient. When the psychiatrist is reqUired to act as an agent for society
instead of in the patient’s best interest, the patient should be made aware of the
conflict so that he/she does not feel betrayed by or blame the doctor for
measures mandated by legal authorities.
5. The confidentiality and privacy of aU patients should be safegUarded. VVhen
required by law, the psychiatrist should disclose only the relevant material and
only to the relevant authority. Data banks which allow automatic transfer of
information from one authority to another may be used provided that medicai
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information from one authority to another may be used provided that medical
confidentiality is respected.
6. A psychiatrist must never use his/her professional position to violate the dignity
or human rights of any individual or group and should never allow hislher
personal desires, needs, feelings, prejudices or beliefs to interfere with the
treatment. Nor should a psychiatrist take advantage of hislher professional
position or the vulnerability of a patient to abuse his/her authority, such as by
using a patient’s labor for personal purposes or by having sexual relations with a …
patient. …
RECOMMENDATION
National Medical Associations should publicize this Statement and use it as a
basis for affirming the ethical foundations of psychiatric practice•
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