PS01.03 - Ethical questions in integrating standard therapies and alternative therapies in psychiatry

Abstract

Increasing predominance of evidence-based therapies and standardisation of their clinical application as well as financial limitations narrow the therapists view and leaving out of account the patients` individual specificities and demands. Consequently patients try to get their subjective needs met by alternative approaches, such as self-medication, procedures of unknown quality, consultation of healers outside the medical professions. According to the prevailing ethical principles the following ethical questions will be discussed:

1. • Respect of the patients` dignity and autonomy means to take him/her seriously. However, what are the limits of taking the view of the patient, particularly in cases of a discrepancy between the patients will and his welfare, and especially in cases of incapacity to decide competently on therapeutic alternatives?

2. • Harm avoidance should keep away from the patient unproven approaches with both the risks of unknown unwanted effects and of omission of an efficient treatment. But how to sail safe through the narrowness of Skylla and Charybdis: to convince the patient of the advantages of the proposed quality proven approach without chasing him away out of medical services to unqualified and uncontrolled approaches?

3. • With regard to justice it seems clear that approaches without proven quality should not be paid by insurance companies in order not to reduce the limited resources for the whole of all its members. However, will this be acceptable also in cases in which there are no efficient treatments, but the alternative approach demanded by the patient may improve his quality of life?