Ethics Consultation Masking Psychiatric Issues in Medicine

PHYSICIANSoften have turned to psychiatric consultants for "help and guidance with morally troublesome cases," in which the consultant may be "expected to fill a mediating role, often... to persuade the patient or family to act in a certain way." The result may be that the "psychiatric consultation mask[s the] moral dilemmas" so that the ethical dimensions of the case are overlooked by both the primary physician and the psychiatrist.¹ In the last decade, ethics consultation programs in hospitals have proliferated.²The Joint Commission on Accreditation of Health Care Organizations now requires that accredited hospitals in the United States have "a functioning process to address ethical issues."³ Perhaps for these reasons there is now a tendency for ethics consultations to mask psychiatric questions. Three examples will illustrate this problem. All three cases arose within a single week at a single institution, a tertiary care teaching hospital in