Saturday, August 31, 2013

Ethics for a blurred image of God

LIKELY with the Greek ideal mens sana in corpore sano in mind, St. Augustine must have been moved to aver: “The mind is the image of God, in that it is capable of Him and can be partaker of Him.”
Reality fled far away from the ideal, current events scream of a craven mind: one that loots taxpayers over P10 billion in “pork barrel” monies with august lawmakers as accomplices may have defiled more than a godly image.
Such a case runs roughshod over the principles of medical ethics that psychiatrists are urged, coaxed to live by.
Says psychiatrist Dr. Pureza Trinidad-Oñate in her address to peers at a plenary session of the Philippine Psychiatric Association’s midyear convention: “Principles of medical ethics are not laws, but standards of conduct which define the essentials of honorable behavior for the psychiatrist.”
Indeed, “ethical concerns about the psychiatrist’s role and functions have dogged the profession for at least three centuries,” she cites.
For 300 years, give or take a decade, the bedrock on which such ethos of the profession stands has always been trust—even in these times where betrayal of public trust has seemingly become the norm.
Trust: a term of Nordic roots that connotes a healer’s role and functions—“confidence, help, comfort and consolation.”
Trust remains at the core of physician-patient relationship that is hinged on, among others, “respect, beneficence, autonomy, honesty, confidentiality, and fidelity,” she notes and adds, “competent care of the patient is the cornerstone of ethical psychiatric practice and is the primary basis of patient trust.
“Professional competence is the ability to apply the accepted standards of clinical practice to patient care. It is an absolute requirement of psychiatric practice,” she points out.
However, “the nature and specific obligations of  (such relationship) can vary because of a patient’s age or cognitive capacity.”
Psychiatric care, Dr. Oñate points out, entails more than professional competence. It also involves:
  • Confidentiality- the obligation not to reveal a patient’s personal information without his/her explicit permission;
  • Honesty and trust- the ‘positive’ duty to tell the truth and ‘negative’ duty not to lie or mislead;
  • Non-participation in fraud
  • Informed consent- or an accurate description of the proposed treatment, including risks, benefits and alternatives; however, genuine emergencies do not require informed consent
  • Decision-making capacity- the patient’s free choice in making a decision conjoined with the psychiatrist’s skills in identifying vulnerabilities and cognitive strengths of the ill;
  • Involuntary treatment- is where the state uses its power as parent (parens patriae) to limit the ill individual’s freedoms to strike a balance between the individual and community weal; and
  • Therapeutic boundary keeping: “A physician will scrupulously avoid using the physician-patient relationship to gratify his own emotional, financial and sexual needs.”
She hurls a cogent question: “Is the doctor’s primary responsibility always to the patient or can serving a broader community good override it?”
Mental illness causes disability for prolonged periods that affect both the individual and his community milieu. In a 2000 National Statistics Office survey, it was found that there were 88 cases of mental illness for every 100,000 people. Too, the survey showed that mental illness “is the third most common form of disability after visual and hearing impairments,” she cites.
Southern Tagalog comprising the Cavite-Laguna-Batangas-Rizal-Quezon (Calabarzon) emerged with the highest prevalence rate of mental illness with 133 cases for every 100,000 people. Metro Manila was a close second at 130.8 cases per 100,00 population while Central Luzon ranked third at 88.2 per 100,000 people, she notes.
A Department of Health-commissioned Social Weather Stations survey in June 2004 found that 0.7 percent of Philippine households has a family member with mental disability.
So sad how the reality of living in these tough times has worn away “the mind (as) the image of God.”

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