22 - Ethical issues in research and treatment of patients with mood disorders

Summary

Introduction

Patients with mood disorders pose ethical challenges for both the clinicians who treat them and the researchers who study them. Although many of those challenges are similar to those posed by other patients with mental illnesses, there are characteristics of mood disorders that present unique problems for issues of informed consent, competence, treatment plan adherence, and so on. Mood disorders may weaken a patient's capacity to make autonomous, informed decisions, and so impose a special moral duty on those who care for them or who involve them in research.

The field of bioethics has achieved consensus about the centrality of a few basic ethical principles and values which have been articulated by physicians, professional organizations, legislatures, and the courts over the last 40 years. Respect for the self determination and dignity of all patients, the need for free, uncoerced informed consent, the importance of patient confidentiality, the right to treatment, truthfulness in all dealings with patients and their families, and equity in the selection of research subjects and the distribution of any risk associated with research form the modern foundations of clinical and research ethics. While these values and principles apply to all patient populations, they have special implications in psychiatric populations.

Clinical issues

Patients with mood disorders present special ethical problems for the clinician. Depressed patients are often indecisive or resistant to treatment, which raises the dilemma of when to consider such resistance a reasonable refusal of consent and when the resistance is a product of the illness itself.