Posted by Toby on March 23, 1999, at 15:39:44
In reply to Re: Medical Records, posted by Elizabeth on March 20, 1999, at 11:41:29
Paternalism and ethics are not mutually exclusive concepts. Paternalism is defined as doing something for someone's benefit without that person's consent. This is the concept that governs guardianship, parenting, and involuntary commitments. Ethics involves a set of principles guiding a person in deciding what is right or wrong. While everything a physician does should be governed by ethics, not every decision is paternalistic; hence the informed consent idea. There have been examples of unethical paternalism such as the involuntary sterilization of mentally retarded persons back in the 50's and currently there is the great debate about euthanasia and Dr. Kervorkian's actions. With regard to allowing a patient free and unsupervised access to their psychiatric record, there is obviously a paternalistic aspect since the therapist is presumed to have knowledge that the patient may be incapable of understanding or, in the therapist's judgement, may be better off not knowing, but as Dr. Bob said, ethics would dictate that if the record is opened to the patient, the therapist should be present to discuss those issues with the patient. The previous statement may offend many who read it here, since most folks who can operate the internet are fairly well educated and believe that they know just as much as any therapist or psychiatrist when it comes to their own mental illness. However, if that were true, there would be no need for anyone here to be seeing a therapist or psychiatrist, much less dialoging here about various forms of treatment experiences. On the other hand, many folks understand the need for experts, but want to be privy to all the juicy details that the therapist may write down. IMHO that is tantamount to gossip about yourself; it's like wanting to read true-crime best sellers where the experts' reports are laid out for all to see about how some killer became that way; it's like wanting to see all the fluids and fat from your liposuction (i.e., you don't need to see it to know that it's gone). When you are reading about "Sybyl," it's fascinating to see what the psychiatrist thought about her behaviour and how dysfunctional it was; when it's about you, it isn't the same, no matter how intelligent you are, no matter how mentally healthy you've become, no matter how technically unemotional the report is. At any rate, I've rambled, but my point is that psychiatrists do many things that patients do not understand and may not like; that's the nature of the treatment of the mind but that does not make those actions unethical or unreasonable.
poster:Toby
thread:3230
URL: http://www.dr-bob.org/babble/19990401/msgs/3923.html