Ethical dilemmas in contemporary psychiatry: findings from a survey of national psychiatric associations in Europe

Background: The European Psychiatric Association (EPA) is an organization that speaks on behalf of its individual members and members of European National Psychiatric Associations (NPAs). The present study originates from the ongoing EPA contribution to the development of ethical codes and regulations in psychiatry. The aims of this study to identify and investigate current contents of ethical codes and practices in the countries of the European Union and beyond can serve as a starting point to a prospective international discussion on a joint ethical approach in mental health services. Methods: The study is an expert survey sent out to 44 representatives of 30 European NPAs covering the following topics: the existence of national bodies dealing with ethical issues in psychiatry, the availability of documents relevant to ethical issues, the types of ethical issues addressed at the national level, and the current and envisaged ethical debates. The experts were also questioned if they were keen to contribute their national documents relevant to ethical issues to create an EPA-supported database. Results: Out of 44 experts invited to participate in the study, 31 NPAs from 30 countries responded (response rate 70.45%). In the majority of countries, the general mission statement serves as the main document covering ethical issues in psychiatry. The governmental bodies on medical ethics were reported to exist in 27 countries. In 25 countries, psychiatry is represented in these bodies by contracting an external expert or the NPA member. Most frequently, internal documents were reported to address medical malpractice, workplace bullying, plagiarism, academic fraud, sexual abuse, and discrimination/racism. Furthermore, internal documents cover the ethical assessment of potentially controversial procedures, including psychosurgery, euthanasia, and pregnancy termination. The most important topics for debate at the level of NPAs/EPA were associated with violations of clinical practice standards and human rights. Conclusions: NPAs are active in the field of professional ethics, defining ethical standards related to interactions among professionals and services provided by mental health care professionals. Future collaboration of NPAs, under the umbrella of the EPA, could allow to develop a database of local ethical documents that would be translated into English and accessible to all EPA members. Prospective steps should include further international debates resulting in standardisation of practices across Europe and joint resolutions for emerging ethical dilemmas in psychiatry. © 2023 Elsevier Masson SAS. All rights reserved