Academic journal article Indian Journal of Psychiatry

Ethics in Psychosocial Interventions

Academic journal article Indian Journal of Psychiatry

Ethics in Psychosocial Interventions

Article excerpt

Byline: Sunita. Kurpad

It is important for health professionals to have an ethical framework to help take decisions regarding psychosocial interventions in patients with addictive disorders. As patients with addictive disorders are vulnerable to unethical actions in the name of treatment, therapists need to aware of their role in delivering ethical care - not just in their own clinical practice but in the setting in which they deliver the interventions. This article aims to sensitize the health professional to the various arenas in which ethical challenges may arise.

Introduction

Ethical challenges arise when a health care intervention intended to help a patient is also associated with a possible negative fallout. This makes it important for health care professionals to have some kind of a framework to help balance the advantages versus disadvantages of an action, (or not taking an action), to enable ethical decision making. This article will focus on ethical issues in psychosocial interventions in addictive disorders. While some of these issues pertain to health care interventions in general- there are some ethical issues of particular relevance in interventions in addictive disorders- whether it is substance use- licit (like alcohol) or illicit (like cannabis) substance use or behavioural addictions (like gambling disorder).

Terminology

As this supplement is intended for health professionals from varied backgrounds, the term therapist will be used to denote the health professional. The term patient will be used, rather than client, as that better captures the nuances of the fiduciary nature of the therapist patient relationship (one in which the patient places trust in the therapist), and the intrinsic power imbalance in this relationship. And while addictions occur in all genders, for ease of reference 'he' will be used to denote the patient. Along the same line, the therapist will be denoted as 'she'.

Fundamental principles of medical ethics

The four principles which have been the bedrock of ethical decision making are listed below.[1]

1. Non maleficence- do no harm

While therapists may be alert to the risks or side effects of pharmacological interventions, it may be hard to imagine that psychosocial interventions could harm. An example of this would be if an untrained therapist tries to deal with domestic violence in a person with alcohol use. It needs training and great sensitivity to deal with this issue safely- while protecting the spouse from further violence, addressing the violence and attempting to change the behavior and attending to legal aspects.

2. Beneficence- to do good

Patients and family members are generally very vulnerable when they access help- especially if they do so in a crisis situation or after getting into legal problems. Any psychosocial intervention should be 'evidence based'. A well trained therapist should be able to evaluate whether things are truly on track and the patient truly benefiting from the intervention. Objective evidence of better socio occupational functioning is a useful outcome measure. For example, in students an improvement in attendance would be a useful indirect marker.

3. Autonomy

The patient has a right to decide whether or not they will engage in a particular form of intervention, and when they want to stop. While one of greatest strengths in our culture is the role and support of family members, it should not mean that family members can override patient autonomy. Respecting the patient's autonomy is not just important from a human rights view, but from the reality that unless the patient truly wants to change behavior/stop or reduce use of substance- no psychosocial intervention can work.

4. Justice

Patients with addictive behaviour especially in certain settings like prison are vulnerable to abuse. If as a therapist one gets to know that this is happening, it would be important to counsel the patient on their right to make a complaint and facilitate additional support or legal help. …

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