Economical framework of psychiatric care

TY - CHAP

T1 - Economical framework of psychiatric care

AU - van der Feltz-Cornelis, C.M.

N1 - Pagination: 781

PY - 2025/3/20

Y1 - 2025/3/20

N2 - In medicine, autonomy of the patient, beneficence of the physician, non-maleficence of the physician and justice are four leading ethical principles and several Medical Associations as well as Psychiatric Associations published a Code of Ethics in which the physician–patient relationship is considered to be at the heart of medical and psychiatric practice. In the economical framework, the principle of equity is paramount for ethical choices. Increased mortality and mental health morbidity as the consequence of the COVID-19 pandemic, and the availability of vaccination programs, l have medical and societal consequences. If ethical decisions would be taken that would inevitably result in an impossibility to sustain the resulting medical treatment because of lack of economic means, this would result in non-ethical injustice in the division of means. Therefore, viability and economic sustainability have ethical implications in themselves. However, ethical decisions should also be based primarily upon sound moral values and their acceptability in a given cultural context. The four models of access to mental health care, the gatekeeper model, the service model, the community-based mental health service, and the managed care model, all pose specific ethical challenges, especially the managed care model, as it intrudes upon the patient–doctor relationship and equity of division of means. Moral and economical implications of managed care and of the influence of pharmaceutical companies and governmental policies are described and possible solutions on micro-, meso- and macrolevel suggested.

AB - In medicine, autonomy of the patient, beneficence of the physician, non-maleficence of the physician and justice are four leading ethical principles and several Medical Associations as well as Psychiatric Associations published a Code of Ethics in which the physician–patient relationship is considered to be at the heart of medical and psychiatric practice. In the economical framework, the principle of equity is paramount for ethical choices. Increased mortality and mental health morbidity as the consequence of the COVID-19 pandemic, and the availability of vaccination programs, l have medical and societal consequences. If ethical decisions would be taken that would inevitably result in an impossibility to sustain the resulting medical treatment because of lack of economic means, this would result in non-ethical injustice in the division of means. Therefore, viability and economic sustainability have ethical implications in themselves. However, ethical decisions should also be based primarily upon sound moral values and their acceptability in a given cultural context. The four models of access to mental health care, the gatekeeper model, the service model, the community-based mental health service, and the managed care model, all pose specific ethical challenges, especially the managed care model, as it intrudes upon the patient–doctor relationship and equity of division of means. Moral and economical implications of managed care and of the influence of pharmaceutical companies and governmental policies are described and possible solutions on micro-, meso- and macrolevel suggested.

U2 - 10.1007/978-94-024-2274-0_10

DO - 10.1007/978-94-024-2274-0_10

M3 - Chapter

SN - 978-94-024-2273-3

SN - 978-94-024-2276-4

T3 - The International Library of Bioethics

SP - 149

EP - 172

BT - Ethics in psychiatry

A2 - Helmchen, Hanfried

A2 - Sartorius, Norman

A2 - Gather, Jakov

PB - Springer, Dordrecht

CY - Dordrecht

ER -