Ethical dilemmas in administering mental health services

Abstract

The ethical perspective on mental health service delivery is receiving fresh attention because of major changes in the structure, technology, and values associated with this enterprise. Complex decisions confront those involved in patient care, and this paper has described elements of the framework within which ethical dilemmas are appraised by clinician-executives. The personal, professional, and social values affecting program directors were considered, and possible approaches to conflict resolution highlighted. While this analysis focused on conflicts arisingwithin competing personal, professional, or social beliefs, frictions arisebetween these value systems as well. Clinician-executives frequently must determine whether personal, professional, or social values are most pertinent in resolving dilemmas. For example, the need for patient advocacy has been debated by administrators, clinicians, and others. Opinions differ widely, however, as to whether this patient need is best addressed as a professional value, i.e., through the ethical code of a discipline, or as a social value, i.e., through national or state legislation. This type of controversy will continue in the future—and necessarily so since the manner in which value dilemmas are resolved has profound implications for the quality of patient care.