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2022 Ethics Panel recap for NCPS newsletter

Cynthia He, MD, PhD and J. Connor Barnhart,

MD

This year's Ethics Panel focused on the theme of Dual Loyalty
and Moral Distress, with case vignettes covering multiple psychiatric practice
settings. We began by reviewing the definition of dual loyalty, i.e., certain situations in which a psychia-
trist experiences role conflicts due to competing obligations to a patient and institution. This may be a
public institution, such as a government agency, judicial system, or correctional system; or a private in-
stitution, such as a health system or employer. We then reviewed key historical changes during the past
60 years, including deinstitutionalization, transinstitutionalization, and evolution in civil commitment
statutes. These changes, along with structural racism and socioeconomic disparities, have led to defi-
ciencies in our mental health system that contribute to the sense of moral distress experienced by psy-
chiatrists working within imperfect systems of care.
Our panelists then presented six cases that illustrated dual loyalty conflict as it can arise in the correc-
tional, inpatient/acute, and outpatient settings. Dr. Tianyi Zhang, UCSF Forensic Psychiatry fellow, de-
scribed ethical issues associated with performing mental health evaluations for gender-affirming surgery
in the prison environment. Dr. Raymond Reyes, NCPS Ethics Committee member and experienced prison
psychiatrist, recounted his experience treating a patient who had been misdiagnosed before being trans-
ferred to his care. Dr. Isaac Johnson, UCSF PGY-2 Resident, described our inability to address in the acute
(emergency room) setting the root causes of a patient’s presentation. Dr. Cynthia He, UCSF PGY-3 Resi-
dent and NCPS Council Co-Representative, described an inpatient case illustrating the variability in how

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Claim your CME Credits before May 17, 2022

The APA designates this live activity for a maximum of 11 AMA PRA Category 1 Credit™. Physicians
should claim only the credit commensurate with the extent of their participation in the activity.

PHYSICIAN CME CERTIFICATES
At the conclusion of the conference, physician participants will be provided with an opportunity to claim
hours of participation and receive an official CME certificate by completing the online CME conference
evaluation.
1. Go to https://education.psychiatry.org/diweb/redeem
2. Log in with your APA username and password or create a new account
3. Enter the Access code: B61E5611DD and click "Redeem"
4. Click "Access". The activity evaluation will open in a new window.
5. Complete the evaluation and click "Submit Response".
6. On the next page, click "Claim Credits". Select the number of credits from the drop-down menu and
click "Claim".
7. Click "Home" to close the course window. From your dashboard, click "My Courses", then select
the "My Completed Activities" tab in the middle of the screen. Beneath "Tapestry of Psychiatric Care
in Unpredictable Times: A Review of Pharmacological and Non-Pharmacological Approaches",
click "Certificate". Your certificate will open in a new tab. A link to your certificate will also be sent via
email.

NORTHERN CALIFORNIA PSYCHIATRIC SOCIETY Page 10 MARCH/APRIL 2022