[Ethics of physician-patient relationship]

Ethical questions pertaining to the examination and treatment of patients have gained considerable importance during the last decades, also in psychiatry and psychotherapy. Interest in these questions, however, is moderate among students and beginning therapists. Ethical and legal problems often arise during practical work and are frequently solved without much consideration of the current ethical opinions and legal issues involved. This article tries to elaborate on the current ethical positions from an historical perspective and to come to a hierarchy of values, which could guide the therapeutic decisions. Nonmaleficence and autonomy are considered to be on top of that hierarchy, paternalism which was a guideline until the early sixties has lost its importance. The article discusses the consequences of this change of values in different practical fields, e.g. consent to long-term treatment with uncertain outcome, confidentiality in the face of dangers to third parties, suicidal patients.