Ethics consultation to PACT teams: balancing client autonomy and clinical necessity

The Program for Assertive Community Treatment (PACT) is a community-based treatment program for people with severe and persistent mental illness, who have been underserved by traditional levels of care and are thought to be at high risk for rehospitalization. Within this model can be found a number of nontraditional treatment practices, some of which challenge the balance between client autonomy and paternalism, and can lead to clinical impasses. In this article we present three clinical cases (with discussions) to illustrate the most common ethical dilemmas that our PACT team has faced in assisting clients with their finances, legal terms of probation, and personal safety. We describe our use of professional ethics consultation to help us manage these dilemmas, enhance client informed consent, and promote collaborative care within the PACT model. Such ethics consultation may be useful to other PACT teams struggling to resolve clinical and ethical dilemmas by respecting both the autonomy and best interests of their clients.