The ethics of therapeutic modality choice

Psychiatrists usually select therapeutic modalities for their patients on the basis of empirical and theoretical considerations. Only in special circumstances (e.g., psychosurgery) are ethical concerns primary. Yet every therapeutic decision involves questions of value and requires ethical justification. The author outlines four resources for ethical direction in therapy: a general systems or biopsychosocial formulation of the clinical problem, the historic ethical commitments of the medical profession, the patient's informed perspective, and the psychiatrist's own values. Finally, a method is proposed for the resolution of conflicts among these four perspectives in individual cases.