Code of Ethics

Rules relating to membership and code of ethics formally adopted on 20th September 1997 at the Annual General Meeting of the Institute of Australian Psychiatrists.

RULES RELATING TO MEMBERSHIP

1. Psychiatrists are medical specialists who have been trained in the medical diagnosis and treatment of patients suffering from mental illness. In order to become a registered psychiatrist the following conditions will have been met:

(a) The person has been adequately trained and has qualified to be recognised as a medical practitioner by the relevant medical registration board. (b) The person has taken part in a post-graduate medical education programme in psychiatry, and has been recognised by the training authority as having achieved a satisfactory standard of competence by that authority. (c) The person is registered as a specialist psychiatrist by the relevant medical registration boards and/or the Specialist Recognition Advisory Committee coordinated through the Australian Health Insurance Commission. (d) The registered psychiatrist continues to practice psychiatry and behave personally within the standards of professional behaviour regarded as acceptable by the relevant medical registration board.

2. The Institute of Australasian Psychiatrists is an association of registered specialist psychiatrists practising in Australia and New Zealand, which provides continuing education and support for its members with the aim of safeguarding high standards of professional competence.

3. Active participation in the Institute's programme of ongoing education is expected to fulfil the requirements of national and state medical registration boards for maintenance of an adequate standard of personal behaviour and professional competence in the practice of psychiatry.

4. Membership of the Institute of Australasian Psychiatrists is available to people who have fulfilled the requirements of the relevant medical registration boards for registration as a specialist psychiatrist in Australia and New Zealand, and who continue to satisfy the conditions of accreditation and code of ethics of the Institute of Australasian Psychiatrists.

5. Associate membership of the Institute of Australasian Psychiatrists is available to registered medical practitioners who have worked for at least twelve months full time in psychiatry and who comply with the aims, objectives and ethical practices of the IAP.

6. Membership of the Institute is not exclusive. Members may also be members of other professional medical organisations, colleges and associations. However, a member of the Institute who is also a member of another college or association may not vote to end the Institute of Australasian Psychiatrists or wind up its financial affairs. The aim of this rule is to prevent the members of another college or association from voting the Institute out of existence or significantly hampering the Institute's activities. Beyond this, there should be no other restriction applying to members of the Institute who are members of other medical colleges, organisations or associations.

7. Members of the Institute of Australasian Psychiatrists must have been members for twelve months before they may hold office on the executive or as convenors of committees.

CODE OF ETHICS OF THE INSTITUTE OF AUSTRALASIAN PSYCHIATRISTS

1. The primary role and purpose of a Member of the Institute of Australasian Psychiatrists is to alleviate the suffering of the patients entrusted to his or her care, treating them with dignity and respect, within the context of the moral, religious, and cultural frames of reference of the patient.

2. Members of the Institute are all medical practitioners bound by the rules, responsibilities and privileges applying to medical practitioners generally. The methods of investigation, diagnosis and treatment employed by members of the Institute should be based on principles familiar to other medical practitioners.

3. Therefore, the professional behaviour of a psychiatrist may be assessed on the basis of whether his or her methods conform to those generally used in the clinical method in which all medical practitioners are trained. This includes the following requirements:

(a) To listen respectfully to the patient's complaints (b) To evaluate the patient's complaints objectively (c) To examine the patient with due regard to dignity (d) To investigate the problem thoroughly (e) To make a competent formulation (f) To respect the patient's privacy, and (g) To employ a treatment method: (i) Which is entered into cooperatively (ii) Which respects the patient's moral, religious and cultural frame of reference (iii) Which carries minimal risk

4. While respecting the traditions and ethics of medical practitioners generally, psychiatrists accept an added burden of responsibility for those mentally ill patients unable to seek appropriate treatment and unable to recognise that their behaviour may harm others. Where a patient, because of a mental illness, requires treatment against his or her will, the primary role of the psychiatrist should be one of caring for the patient, and attempting to represent the patient's interests.

5. The Institute of Australasian Psychiatrists considers that any sexual relationship between psychiatrist and patient is unethical and constitutes professional misconduct, and is grounds for expulsion from the IAP.

6. In ordinary circumstances, it is inappropriate for a psychiatrist to examine and report on a patient at the request of a third party, if the patient has not consented to such an examination. It is unethical for a psychiatrist chosen by an employer to examine an employee who has been forced to attend. In cases where there is a genuine need for employees to be treated, they must have the right to choose their own doctor, and the only communication from doctor to employer should be a statement on whether or not the employee is fit for work. Psychiatrists' reports should be confidential to the patient and the doctor who referred the patient.

A psychiatrist may examine a patient or produce a medical report without the patient's consent where directed by a Court of Law to do so. However, in such cases, the psychiatrist must inform the patient that information given will not be confidential, and that the patient is entitled to refuse the examination.

7. Ownership of information: In view of legal decisions in Australia leading to increasing demands by lawyers to examine psychiatrists' files, the Institute of Australasian Psychiatrists has defined information in patients' files as falling into three categories: (i) Personal and family tree information known only to the patient, and appearing in the patient's file only because the psychiatrist asked questions designed to elicit such information. This material belongs to the patient only, and can only be accessed by others with the patient's express permission. (ii) Material pertaining to the investigation and treatment of the patient's problem. Treatment always involves cooperation between doctor and patient, therefore this information belongs to both, and access to this information properly requires the permission of both patient and doctor. However, when a dispute arises between patient and doctor, neither should have the ability to forbid disclosure of this information by the other. (iii) Material pertaining to the doctor's own thoughts and views about the case, which were not communicated to the patient during the investigation and treatment of the patient's problem. This information belongs only to the doctor and cannot be divulged without the doctor's express permission.

Ownership of information is determined by one's ability to recreate it. Thus a patient may recreate his/her personal and family history without the aid of the doctor. The doctor may recreate his/her own private reflections without reference to the patient. However, in order to relate what took place in the treatment of the patient, neither doctor nor patient would be able to recreate the history of the treatment method and the patient's response to it, without reference to each other.

8. Forced disclosure of information and informed consent. It is not uncommon for a psychiatrist to have grave misgivings about divulging confidential information even when asked by the patient to do so in writing. The psychiatrist may be more aware than the patient, of the origins, unconscious processes, and external pressures motivating such a request, particularly where the patient has been undergoing psychotherapy.

The Institute of Australasian Psychiatrists supports the right of the psychiatrist to refuse to divulge confidential information even when requested by the patient to do so, on the grounds that such disclosure could be against the patient's best interests.

9. The Institute of Australasian Psychiatrists believes it is essential that psychiatrists resist the demands of lawyers to divulge matters discussed during psychotherapy on the grounds that such material is inapplicable to any other situation, and that lawyers are not trained in interpreting such material. Psychiatrists should confine their answers to the reason for referral, the diagnosis, the treatment strategy, the drugs prescribed, the effects and side effects of medication, and the prognosis, where applicable.

10. The Institute of Australasian Psychiatrists views great with concern the current practice of lawyers obtaining psychiatrist's confidential files on patients through court subpoenas. In many, if not most cases, there has been no prior approach to the psychiatrist to obtain a report. It seems that law firms are obtaining files by subpoena as a cheap alternative to paying for professional reports. This practice now poses a major threat to the traditional safeguard of medical confidentiality. The Institute of Australasian Psychiatrists will support its members who feel they have to resist demands they hand over their files to lawyers without substantial prior negotiations or discussions.

11. Mutual support. Where the competence or professional behaviour of a member of the Institute of Australasian Psychiatrists is subject to scrutiny or evaluation by an official committee or board, the member is entitled to seek a statement of good standing from fellow members of the Institute of Australasian Psychiatrists, and to expect that he or she would be accompanied at the hearing by at least one fellow member.

12. Industrial matters. Where it appears that a member of the Institute of Australasian Psychiatrists has been unfairly discriminated against in gaining a position solely on the grounds that the member is not a fellow of the RANZCP, the member is entitled to seek the support of the other members of the Institute of Australasian Psychiatrists in seeking the application of the relevant provisions of the Trade Practices Act.

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