SPECIAL SESSIONS
345
sat, 29 nov 2014
09.00 – 10.00 h
|
Hall A6
E
U
D
Ethical issues in psychiatric diagnosis
Chairs:
Wolfgang Gaebel, Düsseldorf (Germany)
Mazda Adli, Berlin (Germany)
Referent:
Allen J. Frances, Coronado (USA)
Diagnosis has ethical, not just clinical implications. The power to label is the power to
help, but also to potentially to destroy. The outcome depends on way the diagnosis is done
how it is conveyed to the patient and to the family. An accurate diagnosis can serve many
very useful functions- to reduce the patient‘s feelings of loneliness and uncertainty; as an
expression of empathy; the beginning of a good treatment relationship; and as a guide to
safe and effective treatment. An inaccurate diagnosis can sometimes be a lifetime curse and
usually leads to unnecessary and harmful treatment and stigma. It is easy to give a wrong
diagnosis, very hard to erase it. It is unethical to give a diagnosis quickly and carelessly.
There are also more systemic ethical issues. DSM and ICD are both over inclusive due to the
inherent biases of the experts who have created them. The risk of possible financial COI‘s
is obvious, but even more pervasive is the influence of intellectual COI‘s. Experts overvalue
their pet areas of research interest; worry too much about false negatives and too little
about false positives; don‘t understand the difficulty of translating suggestions developed
in university research clinics to everyday primary care settings; and are naive about the
marketing manipulations of the pharmaceutical industry. I will make eight suggestions:
1) Don‘t let the experts on any given topic be the final arbiters on decisions made. DSM
development should include important input from more neutral experts in evidence based
medicine, public health, health economics, primary care, and also consumers; 2) The larger
the group of experts the better; 3) Statistical methods of aggregating surveyed opinion
are better than group discussions; 4) Costs count; 5) The default position is conservative-
anything that expands diagnosis, testing, or treatment has to be clear winner; 6) Diagnostic,
guidelines can have as much impact as treatment guidelines and require the same care; 7)
Sponsorship- responsibility for guideline development should be taken away from professi-
onal organizations that have an inherent vested interest.
