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Difference Between Law and Ethics (with Comparison Chart) - Key Differences

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Difference Between Law and Ethics

In simple terms, the law may be understood as the systematic set of universally accepted rules and regulation created by an appropriate authority such as government, which may be regional, national, international, etc. It is used to govern the action and behavior of the members and can be enforced, by imposing penalties.

Many times the term law is juxtaposed with the term ethics, but there is a difference, as ethics are the principles that guide a person or society, created to decide what is good or bad, right or wrong, in a given situation. It regulates a person’s behavior or conduct and helps an individual in living a good life, by applying the moral rules and guidelines.

For a layman, these two terms are same, but the fact is that there is a difference between law and ethics. Read the article carefully, to overcome your ambiguities.

Content: Law Vs Ethics

Comparison Chart

Definition

Key Differences

Conclusion

Comparison Chart

Basis for Comparison LawEthics

MeaningThe law refers to a systematic body of rules that governs the whole society and the actions of its individual members.Ethics is a branch of moral philosophy that guides people about the basic human conduct.

What is it?Set of rules and regulationsSet of guidelines

Governed ByGovernmentIndividual, Legal and Professional norms

ExpressionExpressed and published in writing.They are abstract.

ViolationViolation of law is not permissible which may result in punishment like imprisonment or fine or both.There is no punishment for violation of ethics.

ObjectiveLaw is created with an intent to maintain social order and peace in the society and provide protection to all the citizens.Ethics are made to help people to decide what is right or wrong and how to act.

BindingLaw has a legal binding.Ethics do not have a binding nature.

Definition of Law

The law is described as the set of rules and regulation, created by the government to govern the whole society. The law is universally accepted, recognized and enforced. It is created with the purpose of maintaining social order, peace, justice in the society and to provide protection to the general public and safeguard their interest. It is made after considering ethical principles and moral values.

The law is made by the judicial system of the country. Every person in the country is bound to follow the law. It clearly defines what a person must or must not do. So, in the case of the breach of law may result in the punishment or penalty or sometimes both.

Definition of Ethics

By ethics, we mean that branch of moral philosophy that guides people about what is good or bad. It is a collection of fundamental concepts and principles of an ideal human character. The principles help us in making decisions regarding, what is right or wrong. It informs us about how to act in a particular situation and make a judgment to make better choices for ourselves.

Ethics are the code of conduct agreed and adopted by the people. It sets a standard of how a person should live and interact with other people.

Types of Ethics

Key Differences Between Law and Ethics

The major differences between law and ethics are mentioned below:

The law is defined as the systematic body of rules that governs the whole society and the actions of its individual members. Ethics means the science of a standard human conduct.

The law consists of a set of rules and regulations, whereas Ethics comprises of guidelines and principles that inform people about how to live or how to behave in a particular situation.

The law is created by the Government, which may be local, regional, national or international. On the other hand, ethics are governed by an individual, legal or professional norms, i.e. workplace ethics, environmental ethics and so on.

The law is expressed in the constitution in a written form. As opposed to ethics, it cannot be found in writing form.

The breach of law may result in punishment or penalty, or both which is not in the case of breach of ethics.

The objective of the law is to maintain social order and peace within the nation and protection to all the citizens. Unlike, ethics that are the code of conduct that helps a person to decide what is right or wrong and how to act.

The law creates a legal binding, but ethics has no such binding on the people.

Conclusion

Law and ethics are different in a manner that what a person must do and what a person should do. The former is universally accepted while the latter is ideal human conduct, agreed upon by most of the people. Although, both the law and ethics are made in alignment so that they do not contradict each other. Both go side by side, as they provide how to act in a particular manner. Every person is equal in the eyes of law and ethics, i.e. nobody is superior or inferior. Further, these two allow a person to think freely and choose.

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Ethics and Law

An Introduction

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2015.

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Philosophy,

Vol. 90,

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167.

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Oeter, Stefan

2019.

Conflicting Norms, Values, and Interests: A Perspective from Legal Academia.

Ethics & International Affairs,

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57.

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Hapla, Martin

2019.

(Ne)morální advokáti: problém ospravedlnění norem profesní etiky.

Časopis pro právní vědu a praxi,

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W. Bradley Wendel, Cornell University, New York

Publisher:

Cambridge University Press

Online publication date:

October 2014

Print publication year:

2014

Online ISBN:

9781107337114

DOI:

https://doi.org/10.1017/CBO9781107337114

Series:

Cambridge Applied Ethics

Subjects:

Law,

Ethics,

Philosophy,

Jurisprudence

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Can someone be a good person yet act in a professional role that may involve deception, procedural trickery, withholding information, and working on behalf of terrible people and institutions? This question is at the heart of legal ethics. Using cases from around the common-law world, W. Bradley Wendel looks at issues including confidentiality, the moral responsibility of lawyers, and truth and deception in advocacy. He then examines the classic questions of philosophy of law, including the nature of law, positivism, natural law, the relationship between law and morality, unjust legal systems, and the obligation to obey the law. Finally, he considers the ethical issues surrounding the role of lawyers, including criminal defense and prosecution, civil litigation, counseling clients on the law, and representing corporations. Combining the theoretical, philosophical, and practical, his book will be of vital interest to students of law, the philosophy of law, ethics, and political philosophy.

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‘A superb, engaging and accessible introduction to the intersection of ethics and law.'

Adam Dodek - University of Ottawa

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Contents

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pp i-iv

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Contents

pp v-vi

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Select Preface

Preface

pp vii-x

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Select Part I - Lawyers, ethics, and the law

Part I - Lawyers, ethics, and the law

pp 1-2

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Select 1 - Defining the problem

1 - Defining the problem

pp 3-20

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Select 2 - Justifying principles of professional ethics

2 - Justifying principles of professional ethics

pp 21-42

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Select 3 - The adversary system

3 - The adversary system

pp 43-61

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Select 4 - The nature of law and why it matters

4 - The nature of law and why it matters

pp 62-88

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Select 5 - Legal obligation and authority

5 - Legal obligation and authority

pp 89-105

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Select 6 - Unjust laws and legal systems

6 - Unjust laws and legal systems

pp 106-128

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Select Part II - The many roles of lawyers

Part II - The many roles of lawyers

pp 129-130

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Select 7 - Criminal defense and the problem of client selection

7 - Criminal defense and the problem of client selection

pp 131-155

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Select 8 - Prosecutors

8 - Prosecutors

pp 156-172

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Select 9 - Civil litigation

9 - Civil litigation

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Select 10 - Counseling clients

10 - Counseling clients

pp 200-215

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Select 11 - Representing corporations: lawyers as gatekeepers?

11 - Representing corporations: lawyers as gatekeepers?

pp 216-235

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Index

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References

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The Confluence of Philosophy and Law in Applied Ethics pp 11–25Cite as

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The Confluence of Philosophy and Law in Applied Ethics

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Ethics, Applied Ethics, and Law

Norbert Paulo2

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First Online: 27 May 2016

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AbstractMany people believe that law and ethics are entirely different practices. Law is a highly institutionalized system, strictly regulating human conduct and consisting of largely contingent rules that every individual has—under the threat of coercion—to follow. Ethics, in contrast, is primarily a personal matter, allowing for ad hoc reasoning and demanding existential decisions. On such a view, the task I set myself in this book seems to be odd and misguided from the start. This chapter aims at rebutting this worry by showing that the parallels between ethics and law are, in fact, so manifold that it actually is promising to compare the two with regards to their methods. There are obvious differences between law and ethics; but a fruitful comparison between two items does not presuppose identity, only similarity. As I shall argue, there are striking similarities between ethics and law, especially between applied ethics and law.KeywordsVirtue EthicMoral TheoryApplied EthicMoral ConvictionSoft SkillThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Notes1.cf. (Pfordten 2010, 34 ff.), who traces this distinction between ethics and morality back to Plato and Aristotle and is surprisingly confident that it is nowadays ‘beyond any doubt for philosophers.’ Not only do I not follow this suggestion; many philosophers use alternative distinctions: For (Blackburn 1994), for instance, ethics designates the kind of practical reasoning that we find in virtue ethics of the Aristotelian kind, whereas morality designates other kinds of practical reasoning; (Habermas 1991, 108 f.) understands ethics as addressing questions of ‘the good life’ for an individual and morality as the norms that regulate societal coexistence; (Williams 1986) holds a very similar view, according to which morality is much narrower in scope than ethics; (Fox and Demarco 2000, 5) take morality to mean certain customary practices and ethics to refer to those rules or principles that people explicitly endorse.2.An exception may be found in (Gert et al. 2006, 5 ff.), who explicitly make the distinction that morality is a particular system of rules and principles, and ethics the theory of morality. They nonetheless gave their book the title Bioethics and primarily use the term ‘morality’ in it. ‘Ethics’ is rarely mentioned within the book; instead they talk about ‘moral theory’ when referring to what they actually defined as ethics.3.cf. (Steinbock 2007, 2 ff.; Toulmin 1982; Düwell and Steigleder 2003, 15 ff.; Grimm 2010, 66). I am telling the story of the development of applied ethics as starting with medical ethics. Tom Beauchamp reminded me that it might even be possible to trace this development back to earlier discussions of race and gender issues. The problem with the latter two is, I suppose, that they have not been taken as seriously as medical ethics in academic philosophy, for they addressed problems that did not affect the—predominantly male and Caucasian—academics themselves.ReferencesAch, Johann S., and Christa Runtenberg. 2002. Bioethik zwischen Disziplin und Diskurs. In Biomedizinische Ethik, ed. Bernward Gesang, 15–28. Paderborn: Mentis.

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Download referencesAuthor informationAuthors and AffiliationsDepartment of Social Sciences and Economics, University of Salzburg, Salzburg, AustriaNorbert PauloAuthorsNorbert PauloView author publicationsYou can also search for this author in

In: The Confluence of Philosophy and Law in Applied Ethics. Palgrave Macmillan, London. https://doi.org/10.1057/978-1-137-55734-6_2Download citation.RIS.ENW.BIBDOI: https://doi.org/10.1057/978-1-137-55734-6_2Published: 27 May 2016

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Medical Ethics in Clinical Practice pp 1–5Cite as

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Medical Ethics in Clinical Practice

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Ethics and Law

Matjaž Zwitter2,3

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First Online: 05 January 2019

2336 Accesses

AbstractHuman conduct and relations are regulated by legal and ethical norms. Why are there two systems? Legislation consists of clear formulations, is limited by political frontiers, and has clear sanctions. In contrast, ethical norms are broader and often limited to recommendations, may cross political or cultural borders, and may be applied retroactively. While the legal system adequately regulates relations among individuals of a comparable position, it often fails to protect the weak side in cases of significant differences in power and social weight. The relations of children to parents, students to teachers, citizens to politicians, readers to journalists, and patients to physicians are examples for which the legal system alone cannot offer adequate protection to the weak side, and for which ethical limitations to the power of the stronger side are essential.KeywordsLegislationCoherent societyImbalance of powerEthics

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Suggested ReadingArras JD, Fenton E, Kukla R, editors. The Routledge companion to bioethics. Abingdon: Routledge; 2015. ISBN-13: 978-0415896665.

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Download references Author informationAuthors and AffiliationsFaculty of Medicine, University of Maribor, Maribor, SloveniaMatjaž ZwitterInstitute of Oncology, Ljubljana, SloveniaMatjaž ZwitterAuthorsMatjaž ZwitterView author publicationsYou can also search for this author in

In: Medical Ethics in Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-00719-5_1Download citation.RIS.ENW.BIBDOI: https://doi.org/10.1007/978-3-030-00719-5_1Published: 05 January 2019

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Health Studies pp 425–453Cite as

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Health Studies

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Ethics and Law

Peter Duncan3

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OverviewThis chapter explores the central relevance of ethics and law to Health Studies. It exposes a range of dilemmas facing those involved in health care provision. These dilemmas relate to issues such as the nature and value of life (at both its beginning and its end), the rationing of scarce health care resources and the accountability of health professionals to the public they are supposed to serve. Is it possible to justify the actions of health care professionals who assist patients in committing suicide? Should economic priorities determine ability to access treatment? To what extent, if at all, should we allow health care professionals just to ‘get on with their job’ without the application of external monitoring or standards? Ethics and law help us understand and respond thoughtfully to these and other similar questions. The dilemmas that they represent are not confined simply to ‘life and death’ situations, but they cover the whole span of health care activity from prevention and health promotion through treatment to rehabilitation. In the first part of the chapter, ethical theory is discussed and related to practical health and health care examples; then law, its nature and application to health and health care is explored. The chapter moves on to expose and investigate difficulties in the relationship between ethics and law and asks the question that should be at the heart of health care practice: is what we must do (our legal obligation) always the same as what we ought to do (our ethical or moral duty)? The chapter closes with an extended example of the dilemma posed by policymakers’ attempts to intervene in individual food choices, and in doing so, it draws out both the problems and possibilities attached to thinking about health care policy and practice through the lenses of law and, especially, ethics.

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Further ReadingBeauchamp, T., & Childress, J. (2019). Principles of Biomedical Ethics (8th ed.). Oxford University Press.

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Beauchamp and Childress developed the idea of the ‘Famous Four’ principles of health care ethics, and this is the book in which their ideas are most completely expressed. It is detailed and technical but offers many helpful points of reference, including extensive signposts to further literature. It has been updated multiple times since its first appearance in 1979 and now has much more to say, for example, on Aristotelian (virtue) ethics, an area that has gradually assumed relatively greater importance in the field of health care ethics.

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Duncan, P. (2010). Values, Ethics and Health Care. SAGE.

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This book explores many of the issues raised in this chapter in more detail, concentrating especially on problems of ethics confronted by those engage in everyday (‘ordinary’) health care.

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Glover, J. (2008). Choosing Children: Genes, Disability and Design. Oxford University Press.

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This is a beautifully written book by a leading moral philosopher and based on a series of lectures in which he explores the dilemmas faced by a society in which genetic and reproductive technology is radically changing the nature of life’s beginnings.

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Download referencesAuthor informationAuthors and AffiliationsLondon, UKPeter DuncanAuthorsPeter DuncanView author publicationsYou can also search for this author in

PubMed Google ScholarEditor informationEditors and AffiliationsSchool of Health, Community & Policy Studies, University of the West of England, Bristol, UKJennie Naidoo London South Bank University, London, UKJane Wills Rights and permissionsReprints and permissionsCopyright information© 2022 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.About this chapterCite this chapterDuncan, P. (2022). Ethics and Law.

In: Naidoo, J., Wills, J. (eds) Health Studies. Palgrave Macmillan, Singapore. https://doi.org/10.1007/978-981-16-2149-9_14Download citation.RIS.ENW.BIBDOI: https://doi.org/10.1007/978-981-16-2149-9_14Published: 23 March 2022

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Indian J Psychiatry. 2022 Mar; 64(Suppl 1): S7–S15. Published online 2022 Mar 22. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_726_21PMCID: PMC9122144PMID: 35599656Ethics and LawPrasad Rao Gundugurti, Ranjan Bhattacharyya,1,2 Sandeep Kondepi,3 Kaustav Chakraborty,4 and Abir Mukherjee5Prasad Rao GundugurtiSchizophrenia and Psychopharmacology Division, Asha Hospital, Hyderabad, Telangana, IndiaFind articles by Prasad Rao GundugurtiRanjan Bhattacharyya1Department of Psychiatry, Murshidabad Medical College and Hospital, West Bengal, India2Charak Square Diagnostic and Research Center, Berhampore, West Bengal, IndiaFind articles by Ranjan BhattacharyyaSandeep Kondepi3Department of Psychiatry, Asha Hospital, Hyderabad, Telangana, IndiaFind articles by Sandeep KondepiKaustav Chakraborty4Department of Psychiatry, College of Medicine and JNM Hospital, Kalyani, West Bengal, IndiaFind articles by Kaustav ChakrabortyAbir Mukherjee5Department of Psychiatry, Medica Superspeciality Hospital, Kolkata, West Bengal, India E-mail: moc.liamg@lacbrrdFind articles by Abir MukherjeeAuthor information Article notes Copyright and License information PMC DisclaimerSchizophrenia and Psychopharmacology Division, Asha Hospital, Hyderabad, Telangana, India1Department of Psychiatry, Murshidabad Medical College and Hospital, West Bengal, India2Charak Square Diagnostic and Research Center, Berhampore, West Bengal, India3Department of Psychiatry, Asha Hospital, Hyderabad, Telangana, India4Department of Psychiatry, College of Medicine and JNM Hospital, Kalyani, West Bengal, India5Department of Psychiatry, Medica Superspeciality Hospital, Kolkata, West Bengal, India E-mail: moc.liamg@lacbrrdReceived 2021 Aug 31; Revised 2021 Sep 21; Accepted 2021 Oct 14.Copyright : © 2022 Indian Journal of PsychiatryThis is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.BACKGROUNDThe fundamental concept and understanding of ethics started to be evolving for the last half a century when American Psychiatric Association (APA) developed a code of ethics in 1970. The World Psychiatric Association (WPA) developed it in 1977 and the Indian Psychiatric Society (IPS) adopted it at the Annual National Conference of IPS (ANCIPS), Cuttack in 1989.[1,2]The committee members which comprises Prof. J. S. Neki, Prof. D. N. Nandi, Prof. A. K. Agarwal, Dr. V. N. Vahia and Dr. J. K. Trivedi and others formulated the code of ethics in ANCIPS Cuttack 1989. This guideline covered the various aspects of duties and responsibilities of a psychiatrist as a practitioner, scientist as well as dealt with their social responsibilities. The professional competence of being a life-time learner even has been echoed in the recently formulated Competency-Based Medical Education issued by Medical Council of India, now National Medical Commission. The benevolence of the patients and their welfare, maintaining highest moral standards and safeguarding the interests of the patient had been given top priorities. The initial draft formulated by the pioneers of IPS.[3] The details of the draft are summarized in Table 1.Table 1Ancillary rules of consent formulated by expert group of Indian Psychiatric Society1. The consent is required for every medical examination2. Before any invasive procedure consent will be required which ranges from surgery to blood transfusion3. The consent should be, free, direct, clear, unambiguous and voluntary without any undue influences4. An adult person can’t be detained in hospital forcibly. The secret informations of the patient can’t be divulged by all means to others5. Even in criminal cases the accused or victim can’t be examined forcefully without the consent except in emergency situation in presence of police officer not below the rank of sub inspector6. Female victims should be examined by only lady RMP (Registered Medical practitioner) (Sec 53, CrPC, 1973.)7. The blood, urine and breath samples shouldn’t be collected without consent8. The mentally ill patient can be treated against his/her will whereas the same is not valid for non mentally ill person who has the right to refuse the treatment9. A prisoner can’t be treated forcibly, consent for criminal abortions are invalid10. A person above 18 years can give valid consent to i) suffer any harm as a result not intended to cause death or grievous hurt, (ii) act done in good faith & for its benefit. A child less than 12 years age and an insane or intoxicated person can’t give valid consent (Sec. 90, I.P.C.)11. The consent by no way is a defense in professional negligence12. The selfish motives for financial gain, research, publication, own interest from the part of therapist must be abandonedOpen in a separate windowThe purpose of updating the guidelines has become an eventuality to establish high-quality ethical standards of current practices in changing era. The therapists should have the required skills, knowledge, training, and supervised experiences as well as they should be aware of the emotional state of the patients. They should also take opinion from their professional colleagues, other experts, and specialists whenever necessary.Ethics and law are the different forms of rules by which humans are expected to behave themselves in the society. Ethics represents internal system of controls, and Law refers to an external mechanism of control. Both these controls ar essential for optimal behavior, which includes seeking and dispensing treatment.Salient pointsThe fraud and abuse of psychiatry (such as upgrading, Ganging, Touting, Self advertisement, unavailability, publishing research or report to press, unethical drug trials, teaching unprepared topics, not upgrading self through CMEs, selling of sample medicines, prescribing unscientific drug formulations, practicing quackery, dichotomy or fee-splitting, offering or receiving kickbacks, steering the patient to a particular pharmacy, non-capping, out of proportion, and illegitimate claim for professional services) must be dealt on a serious note to maintain highest possible ethical and professional standards.Ethics is the term used interchangeably with science of morality which represents a body of knowledge that contains principles or standards for value-based human behavior whereas law refers to a system of rules which are enforced through social institutions or the state. Empathetic mode has been the universal method of deciding ethical questions. It is done by placing oneself in the place of the other person and then deciding whether he would like it or not.[4] The guiding principles of Ethics are all that is “good” or “right” have varied with respect to the time, place and the context whereas Laws of the land are made more on the reality considerations based on what is required, aspired for and is practically possible. The term “Ethics” was derived from the Greek word ethikos, which means “rules of conduct that govern natural disposition in human beings.” To put simply, ETHICS means principles of right conduct. In oxford dictionary, it has been defined as “moral principles that govern a person’s behavior or an activity. The ethics is inclusive of active participation in amoral community which deals with problem solving activity is an educational process. However, it does not include personal reliance, expert authorities, interminable disputes, or the dilemma.[5,6]Philosophical foundations of the ethical principlesUtilitarianism (consequentialism) which states “the ends justify the means.” That is, whatever be the method used, if the final outcome of any act turns out to be “good,” then the act is considered justifiable.Deontologism (rule-based ethics), which states that every act has to be done according to particular rules or laws. Irrespective of the outcome, these rules have to be followed, and violation is not acceptable at any time. Both these apparently contrasting viewpoints on ethics have their individual pros and cons but can be taken together. It is the “Rule-based utilitarianism” which forms the pillar of modern medical ethics. Besides utilitarianism and deontologism, virtue-based ethics is having a resurgence in medical ethics. It posits that to safeguard against ethical problems, certain attributes or “virtues” are essential for health care professionals which are related to their field.[3]Salient pointsThere are certain ethical theories, for example, (i) Deontology-which is the basis of all actions. (ii) Teleology-actions can be judged on the consequences. (iii) Utilitarianism-“general welfare” instead of “individual welfare.”TIMELINEThe earliest code of ethics could be found in Charaka Samhita. In 5th century BC, the Code of Medical Ethics was postulated by Hippocrates. Down the lane, it was the mistreatment of human subjects in Nazi experiments led to the development of Nuremberg code (1949) which includes voluntary consent, withdrawals of human subjects from the study, and balance between benefits and risks. In the declaration of Helsinki (1964), it was unanimously decided for the first time that greater care is needed to protect the individual Human rights and was set a standard in Medical Research Ethics. The Tuskegee syphilis study (1932-1972) withholding treatment of syphilis to negro males, Willowbrook hepatitis study (1956-70) by allowing hepatitis and depriving intellectually disabled children the protective gamma globulin and Jewish Chronic Disease Hospital (JCDH) study in Brooklyn (1963) where cancer cells injected to noncancerous patients without their consent are some of the dark zones of unethical research in previous century. This was followed by 18th Declaration of Helsinki (1964) which has been modified for five times and ultimately incorporated in 58th WMA (World Medical Assembly) in 2000. The ancient code of ethics and its trajectory is summarized in Table 2.Table 2Chronological development of different codes of ethicsa. Code of Hammurabi (2000 B.C.)b. Sun Simiao code, King of Chinese Medicine (682)c. Medical Ethics or a code of Institutes adapted from the professional conduct of physicians and surgeons (Thomas Percival 1740-1804)d. International Code of Medical Ethics (Geneva Declaration of the WMA 1948)e. Declaration of Sydney (1968)f. Declaration of Oslo (1970)g. Declaration of Medical Ethics (by AMA, 1973) especially applicable to Psychiatryh. WPA code of Ethics (1977)J. Declaration of Madrid by WPA in 1996Open in a separate windowWPA – World Psychiatric Association; AMA – American Medical AssociationCode of ethics in Psychiatry was introduced by the APA in 1973. WPA introduced a code of ethics in 1977. In 1979, Tom Beauchamp and James Childress issued the first Edition of “Principles of Biomedical Ethics.” Declaration of Madrid was done by WPA in 1996. Later, a committee was allotted by the IPS to prepare the code of ethics for the Indian Psychiatrists. It was approved in ANCIPS, Cuttack in 1989. Further, Medical council of India has published its ethical rules in 2002.[5]RecommendationsThe ethical principles guiding research are (i) respect for human dignity, (ii) respect for free and informed consent, (iii) respect for vulnerable persons, (iv) respect for confidentiality and privacy, (v) respect for justice, (vi) judging for potential harms and benefits, (vii) minimizing harm, (viii) maximizing benefits.There are lacunae of resident training decades back in ethics, research, and law in tertiary medical colleges (both in Government and private institutions), especially while working in General Hospital Psychiatry Units. The most of the residents do not have any first-hand knowledge of appearing in the court of law, and forensic psychiatry training should be prioritized in PG training. It is recommended that residents should be involved to attend medical boards, discharge committee meetings, certification procedures.[5]There are other unethical practices mentioned anecdotally, which are summarized in Table 3.Table 3Common examples of unethical practicesProviding less time in OPDs and IPDs of government Hospital and more time in private clinicIn hospital not discharging duties in optimum mannerIntentionally treating patients potentially having frequent relapses and recurrencesAbusing, coercing, threatening, blackmailing patients with respect to the privacyProviding wrong evidence in courtIssuing false certificates for sick benefit, pension, attendance in court, insurance, and passportCriticizing the prescriptions of other or same subject specialistsProper and timely referral not being doneWithholding information of notifiable diseasesOpening medicine shop for sale and gaining profitRefusal to consult patient on religious groundConsultation of patients in drunked state where judgement is poorOpen in a separate windowOPDs – Out patient departments; IPDs – In patient departmentsIn view of the development of Bioethics jurisprudence of India, it can be stated that bioethics has now emerged as professional discourse nowadays, and with changing milieu and domains of research these significant points have been added on.Ethics and morals are everybody’s concern. Human rights are said to be universal, inviolable, and indivisible. It is a matter of perception, interpretation, and experience. This makes bioethics a fertile area for inquiry, comparison, conceptualization, and application. Lawyers know little of science and technology, particularly the frontier science of biomedical research. However, law cannot be totally avoided so long as technology can be abused and exploitation can happen in the name of experimentation.[7,8]Medical ethics are defined as moral principles which guide the members of medical profession in their dealing with each other, their patients and state. These ethical codes guide each others to regulate their relationships. The medical etiquette is self-induced duties upon each other.[9]Four widely accepted principles of health care ethics, extracted from Beauchamp and Childress publications.[10] This is summarized in Table 4.Table 4Principles of medical ethicsBenefiance - Do good. A psychiatrist should act in the best interest of the patientNonmalfeasance=Do not harm. A psychiatrist should not prescribe a drug or any form of treatment that will harm the patientAutonomy=Freedom, here the patients can take an independent decision.Justice=Equity and fairnessOpen in a separate window

Principle of respect for autonomyPrinciple of nonmaleficencePrinciple of beneficencePrinciple of justice.

CODE OF ETHICS FOR PSYCHIATRISTS IN INDIA (INDIAN PSYCHIATRIC SOCIETY 1989)IPS, the largest professional body of psychiatrists in India with current membership strength more than 7000, formulated code of ethics in 1989 which is guided by the following principles.[11]1. ResponsibilityThe psychiatrist must know that he carries a high social responsibility because he deals with disturbed human behavior and intimacies of life. He would also serve the society through observation, investigation, experimentation, and research.2. CompetencePsychiatrists are responsible for their continued education and should understand that lifetime learning is needed.3. BenevolencePatient’s interest and their health should be given the prime importance in professional practices.4. Moral standardsConsider all the moral codes and expectations of the community they serve and will not let their behavior in anyway damage their profession.5. Patient welfareThey will not treat any case that does not fall within their competence.6. ConfidentialityThe psychiatrists should safeguard the information obtained from their patients, relatives, and informants during their clinical work, teaching, or research.Ethics and morals are concerns of all of us, and human rights are said to be inviolable, indivisible, and global which is a matter of perception, interpretation, and experience. Thus bioethics is a fertile area for application with comparison, conceptualization, and inquiry. The science and technology, the frontier of biomedical research is not known to the lawyers in general; however, technology can be abused, and exploitation can happen in the name of experimentation.[12]GOOD PSYCHIATRIC PRACTICE (CODE OF ETHICS)College report CR 186 of Royal College of Psychiatrists suggests 12 principles in 2014.[13]

The essential dignity and humanity of every patient should be maintained by the treating psychiatristPsychiatrists shall not exploit patients’ vulnerabilityPatients should receive the best attainable care for their treating psychiatristPsychiatrists shall maintain the confidentiality of patients and their familiesThe valid informed consent must be obtained from the patients undergoing proceduresThe best available treatment options should be discussed and provided to the patients and their caregiversThe misuse of professional skills should not be done for personal or monetary gainWhile doing research work, the psychiatrist should follow national and international guidelines and should not disclose the identity of their patient and publish photographs without the consent of the patientThey should continuously develop, maintain and share their knowledge, expertise, and skills with medical colleagues, trainees, and students through CME program and medical conferencesPsychiatrists have a duty to attend to the mental health and well-being of their colleagues, including trainees and studentsAbove all, the professional integrity should be maintainedPsychiatrists shall work to improve mental health services and promote community awareness of mental illness and its treatment and prevention and reduce the effects of stigma and discrimination.

On March 27, 2017, Lok Sabha unanimously passed the Mental Healthcare Act 2017 and was approved by Honorable President of India on April 2017. In MHCA 2017, the legal and ethical aspects related to admission, discharge, consent to treatment, the capacity to consent, and role of the nominated representative (NR) are clearly set forward.[14]The Ethics Subcommittee of the IPS issued version 1.3 of the code of ethics for Indian Psychiatrist in December 2018. It stipulates 13 principles which include patient’s well-being, competence in the field of practice, professionalism, maintaining discretion, collaborating with colleagues when needed, maintaining patient rights and confidentiality, updating knowledge regularly, acting appropriately if a colleague or professional acts unethically, upholding the dignity of the medical profession, raise awareness about mental illness among the general public, abiding to ethical principles of academic conduct when involved in medical education and in research.[15]GOALS OF PSYCHIATRIC ETHICSTo provide competent, compassionate, and respectful care.Being honest with patients and colleagues.Act within the boundaries of law.Consider the rights and autonomy of patients.Be accountable to the community and society.ETHICAL ISSUES SPECIFIC TO PSYCHIATRYDiagnosis, Psychiatrist-patient relationship, Involuntary admissions, Confidentiality, Boundary violations, Informed consent, Human rights, etc.A psychiatrist is the connecting link between the individual and the society. He needs to abide with the ethics and law, to fulfill his dual responsibility.The aberration of normal behaviors cannot be equated as abnormality and mental illnesses. The human behaviors classified as autonormal, heteronormal, auto pathological, and heteropathological depending on the societal norms, cultural context, belief system, and situational as well as environmental factors [Table 5]. There are still grey areas of research, and continuous upgradation of diagnostic criteria is always under process.Table 5Concept of normality in mental healthAutonormalAutopathologicalHeteronormalHeteropathologicalOpen in a separate windowMedical ethics can be defined as moral principles which guide the members of the medical profession in their dealing with each other, their patients and state. These ethical codes guide each other to regulate their relationships. The medical etiquette is self-induced duties on each other.They should obey and follow the IMC Act 1956. There had been very few published articles as found in electronic searches by the reviewers. It was not found to be a favorite topic for discussion by the Indian authors, only six articles directly related to ethics as found in a review article published in the Indian Journal of Psychiatry in 2010.[16]In general, a relationship is built up by two autonomous individuals who can evaluate the pros and cons and decide whether to continue or break the relationship in the long run. However, the psychiatrist-patient relationships have other angles to consider. Due to their emotional vulnerabilities and potentiality of the development of transference reaction, a psychiatrist should have to vigilant and sensitively deal with their patients. At the same time, it is prudent to judge whether their own counter-transference could have a biased assessment and therapeutic influences while treating a mentally ill patient.[15]Informed consentThe concept of informed consent has also been challenged as there are schools of thought that this has come as a consequence of defensive practice from the UK due to rowing litigations. Sill there are myths and misconceptions prevailing that mental illnesses are caused by possession of demon, evil spirits, supernatural powers, wrongdoings, and misfortunes, psychotropic medicines are addictive, ECT may cause more harm than illnesses and be applied as a mean of punishment, etc., Even there are biases and prejudices that come into play in the court of law during capacity assessment. The inform consent should not be a blanket consent as it is practiced in our country widely. The procedures of the consent are not followed properly and not sufficiently discussed with the patient. It is imperative to take consent for each procedure separately.The voluntary informed consent is essential for research involving human subjects, which include (i) description of the nature of research, (ii) disclosure that the consent is voluntary and the individual can withdraw consent at any time, (iii) description of pros and cons of the research, (iv) description of how the confidentiality issues will be protected, description of compensation, (v) detail information that the researchers will share with the participant and (vi) the contact personals name with contact number who will be responsible for liaison with the research activities.ConfidentialityMajor exceptions to confidentiality:

Consent obtained: The patient has given consent to share information to family members, insurance company, employer, or anybody elseTarasoff duty: When the patient’s act has potential to harm others, it is the duty of treating psychiatrist to inform appropriate authorityEmergency situations: The onus is on treating psychiatrist with documentation that there had been emergency situation beyond reasonable doubt which has necessitated him or her to breech the confidentialityMandatory reporting: In case of child abuse or violation of the right to protection of womanCourt orders: The patient must be informed and if the patient refuses the permission, that has also to be informed to the courtUnder litigation: If the patient had initiated legal proceedings the psychiatrist has the right to share information before the court of law which is relevant to the case.

Principles to follow while breaching confidentiality:

Informing the patient and obtain written consent preferablyDisclose the relevant part only that is utmost important to shareDocumentation with proper notes what the rationale for this decision was.

Competence and responsibilities The competence and responsibilities of a therapist are immense. They should be aware of their responsibilities toward self and clients.[17]They should maintain their own functioning and accountability to monitor their own performances as summarized in Table 6.Table 6Competence and responsibilities of a therapist: dimensional conceptCompetence of a therapist: The acquired skill, knowledge, qualification or capacity which depends on the level of knowledge, experience and supervised skillsResponsibilities of a therapist: The therapists on ethical point of view are aware of their responsibilities toward clientsResponsibilities to the client: Therapy should be undertaken only with professional intents and contracts involving clients should be realistic. Therapist should avoid harm and promote autonomy and maintain professional boundariesResponsibilities to self as a therapist: The onus is on therapist to maintain their own effectiveness, resilience and ability to help clients. The therapist should undertake their own therapy when their capacity will be impairedOpen in a separate windowInfamous conductThe behavior and practices of a doctor which is considered as disgraceful and dishonorable which can be judged as abuse of professional position is called Infamous conduct, which includes 6 “A” s, for example, Adultery, Advertisement, Abortion (criminal), Associations with unqualified persons in professional matters, Alcohol, and Addiction. This includes 1. Dichotomy (Fee spitting), 2 Engagement with touts, 3. Immoral and criminal acts, 4. Refusing treatment on the basis of race, caste, creed, religion, 5. Not doing mandatory reporting in alleged Rape and communicable diseases like AIDS, 6. Issuing false certificates, 7. Prescribing schedule H drugs violating NDPS act, 8. Refusing treatment in emergency, 9. Violation of PCPNDT act 1994, 10. Human rights violation, 11. Publication of photos and case reports without consent (Disclosure of identity).During consultation unnecessary referrals, consultations and professional jousting should be avoided.Privileged communication It is a statement made bonafide on any subject matter by a doctor to the competent authority as a duty protects the community or state at large. The interest of public cannot be held at jeopardy or risk for sole interest of a particular patient who may endanger the safety of larger sections of society.Professional negligence Professional negligence can be defined as the absence of reasonable care and skill or willful negligence of a medical practitioner in the treatment of a patient, which may cause bodily injury or death of the patient. The doctor is liable of professional negligence when there is failure to discharge the duty, dereliction, direct causation, diagnosis (4’D’s).The professional negligence can be of two types, (i) Civil negligence and (ii) Criminal negligence. However, professional misconduct cannot be equated with professional negligence. In negligence, the absence of care and skill with damage has to be proved, and trial has to be done in court of law, whereas in misconduct the act is considered disgraceful, and trial is being done by state medical council. The difference between Civil and Criminal negligence are summarized in Table 7.Table 7Basic differentiating features of civil and criminal negligenceCivil negligenceCriminal negligenceSimple act of care and skillGross violation and deviation from standard of care which endangered patient’s safetyNo specific or gross violation of act or lawClear violation of law dealt with IPC section 304 AThe onus to prove lies on balance of probabilitiesThe proof has to be sufficient beyond reasonable doubtConsent and contributory negligence acts as a good defenseEssentially notTrial is being done in civil courtTrial is being done in criminal courtPunishment by compensation onlyPunishment is by imprisonment and/or fineThe doctor can be tried twice for the same offenceThe doctor cannot be tried twice hereOpen in a separate windowContributory negligence The concurrent damage of patient and or attendant, which added on doctor’s negligence, which has caused the eventual damage (e.g., failure to give adequate history, neglecting follow-up).Medical maloccurrence It happens due to bio-physiological variations of individual responses due to tolerance, idiosyncrasy, etc. (e.g., Steven Johnson’s syndrome caused by Lamotrigine).Misadventure This can be therapeutic, diagnostic, and experimental. When certain drugs are administered, and procedures are being done despite the extreme risk and lacking any scientific evidences (antisnake venom, anticancer drugs) or certain procedures mostly outmoded these days (Barium enema causing poisoning and rupture).Calculated risks and product liabilities When certain procedures can have inevitable risks, but the doctor should write proper justification and preventive measures taken. Similarly, certain physical agents (pacemaker, prosthesis, etc.,) may become malfunctioned as wear and tear or faulty manufacture.Res ipsa loquitur The fact that speaks itself that is in the absence of negligence, the injury or damage would not have occurred ordinarily. The doctor had exclusive control over injury-producing treatment or machinery, and the patient was not guilty of contributory negligence (e.g., leaving swab in the abdomen, mismatched blood transfusion etc.).Novus actus interveniens The terminology is applicable when the doctor is not only responsible for his own actions but also the logical consequences of the action.Vicarious liability This is applicable when the employer is not only held responsible for own’s negligence but also for the negligence of the employees, which is called “Respondant superior” (let the master answer). This should be applicable under the scope of employment and while on job.Borrowed servant doctrine It is applicable to an employer for a borrowed employee serving under multiple employer, especially applicable for professionals such as junior doctors, interns, nursing staffs, and pharmacists. However, the surgeon is not held responsible usually for the negligence of anesthetist and vice versa.Medical etiquette The essence of the medical etiquette is that the psychiatrist should treat their colleagues with utmost respect and care. A patient can be referred to a competent professional or institutions or individuals of the same or different specialties by a psychiatrist for a second opinion or further treatment. It is the self-imposed duty on each other, the conventional laws of courtesy observed between the members of the medical profession. In case of applying some unconventional treatment of a disorders psychiatrist should refer their patient to his/her colleague for a second opinion.The movements to encompass the mental health problems like the other medical illnesses under insurance cover are gaining momentum, and some successes are now visible. The psychiatrist should inform their patients at the very beginning of the treatment about their professional obligations.MCHA 17 and human right issues The word Human Rights in a broader way means “those claim which every individual has or should have upon the society in which he/she lives.”The MCHA 2017 specifically dealt with human right issues of PWMI (patients with mental illness). The ethical and legal safeguard and framework have been constituted for this vulnerable group in evaluation, management, and research perspectives. The basic tenants of ethical standard of care Beneficence, non-malaficence, autonomy, and justice for mentally ill patients have also taken care of. The confidentiality issues and boundary violation-related matters have also been judged with due weightage.[17]Rights of the mentally ill as per mental health care Act 2017

The right to get considerate and competent treatmentThe right to be informed about the treatmentThe right to give consentThe right to privacyThe same fundamental rights as other citizens, including the right to a decent life as normal as possibleProtection against exploitation and discriminatory, abusive, or degrading treatmentAssistance including legal aid to protect their rights.[18]

DEFINITION OF BOUNDARYA boundary may be defined as the “edge” of appropriate professional behavior, transgression of which involves the therapist stepping out of the clinical role or breaching the clinical role. In other words, It is the physical, psychological, and social space occupied by the patient in the clinical relationship.[19]Boundary issue typesGutheil and Gabhard identified two types of boundary issues-boundary crossings and boundary violations. A boundary crossing is a deviation from classical therapeutic activity which is harmless, nonexploitative, and possibly supportive of the therapy itself.[20]On the other hand, a boundary violation is potentially harmful to the patient and the therapy. It constitutes exploitation of the patient. Boundary crossings and violation may arise from the therapist or from the patient. This might lead to non-sexual or sexual boundary crossings or boundary violations.[21]Though all health professionals need to be aware of boundary issues, psychiatrist have an additional responsibility for various reasons, as mentioned below.[22]

Knowledge about boundary issues is important for effective healthcare for prevention of BVs by oneself and in reducing harm to patientsPsychiatric patients are more vulnerable to BVsBVs can lead to further emotional problems; therefore, unless the treating therapist is aware that BVs, he or she is unlikely to recognize or handle it effectivelyThe doctor/therapist who violates sexual boundaries needs to be confronted and may need psychiatric or psychological evaluationIn psychiatry, as the therapeutic relationship is prolonged and more personal as many confidential matters are discussed, there is likelihood of developing strong emotional bonds. This may lead to nontherapeutic activityFalse allegations by patients are not uncommon in IndiaThe ethical issues in managing boundaries have to be taught, discussed, and supervised.

REASONS FOR BOUNDARY VIOLATION

Negligence of “transference and counter-transference”Personality, illness, and life situation factors in some patients and doctorsDeficits in training about boundary issuesLack of knowledge on “dual relationships” risks between doctors and patients.

MEASURES TO BE TAKEN

Educate all the health care professionals, patients, and caregiversMake certain supervision in clinical practiceDevelop clear ethical guidelinesMotivate hospital/health management/medical societies in India to implement the guidelinesEnsure legal advice for all involved – patient victim, offending doctor, and “third party doctors.”

Guidelines for doctors on Sexual boundaries Version 3.4 (IPS)The Bangalore declaration group had formulated this guideline which had been uploaded to the Medical Council of India website, the excerpts had been given below.[23]

Sexual relationships between doctors and patients invariably harm bothCode of conduct for doctors and patients irrespective of genderDoctors should not exploit the doctor–patient relationship for personal, social, business, or sexual gainEven if the patient attempts to initiate the sexual relationship, it will be against good medical practice for a doctor to enter into such a relationshipAny sort of non-consensual sexual activity would account to sexual abuse/molestation/rape, and doctors would be answerable to the law of the landTaking sexual history and performing appropriate physical examination should be done sensitively and documented properlyTreatments which require sedation (like electroconvulsive therapy), a nurse should be presentEven a relationship with a former patient is unethical. As of now, IPS puts the time frame as “one year at the very least, after the termination of the doctor–patient relationship”As NSBVs can “slip into” SBVs, it is crucial for all doctors to cautious about warning signalsSocial media should be used responsiblyDoctors should not exploit the doctor–patient relationship for sexual gain. These guidelines are for the safety of both patients and their family membersAny breach in following the guidelines, if reported to the IPS will be referred to the Ethics CommitteeSimilar care should be extended by the doctors while interacting with students, colleagues, and other professionalsFalse allegations can occur, and the doctors should remain alertThe IPS recognizes that SBVs are not restricted to any particular group of doctors, indeed not restricted to doctors alone, but occurs in all professional groups.[24]

MHCA 17, new visionary, new changes The decriminalization of suicide and protecting rights of lesbian, gay, bisexual, transgender, questioning/queer (LGBTQ) community with respect to IPC 306 and IPS 377 are a step ahead towards the futuristic goal. The new challenges with MHCA 2017 with respect to mental health capacity assessment, banning ECT less than 18 years of age, advance directives, nominated representative, etc., have thrown new challenges, and the psychiatrists are on the process of examining pros and cons in their practical field of work over last three years after the implementation of this legislation.One should work in the existing legal framework and should follow the law of the land. Therefore, ethical and legal issues are intertwined as well as bidirectional. The confidentiality builds the foundation stone for the doctor–patient relationship, and breach of confidentiality is both illegal and unethical except in exceptional situation (Tarasoff duty, Privileged communication). Young ladies with higher socioeconomic and educational status are more significantly associated with unwillingness to voluntarily disclose, which makes them guarded in initial settings.[25]The procedures of involuntary admission had evolved gradually over the years with utmost care given to the human right issues which is summarized in Table 8.Table 8Chronology of management of involuntary admissionMental Health Act ‘87Madrid Declaration ‘96Hawaii Declaration, 88Major situations when it’s necessary for involuntary admission areInvoluntary intervention is a great infringement of the human rights. Specific criteria and safeguards are requiredNo procedures must be performed or treatment given against patient’s will unless the patient lacks capacity (i) Patient is dangerous to self and others (ii) Possibility of improvement following hospitalization (iii) Patient is incompetentOpen in a separate windowThe specialized training with respect to mental health in prison set up is required. The inmates, patients, individuals having severe psychosis, dementia, and intellectual disability have more chance of having absconding behavior, and they can be provided with metal bracelets (“kadas”) which are most acceptable religiously which can be engrossed with name, address, contact numbers, and GPS trackers.[26]The disability benefit for PWMI has to be provided in accordance with Rights to Persons with Disabilities Act, 2016. The deficits have been subclassified on self-care, interpersonal, social, and occupational functioning and in turn, impaired quality of life domain. The decentralization of certification procedure at PHC (primary health care staff) is now a reality.[27,28,29]The conflicts of interest often arise when the primary interest such as patient’s welfare and validity of research is subsequently being influenced by secondary interest (financial gain, promotion of brands of pharmaceutical companies, etc.).Minimizing disruption of care in pandemic days The Telemedicine Practice Guideline has already been issued, which increases the responsibility of a psychiatrist, especially when it comes to the issues related to confidentiality and boundary violations. In person consultations, though have specific advantages as Indian patients are more boosted up by “Darshan” of their doctors which also helps to build therapeutic relationships. However, in the days of a pandemic the patients are being encouraged to follow Telemedicine for the safety of both the patients and their doctors. APA termed it as life saving physical distancing measures to be followed if at all in person consultation is required in the office of a psychiatrist.In the current Telemedicine guideline, the voluntary consultation by video, audio calls, text messages and E-mails are considered as implied consent. However, the exemptions of concepts are there, for example, in emergency situation, therapeutic privilege (when the necessary information may potentially harm the patients), incompetence due to mental illnesses, in minors and when as a waiver patient explicitly accepts all the decisions of the treating team. The former Medical Council of India (now replaced by Board of Governors) recommended that all the professionals should join their respective societies to constantly update their knowledge and should work in their own ambit. A neurologist treating a psychiatric patient and vice versa routinely other than in emergency situation are essentially unethical. There are other explicit unethical practices in these noble practices also but the nefarious activities by a negligible few blacksheeps could not be generalized.CONCLUSIONSEven today in medical practice, the doctors enjoy paternalism and it’s the need of the hour to maintain highest professional ethical standards to avoid controversy in the era where information are spreading at the fastest pace. The sensitization process should begin in undergraduate education and winded up in post-graduation training keeping in mind our own culture, standards of living, cultures, ethos, and values.

Ethical aspects of psychiatry practice should be learned and updated to all from time to timeThe clinician should learn most suitable and best fit modelThe ethical guidelines are continuously evolving and one has to work in this frameworkOne should not do any act which one should not like to receive from othersThe essence of all these recommendations is that psychiatric patients should be treated with dignity and respectOne should work in the existing legal framework and should follow the law of the land. Therefore ethical and legal issues are intertwined as well as bidirectional. The confidentiality builds the foundation stone for the doctor patient relationship and breach of confidentiality is both illegal and unethical except in exceptional situation (Tarasoff duty, Privileged communication etc.).

Financial support and sponsorshipNil.Conflicts of interestThere are no conflicts of interest.REFERENCES1. Agarwal AK. Ethics in psychiatry. Indian J Psychiatry. 1994;36:5–11. [PMC free article] [PubMed] [Google Scholar]2. Rao TS. Ethics in psychiatry. Med Ethics. 1995;3:45. [Google Scholar]3. Sanmukhani J, Tripathi CB. Ethics in clinical research:The Indian perspective. Indian J Pharm Sci. 2011;73:125–30. [PMC free article] [PubMed] [Google Scholar]4. Singh S, Sharma PK, Bhandari B, Kaur R. Knowledge, awareness and practice of ethics among doctors in tertiary care hospital. Indian J Pharmacol. 2016;48(Suppl 1):S89–S93. [PMC free article] [PubMed] [Google Scholar]5. Umashankar M. Ethics in psychiatric society. Telangana J Psychiatry. 2017;3:57–60. [Google Scholar]6. [Last accessed on 2020 Aug 24]. Available from:https://www.lexico.com/definition/ethics .7. Basavaraju V, Enara A, Gowda GS, Harihara SN, Manjunatha N, Kumar CN, et al. Psychiatrist in court:Indian scenario. Indian J Psychol Med. 2019;41:126–32. [PMC free article] [PubMed] [Google Scholar]8. [Last accessed on 2020 Aug 24]. Available from:https://ijme.in/articles/medicine-ethics-and-the-law/?galley=html .9. Agarwal AK. Ethical issues in the practice of psychiatry. Indian J Psychiatry. 2001;43:16–21. [PMC free article] [PubMed] [Google Scholar]10. Beauchamp TL, Childress JF. New York, Oxford: Oxford University Press; 2001. Principles of Biomedical Ethics. [Google Scholar]11. Agarwal AK. Lucknow: Department Psychiatry K.G's. Medical College; 1989. Proceedings of Workshop on Ethics in Psychiatry. [Google Scholar]12. Madhava Menon NR. Medicine, ethics and the law. Indian J Med Ethics. 2008;5:31–3. [PubMed] [Google Scholar]13. [Last accessed on 2020 Aug 24]. Available from:https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr186.pdf?sfvrsn=15f49e84_2 .14. Mishra A, Galhotra A. Mental Healthcare Act 2017:Need to wait and watch. Int J Appl Basic Med Res. 2018;8:67–70. [PMC free article] [PubMed] [Google Scholar]15. Nallur DG. The need for “Code of Practice”as a supplement to Mental Healthcare Act 2017. Indian J Psychiatry. 2019;61:S798–803. [PMC free article] [PubMed] [Google Scholar]16. Agarwal A. AK review of Indian psychiatry research and ethics. Indian J Psychiatry. 2010;52(Suppl 1):S297–305. [PMC free article] [PubMed] [Google Scholar]17. Avasthi A, Grover S. Ethical and legal issues in psychotherapy. CPG. 2009;11:148–63. [Google Scholar]18. Bipeta R. Legal and ethical aspects of mental health care. Indian J Psychol Med. 2019;41:108–12. [PMC free article] [PubMed] [Google Scholar]19. Nambi S, Ilango S, Prabha L. Forensic psychiatry in India:Past, present, and future. Indian J Psychiatry. 2016;58:S175–80. [PMC free article] [PubMed] [Google Scholar]20. Sidhu N, Srinivasraghavan J. Ethics and medical practice:Why psychiatry is unique. Indian J Psychiatry. 2016;58:S199–202. [PMC free article] [PubMed] [Google Scholar]21. Gutheil TG, Gabbard GO. The concept of boundaries in clinical practice:Theoretical and risk-management dimensions. Am J Psychiatry. 1993;150:188–96. [PubMed] [Google Scholar]22. Aravind VK, Krishnaram VD, Thasneem Z. Boundary crossings and violations in clinical settings. Indian J Psychol Med. 2012;34:21–4. [PMC free article] [PubMed] [Google Scholar]23. Kurpad SS, Machado T, Galgali RB. Is there an elephant in the room?Boundary violations in the doctor-patient relationship in India. Indian J Med Ethics. 2010;7:76–81. [PubMed] [Google Scholar]24. Bangalore Declaration Group. A consensus document requesting the Medical Council of India to take action on the issue of boundary violations in doctor-patient relationships. Natl Med J India. 2012;25:96–8. [PubMed] [Google Scholar]25. Gupta S, Sarkar S, Patil V, Patra B. Does sociodemographic background determine the responses to ethical dilemma vignettes among patients? Indian J Psychol Med. 2019;41:155–9. [PMC free article] [PubMed] [Google Scholar]26. Gowda GS, Komal S, Sanjay TN, Mishra S, Kumar CN, Math SB. Socio-demographic, legal and clinical profiles of female forensic inpatients in Karnataka:A retrospective study. Indian J Psychol Med. 2019;41:16–32. [PMC free article] [PubMed] [Google Scholar]27. Lehman AF. Measures of quality of life among persons with severe and persistent mental disorders. Soc Psychiatry Psychiatr Epidemiol. 1996;31:78–88. [PubMed] [Google Scholar]28. Mohan I, Tandon R, Kalra H, Trivedi JK. Disability assessment in mental illnesses using Indian Disability Evaluation Assessment Scale (IDEAS) Indian J Med Res. 2005;121:759–63. [PubMed] [Google Scholar]29. Balakrishnan A, Kulkarni K, Moirangthem S, Kumar CN, Math SB, Murthy P. The Rights of Persons with Disabilities Act 2016:Mental health implications. Indian J Psychol Med. 2019;41:119–25. [PMC free article] [PubMed] [Google Scholar]Articles from Indian Journal of Psychiatry are provided here courtesy of Wolters Kluwer -- Medknow Publications

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Principle of respect for autonomyPrinciple of nonmaleficencePrinciple of beneficencePrinciple of justice.

Principles to follow while breaching confidentiality:

Informing the patient and obtain written consent preferablyDisclose the relevant part only that is utmost important to shareDocumentation with proper notes what the rationale for this decision was.

REASONS FOR BOUNDARY VIOLATION

MEASURES TO BE TAKEN

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tokenpockettokenpocket苹果官网下载|ethics and law

tokenpockettokenpocket苹果官网下载|ethics and law

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