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Ethics Commentary: Ethical Issues in Psychosomatic Medicine (Consultation-Liaison Psychiatry)
Sermsak Lolak, M.D.; Yelizaveta Sher, M.D.
FOCUS 2013;11:511-515. doi:10.1176/appi.focus.11.4.511
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Author Information and CME Disclosure

Sermsak Lolak, M.D., Associate Professor, Director of GWU Hospital Consultation-Liaison Service, Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC

Yelizaveta Sher, M.D., Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA

The authors report no competing interests.

Address correspondence to Sermsak Lolak, M.D., George Washington University School of Medicine and Health Sciences, 2120 L St, NW, Washington, DC 20002; e-mail: slolak@mfa.gwu.edu


Psychiatrists who practice in medical settings are often called on to provide their recommendations in medical situations with challenging ethical dilemmas. Although not necessarily trained ethicists, psychiatric consultants are often expected to be expertly versed in the field of medical ethics. It is thus imperative for psychiatrists working in medical hospitals to be familiar with important ethical concepts and questions and have a framework within which they can conceptualize their cases. In this paper, we review the “Four Topics Method,” which provides a framework to help with ethical decision-making strategies for patients in a medical setting. We then discuss three cases using this framework, outlining the ethical dilemmas in question and highlighting important themes.

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Figure 1. A Model for Ethical Decision Making

From Roberts LW, Dyer AR: Concise Guide to Ethics in Mental Health Care. Washington, DC, American Psychiatric Publishing, 2004, p. 307. Reprinted with permission.



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