Foreword on the Ethical Way Forward? The 2025 Update of Opinions of the Ethics Committee of the American Psychiatric Association

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

Very quietly, it seems that the 2025 edition of “Opinions of the Ethics Committee on The Principles of Medical Ethics, with Annotations Especially Applicable to Psychiatry” has been published by the American Psychiatric Association.¹ I unexpectedly was notified of them from a colleague. It focuses on questions and answers about specific ethical issues. Those accumulate over the years and now take up about 120 pages. So, will these additions help move our ethical principles and actions positively forward? Perhaps an answer comes right in the beginning, in the Foreword to this update.

Being involved with several psychiatric ethics committees over the years and leading the development of an ethics guideline for psychiatrist administrators and organizations that led to my receiving the APA’s 2016 Administrative Psychiatry Award,² I was quite familiar with the Foreword of the 2013 Edition—the Edition that was commonly available and linked until now. These editions focus on individual clinical psychiatrists. Regardless, if you compare the 2 Forewords, the changes in the 2025 edition are striking. The 2013 Foreword is 3 short paragraphs, while that of 2025 is 6 paragraphs, 2 of them quite long. If I understand these 2 Forewords well enough, the main point of the 2013 Edition is that “there are special ethical problems in psychiatric practice that differ in coloring and degree from ethical problems in other branches of medical practice, though the basic principles are the same.”

One of the long paragraphs in the 2025 Edition is devoted to the overall concept of diversity¹:

“This includes practicing cultural sensitivity and adopting practices which will promote the dignity and well-being of each individual patient. A small example would be to ask a patient their preferred name and/or pronouns if the psychiatrist is unsure of the patient’s preference.”

The 2025 Foreword ends with a clarification¹:

“Of note, these options are those of the APA Ethics Committee only. They do not represent official positions of the American Psychiatric Association.”

Why do these changes matter? Due credit should be given in our update about the importance of diversity because that is such an important variable in the access and outcome of mental health challenges and patient care, let alone the necessary diversity among psychiatrists ourselves. In many columns and circumstances, I have labelled diversity problems such as racism and anti-Semitism as social psychopathologies needing their own classification and better interventions. Additionally, as in other of my recent columns, especially yesterday’s, the current relevance of the ethical “Goldwater Rule” has risen once more with the recent Presidential transfer of leadership and administration.

These 2 ethical emphases—diversity and the Goldwater Rule—currently combine in the major dismantling of DEI by the federal government. As President Trump said in an address before a joint session of Congress about a month ago:

“We have ended the tyranny of so-called diversity, equity and inclusion policies all across the entire federal government and, indeed, the private sector and our military. And our country will be woke no longer.”

Would this DEI change essentially mean that the preferred pronouns emphasis in our 2025 Foreword is passe? It would seem like these current political values do not jive with our psychiatric values. Inadequate attention to diversity is often mentally and practically harmful to people and patients. One therefore must question a leader who would not only allow that value of diversity to dissipate, but would kick it along the way out.

The 2025 Foreword, as it reads, will push our ethics forward, but only if we understand and apply it, starting right now in our time of clashing societal values. In a prior book about the dangers of for-profit managed care, I labelled this challenge as trying to take the ethical way.³ As Psychiatric Times polls our readers about our ethical concerns, how can we sit by silently as these incongruent political ethical values are embraced by the current government?

Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He presented the third Rabbi Jeffrey B. Stiffman lecture at Congregation Shaare Emeth in St. Louis on Sunday, May 19, 2024. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.

References

1. Opinions of the Ethics Committee on The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry, 2025 Edition. American Psychiatric Association; 2025.

2. Moffic HS, Saeed SA, Silver S, Koh S. Ethical challenges in psychiatric administration and leadership. Psychiatr Q. 2015;86(3):43-54.

3. Moffic HS. Challenges & Solutions for Managed Behavioral Care. Jossey-Bass; 1997.