We Have a Need: The Ethical Dilemmas for Ukraine and for Our Patients

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

In his speech to Congress yesterday, President Zelensky of Ukraine, referring to Rev Dr Martin Luther King Jr.’s “I Have a Dream” speech, said “I Have a Need” in terms of help from the United States. He got a bipartisan standing ovation. Later that day, President Biden promised to fill some of those needs, but certainly not all. The Russian response seemed to be to bomb a theater shelter despite—or because of—signs saying there were children inside.

Our government has had a major ethical dilemma in trying to help Ukraine, toeing how far to safely go on the narrow bridge of providing resources. When bullies are cornered, they often strike back stronger. On the other hand, the nuclear option could be used no matter what our country does or does not do. We know from our individual patient care that future violence is difficult to predict. In this case of a leader and a country, that nuclear option has not been used in prior conflicts with us. A cease fire and compromise would provide some realistic optimism.

In the meantime, massive numbers of refugees from broken up families, civilian deaths, and massive infrastructure destruction, including medical facilities, pile up, while posttraumatic stress disorders lie in waiting. It could be much worse, of course; Ukraine could already be conquered.

If any field should have ready empathy with our political deliberations, it is ours. On a much, much smaller scale, but more personal scale, over the last 30 years or so, we have faced a similar ethical dilemma in our patient care under for-profit managed care control.¹ What is limited is more costly medication and amount of psychotherapy. Either acquiesce or go into private practice, for which there is limited opportunity. So far, psychiatrists have not tested the presumed restraint of trade legality in order to collectively fight these limitations. Fortunately, there is no similar nuclear option for managed care and insurance companies.

When we accept the current limitations for how we can help, we are often left with a painful moral anguish. Burnout often follows.

I, with my only readily available tool being writing so many of these daily columns on Ukraine over the last 3 weeks, feel anguish in not being able to do more for the Ukrainian people.

We want enough freedom to take care of our patients well. Our patients want enough freedom from their illness to be well. The Ukrainians want enough freedom to live and live their lives well.

Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues relate to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times^TM.

Reference

1. Moffic HS. The Ethical Way: Challenges & Solutions for Managed Behavioral Healthcare. Jossey-Bass; 1997.