{"id":3483,"date":"2019-02-25T21:09:53","date_gmt":"2019-02-25T20:09:53","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=3483"},"modified":"2019-03-22T22:32:43","modified_gmt":"2019-03-22T21:32:43","slug":"getting-un-psyched-about-ethics","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/02\/25\/getting-un-psyched-about-ethics\/","title":{"rendered":"Getting Un-Psyched About Ethics"},"content":{"rendered":"

By Nicholas Kontos<\/p>\n

My biggest insecurity about being a psychiatrist with an interest in medical ethics is being a psychiatrist with an interest in medical ethics.\u00a0 Either of those elements is fantastic on its own, and a handful of psychiatrists do advance the idea of our specialty having special ethical standing and knowledge.\u00a0 Yet, having served on transplant listing committees and being consulted for medical decision-making capacity evaluations at an ever-rising frequency, my experience and opinion are that a psychiatrist assuming or assumed to possess the mantle of \u201cethicist\u201d faces two risks.\u00a0 He or she at best becomes a welcome repository for ethical concerns filed under the heading, \u201cpsychosocial,\u201d and at worst may be regarded as a poseur or a pedlar of the esoteric.\u00a0 It is an unfair but, in my opinion, very real state of affairs.<\/p>\n

These anxieties lurked in the background of my thoughts as I researched and wrote my paper, \u201cEthics of Incongruity:\u00a0 Moral Tension Generators in Clinical Medicine.\u201d\u00a0 On the one hand, the piece is an attempt to understand the intense and very human emotional discomfort we experience, seemingly paradoxically, in the face of dilemmas often framed dispassionately as intellectual abstractions.\u00a0 What medical professional is better acquainted with uncomfortable feelings than a psychiatrist?\u00a0 On the other hand, this moral tension, while emotional, is not pathological.\u00a0 So, who am I to claim any special expertise in it, let alone in its ethical bases and implications?<\/p>\n

As is often the case, the wisdom of mentors came to the rescue.\u00a0 My late mentor, Dr. George Murray, emphasized to his fellows that professionally, \u201cyou are physicians first and psychiatrists second\u201d (something he felt should go without saying in an ideal medical world).\u00a0 With that maxim in mind, I set out to delineate and describe \u201cincongruities\u201d of values, agendas, actions, and regard as they occur between and within patients, clinicians, and society, using my observations as a hospital-based physician to guide my thinking and reading.<\/p>\n

Make no mistake, though.\u00a0 I am proud to be a psychiatrist and feel that my specialty has as much to contribute to ethical discussions as any clinical discipline.\u00a0 My education and experience as a consultation psychiatrist foster ongoing consideration of what the word \u201cmedical\u201d means when applied to terms such as \u201cmedical ethics\u201d and \u201cmedical model.\u201d\u00a0 Minus those considerations, I doubt I would have written this paper at all, let alone in the way I chose to.<\/p>\n

However, except when discussing specifically psychiatric ethical matters, I feel it is important to minimize psychiatric jargon and theoretical backing for one\u2019s arguments.\u00a0 In the case of \u201cEthics of Incongruity,\u201d doing so shunted me toward new and useful ways to look at what riles people up ethically (e.g., akrasia and self-deception rather than intrapsychic \u201cconflicts\u201d).\u00a0 Hopefully that process also yielded something useful for ethically engaged clinicians of all stripes.<\/p>\n

 <\/p>\n

Paper title:<\/strong> Ethics of Incongruity:\u00a0 Moral Tension Generators in Clinical Medicine<\/a><\/p>\n

Author:<\/strong> \u00a0Nicholas Kontos, MD<\/p>\n

Affiliations:<\/strong> \u00a0Director of Fellowship in Consultation-Liaison Psychiatry \u2013 Massachusetts General Hospital; Assistant Professor of Psychiatry \u2013 Harvard Medical School<\/p>\n

Competing interests:<\/strong> none<\/p>\n

Email:<\/strong> nkontos@mgh.harvard.edu<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

By Nicholas Kontos My biggest insecurity about being a psychiatrist with an interest in medical ethics is being a psychiatrist with an interest in medical ethics.\u00a0 Either of those elements is fantastic on its own, and a handful of psychiatrists do advance the idea of our specialty having special ethical standing and knowledge.\u00a0 Yet, having […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":353,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[968],"tags":[],"class_list":["post-3483","post","type-post","status-publish","format-standard","hentry","category-clinical-ethics"],"yoast_head":"\nGetting Un-Psyched About Ethics - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/02\/25\/getting-un-psyched-about-ethics\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Getting Un-Psyched About Ethics - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By Nicholas Kontos My biggest insecurity about being a psychiatrist with an interest in medical ethics is being a psychiatrist with an interest in medical ethics.\u00a0 Either of those elements is fantastic on its own, and a handful of psychiatrists do advance the idea of our specialty having special ethical standing and knowledge.\u00a0 Yet, having [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/02\/25\/getting-un-psyched-about-ethics\/\" \/>\n<meta property=\"og:site_name\" content=\"Journal of Medical Ethics blog\" \/>\n<meta property=\"article:published_time\" content=\"2019-02-25T20:09:53+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2019-03-22T21:32:43+00:00\" \/>\n<meta name=\"author\" content=\"Mike King\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Mike King\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2019\\\/02\\\/25\\\/getting-un-psyched-about-ethics\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2019\\\/02\\\/25\\\/getting-un-psyched-about-ethics\\\/\"},\"author\":{\"name\":\"Mike King\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/person\\\/b107957622bc42b2097d15e5e02a112c\"},\"headline\":\"Getting Un-Psyched About Ethics\",\"datePublished\":\"2019-02-25T20:09:53+00:00\",\"dateModified\":\"2019-03-22T21:32:43+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2019\\\/02\\\/25\\\/getting-un-psyched-about-ethics\\\/\"},\"wordCount\":517,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\"},\"articleSection\":[\"clinical ethics\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2019\\\/02\\\/25\\\/getting-un-psyched-about-ethics\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2019\\\/02\\\/25\\\/getting-un-psyched-about-ethics\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2019\\\/02\\\/25\\\/getting-un-psyched-about-ethics\\\/\",\"name\":\"Getting Un-Psyched About Ethics - Journal of Medical Ethics blog\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#website\"},\"datePublished\":\"2019-02-25T20:09:53+00:00\",\"dateModified\":\"2019-03-22T21:32:43+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2019\\\/02\\\/25\\\/getting-un-psyched-about-ethics\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2019\\\/02\\\/25\\\/getting-un-psyched-about-ethics\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2019\\\/02\\\/25\\\/getting-un-psyched-about-ethics\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Getting Un-Psyched About Ethics\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/\",\"name\":\"Journal of Medical Ethics blog\",\"description\":\"A blog to discuss the ethics of medicine in its many guises and formats.\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\",\"name\":\"Journal of Medical Ethics blog\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/files\\\/2026\\\/04\\\/jme-logo.png\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/files\\\/2026\\\/04\\\/jme-logo.png\",\"width\":200,\"height\":50,\"caption\":\"Journal of Medical Ethics blog\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/logo\\\/image\\\/\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/person\\\/b107957622bc42b2097d15e5e02a112c\",\"name\":\"Mike King\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/8caa7ddd85361ccfd46160d9dd41e9ff9aadde6fd8379b80c066d095d69f9f7b?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/8caa7ddd85361ccfd46160d9dd41e9ff9aadde6fd8379b80c066d095d69f9f7b?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/8caa7ddd85361ccfd46160d9dd41e9ff9aadde6fd8379b80c066d095d69f9f7b?s=96&d=mm&r=g\",\"caption\":\"Mike King\"},\"sameAs\":[\"https:\\\/\\\/www.otago.ac.nz\\\/bioethics\\\/people\\\/academic\\\/profile\\\/index.html?id=774\"],\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/author\\\/mking\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Getting Un-Psyched About Ethics - Journal of Medical Ethics blog","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/02\/25\/getting-un-psyched-about-ethics\/","og_locale":"en_US","og_type":"article","og_title":"Getting Un-Psyched About Ethics - Journal of Medical Ethics blog","og_description":"By Nicholas Kontos My biggest insecurity about being a psychiatrist with an interest in medical ethics is being a psychiatrist with an interest in medical ethics.\u00a0 Either of those elements is fantastic on its own, and a handful of psychiatrists do advance the idea of our specialty having special ethical standing and knowledge.\u00a0 Yet, having [...]Read More...","og_url":"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/02\/25\/getting-un-psyched-about-ethics\/","og_site_name":"Journal of Medical Ethics blog","article_published_time":"2019-02-25T20:09:53+00:00","article_modified_time":"2019-03-22T21:32:43+00:00","author":"Mike King","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Mike King","Est. reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/02\/25\/getting-un-psyched-about-ethics\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/02\/25\/getting-un-psyched-about-ethics\/"},"author":{"name":"Mike King","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#\/schema\/person\/b107957622bc42b2097d15e5e02a112c"},"headline":"Getting Un-Psyched About Ethics","datePublished":"2019-02-25T20:09:53+00:00","dateModified":"2019-03-22T21:32:43+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/02\/25\/getting-un-psyched-about-ethics\/"},"wordCount":517,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#organization"},"articleSection":["clinical ethics"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/medical-ethics\/2019\/02\/25\/getting-un-psyched-about-ethics\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/02\/25\/getting-un-psyched-about-ethics\/","url":"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/02\/25\/getting-un-psyched-about-ethics\/","name":"Getting Un-Psyched About Ethics - Journal of Medical Ethics blog","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#website"},"datePublished":"2019-02-25T20:09:53+00:00","dateModified":"2019-03-22T21:32:43+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/02\/25\/getting-un-psyched-about-ethics\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/medical-ethics\/2019\/02\/25\/getting-un-psyched-about-ethics\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2019\/02\/25\/getting-un-psyched-about-ethics\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/medical-ethics\/"},{"@type":"ListItem","position":2,"name":"Getting Un-Psyched About Ethics"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#website","url":"https:\/\/blogs.bmj.com\/medical-ethics\/","name":"Journal of Medical Ethics blog","description":"A blog to discuss the ethics of medicine in its many guises and formats.","publisher":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/medical-ethics\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#organization","name":"Journal of Medical Ethics blog","url":"https:\/\/blogs.bmj.com\/medical-ethics\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/medical-ethics\/files\/2026\/04\/jme-logo.png","contentUrl":"https:\/\/blogs.bmj.com\/medical-ethics\/files\/2026\/04\/jme-logo.png","width":200,"height":50,"caption":"Journal of Medical Ethics blog"},"image":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#\/schema\/person\/b107957622bc42b2097d15e5e02a112c","name":"Mike King","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/8caa7ddd85361ccfd46160d9dd41e9ff9aadde6fd8379b80c066d095d69f9f7b?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/8caa7ddd85361ccfd46160d9dd41e9ff9aadde6fd8379b80c066d095d69f9f7b?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/8caa7ddd85361ccfd46160d9dd41e9ff9aadde6fd8379b80c066d095d69f9f7b?s=96&d=mm&r=g","caption":"Mike King"},"sameAs":["https:\/\/www.otago.ac.nz\/bioethics\/people\/academic\/profile\/index.html?id=774"],"url":"https:\/\/blogs.bmj.com\/medical-ethics\/author\/mking\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/posts\/3483","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/users\/353"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/comments?post=3483"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/posts\/3483\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/media?parent=3483"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/categories?post=3483"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/tags?post=3483"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}