Ethical and Legal Challenges Complicating Psychiatric Treatment of Youth with Chronic Medical Illness

There are many ethical dilemmas, cultural issues, and legal questions to consider while treating adolescents and transitional age youth (TAY) with chronic medical (including psychiatric) illnesses. This 90-minute workshop, sponsored by the Pediatric CL Psychiatry SIG, will include a series of talks designed to systematically expand the attendee’s knowledge and understanding of these issues through presentations and clinical cases while emphasizing ways to enhance communication with providers from other specialties.

A panel of five presenters, in each of their 15-minute presentations, will highlight the ethical, cultural, and legal issues facing adolescents and TAY with chronic illnesses. This workshop will include high impact case presentations which demonstrate the complexity inherent to clinical practice in caring for this patient population. Research, legal statutes and policy, immigration issues, advocacy, and access to mental health services specific to adolescents and TAY will be explored. The workshop will begin and end with use of the Audience Response System to facilitate engagement and to determine pre- and post-workshop awareness of these complex matters.

Dr. Eva Ihle will examine the ethical, clinical, and legal concerns in patients with disordered eating who view their illness as a personal philosophy or a spiritual belief. The focus of the presentation will be a patient-centered approach to the management of disordered eating from an understanding of the patients’ philosophical constructs. Dr. Andrea Mendiola will describe the protective factors for and legal struggles of a 24-year-old undocumented patient with psychosis simultaneously navigating acculturation. Dr. Tim Van Deusen will address the ethical and legal responsibilities faced by clinicians when treating a homeless, 20-year-old patient with a substance use disorder and other serious medical complications. Dr. Gena Mooneyham will discuss ways in which the consultation-liaison psychiatrist may become a patient care advocate, using examples from the interface of psychiatry and law enforcement. Dr. Mooneyham will also discuss the concept of moral distress, on the part of the provider, as it relates to participating in a system of care that may led to iatrogenic trauma when caring for youth on involuntary psychiatric holds. Finally, Dr. Mary Lynn Dell will discuss dilemmas and treatment obstacles associated with the lack of appropriate medical services when medically complex youth and TAY patients require psychiatric hospitalization outside the optimal setting of a psychiatric unit within a medical facility.

Consultation-Liaison psychiatrists treating complex adolescent and TAY patients with chronic medical and psychiatric comorbidities must be able to contend with multiple ethical, cultural, and legal matters. Audience members will be able to utilize strategies learned in this workshop to mobilize patient advocacy efforts and to apply knowledge gained in order to safeguard the treatment of their adolescent and TAY patients.