Moral Side of Medicine
tions in clinical practice. It’ s fair to say morality is a deceptively complex concept. In fact, I suspect most adults can’ t explain the difference between morals and ethics. While the terms are often used interchangeably, there’ s an important distinction between the two. 3 Morals are subjective beliefs about right and wrong and can vary across individuals, cultures and time. They can be influenced by upbringing, life experiences and religious beliefs. Ethics, on the other hand, are an agreed upon set of norms that guide behavior within a group or society. An action that aligns with an individual’ s moral beliefs may be considered unethical by societal standards. When determining whether to pursue involuntary hospitalization, two physicians could arrive at completely different decisions based on their moral convictions. Thus, some sort of ethical framework is essential to standardize the decision-making process so that the“ right” outcome is achieved as often as possible.
When faced with a morally perplexing clinical decision, medical professionals have turned for decades to Beauchamp and Childress’ four principles of biomedical ethics: 4 beneficence, non-maleficence, autonomy and justice. In a perfect world, each of these principles is upheld simultaneously. However, reality is hardly ever so straightforward. Physicians are frequently faced with the task of deciding which of the principles should be prioritized, with the answer changing depending on the details of a given clinical scenario.
Imagine you’ re treating a patient who’ s expressed suicidal thoughts and has access to a firearm. There are no family members available to remove the firearm or stay with the patient to help ensure safety. The patient has declined voluntary admission, so you must decide whether to proceed with involuntary hospitalization. The ethical principles most at odds in this case are autonomy, non-maleficence and beneficence. Proceeding with hospitalization would obviously violate the patient’ s right to autonomy. Regarding the principle of non-maleficence, it can be argued that failure to hospitalize qualifies as maleficence via act of omission, especially should the patient end up attempting or dying by suicide. However, a case can also be made that physicians aren’ t able to accurately predict which patients will act on suicidal thoughts, and an unnecessary hospitalization on a locked behavioral health unit has the potential to be very traumatic for the patient. Ultimately, it’ s the principle of beneficence that takes priority in such a case, as the possible harm related to a brief involuntary hospitalization is reasonably believed to be outweighed by the potential for preventing the patient’ s death.
Now, let’ s consider a patient experiencing paranoid delusions about his spouse. He presents to your office with his wife, whom he believes is trying to poison him. No other symptoms of psychosis( e. g., hallucinations, disorganized thinking / speech) are present, and the patient denies any intention to harm his wife or himself. At the conclusion of the visit, the patient’ s spouse pulls you aside and asks you to hospitalize the patient, as he has refused to take the antipsychotic medication you’ ve recommended. Is involuntary hospitalization ethical in this scenario? Compared to the previous patient, it’ s less likely that failure to hospitalize will result in significant harm, given the absence of disorganized behavior or suicidal / homicidal intent. Furthermore, the immediate benefit of hospitalization is less clear, especially considering that the patient’ s delusions could be unresponsive to treatment. Unlike the previous case, the patient’ s right to self-determination wins out in the end.
I’ ve provided here only a small sampling of the many potential scenarios where physicians might have to make a choice regarding involuntary hospitalization. These decisions are almost always challenging, especially when faced with an angry patient or a desperate family member seeking help for a loved one. As I explained to my inquisitive family member, it wouldn’ t be appropriate for me to say whether Lindsay Clancy should’ ve been involuntarily hospitalized without knowing all the details of her illness and treatment; however, by adhering to the four principles of biomedical ethics – autonomy, beneficence, non-maleficence and justice – we can be confident that our decisions in such cases are morally sound.
References:
1
Testa M, West SG. Civil Commitment in the United States. Psychiatry( Edgmont). 2010; 7( 10): 30-40.
2
Kentucky Revised Statutes- Chapter 202A. Accessed September 15, 2026. apps. legislature. ky. gov / law / statutes / chapter. aspx? id = 38119
3
Chaddha R, Agrawal G. Ethics and Morality. Indian J Orthop. 2023; 57( 11): 1707- 1713. doi: 10.1007 / s43465-023-01004-3
4
Principles of Clinical Ethics and Their Application to Practice | Medical Principles and Practice | Karger Publishers. Accessed September 15, 2026. https:// karger. com / mpp / article / 30 / 1 / 17 / 204816 / Principles-of-Clinical-Ethics-and-Their
Dr. Bilbro is a practicing psychiatrist.
November 2026 15