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date: 29 January 2020

Abstract and Keywords

We consider the ethical aspects of the relationship of the psychiatrist to the community. We initially use the framework of a “social contract” to explore psychiatrists’ and communities’ reciprocal expectations for one another. We then argue that the concept of an “alliance” between the psychiatrist and community provides a more accurate, productive lens for psychiatrists to advocate and change in their communities. We apply this framework to the following ethical challenges that may arise when psychiatrists become active in their communities: (1) disagreements with allies about public policy; (2) difficulties separating professional expertise and personal values; (3) boundary tensions arising from patient contact outside the usual framework of treatment; and (4) the loss of the psychiatrist’s monopoly on cultural authority.

Keywords: psychiatrist, community, expectations, social contract, alliance

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