Conclusion

Conflicting responsibilities, contradictory goals, hidden scenarios, and unsigned contracts existing in the changing world of both the patient and the professional serve as reminders that ideal resolutions may be unattainable in many divided-loyalty dilemmas. Professionals must be very sensitive to the possibility that they may become double agents in the routines of their everyday practice with its many ambiguities and subtleties.

Further, review and examination of dual-agent issues should be a continuing obligation of mental health professionals, for that is one way to prevent these issues from disrupting the doctor-patient relationship. These are issues that often come before professional ethics committees, which keep them alive through education, codes, and professional discipline.

In cases of divided loyalties, physicians and other health professionals should give the patient their primary loyalty, and other allegiances should be subordinated to that of the patient. Where this is not possible, any conflicting allegiance should be explicitly disclosed. The goal of maintaining trust is essential for the therapeutic relationship, and anything that erodes that goal diminishes not only the therapy or the treatment, but also the therapist and the profession he or she represents.

JAMES ALLEN KNIGHT (1 995) REVISED BY ALLEN R. DYER LAURA WEISS ROBERTS

SEE ALSO: Conflict of Interest; Profession and Professional Ethics; Professional-Patient Relationship; Psychiatry, Abuses of; Research, Unethical

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