Accepted by the 1st Extraordinary General Board of the Psychiatric Association of Turkey on 22 June, 2002.
Psychiatry is a branch of medical science and every psychiatrist has to abide by the universal, ethical rules of medicine. Provided that no deviation is made from the general, ethical principles of medicine, psychiatry has unique principles and applications. It may be necessary to continuously review ethical principles and rules, as there could be cultural, social and national differences.

Section One (Aim and Scope)

Aim

Article 1. The aim of these rules is to determine the occupational ethical rules psychiatrists are obliged to comply with while performing the necessities of their profession.

Scope

Article 2. All Psychiatrist specialists, neuropsychiatry specialists working in the field of psychiatry, or psychiatrists continuing their psychiatry specialist training fall within the scope of these rules.

Section Two (General Assembly and Principles)

Duties and Tasks of Psychiatrists

Article 3. Psychiatry is the field of medicine concerned with the protection of the mental health of society and the prevention of mental diseases, diagnosis, therapy and rehabilitation of persons with mental disorders, and the development of mental health. Psychiatrists should provide services to patients and their families by making the best cure available that is contemporary, scientific and in compliance with ethical principles. While this service is being provided, consulting with or asking for consultation from colleagues in other fields of medicine or those who have specialized in side branches of psychiatry should be possible whenever deemed necessary.
Psychiatrists should closely follow scientific developments in the field of psychiatry, and reflect these in their application and should not refrain from sharing such new information with their colleagues. The purpose of their research should be to expand the scientific borders of psychiatry.

Article 4. While performing their occupational duties, psychiatrists should be the implementers and advocates of fair and equal right to treatment of patients, of social justice and equality for all, and should act in accordance with principles of medical profession, and scientific and ethical principles of psychiatry in the face of any discrimination.

Neutrality of the Physician

Article 5. Psychiatrists should perform their duties, under all circumstances, indiscriminately, without taking into consideration any political opinions, social status, religious beliefs, nationality, ethnicity, race, color, gender, age, social and economic situation or similar differences of their patients.

Confidentiality Obligation

Article 6. Any and all information regarding a person under any psychiatric examination and/or treatment should be kept confidential within the framework of the patient-doctor confidentiality principle. This information may only be shared, when necessary, with the family on a need to know basis or for consulting with other specialist physicians, solely with the purpose of protecting and developing the mental health of the patient, and by obtaining the approval of the patient. Psychiatrists should not disclose any information concerning their patient to achieve personal, political, administrative, media oriented, or financial interests, or to achieve interests oriented towards academic, professional or personal gains unless their patient’s benefit is in question with respect to personal rights, right to treatment, malpractice, and similar situations.

Information gathered within patient-doctor confidentiality may constitute a justification to withdraw from appearing as a witness at court or being an expert witness, if seen as necessary. When private information related to psychological formation, such as private relations and defense mechanisms, is requested about the private life of the person, presentation of these at court is contingent on the clear and plain permission of the person. When the psychiatrist thinks that it may not be beneficial for the person, he or she should know that he or she is under no obligation to disclose such information even though the person may have granted permission.
The rule of confidentiality may only be broken in a case where there is a possibility that the patient may inflict serious physical, mental or economic damage to self or to his or her environment. In case the psychiatrist encounters a situation, which may require the breach of confidentiality principle, he or she may be obliged to make disclosures to places or persons he or she will see fit and after consulting with his or her colleagues, if possible. In such instances, the psychiatrist should, first of all, warn the patient regarding the steps he or she will be taking, if conditions permit.

The psychiatrist may not provide any information to others or any organization that will cause his or her patient to be known, or else cause the patient’s possible behavior to be predicted. Information being transferred among physicians with the purpose of scientific discussion, throughout the education period, and for control and consultation regarding the disease, fall outside of this rule, provided all characteristics (such as name, identification information and facial profile) which would make identification of the person possible are concealed.

The physician’s preparing a report under circumstances of legal obligation shall not be construed as disclosure of patient-doctor privilege.

Mass Media and Confidentiality Obligation

Article 7. The psychiatrist should take care not to tarnish the honor of the psychiatric profession in front of the public in his or her relations with mass media.
The psychiatrist should not make any diagnosis or comments in any mass media regarding persons he or she has not examined within the patient-doctor relationship. When participating for the purpose of public education, the psychiatrist should not ask questions which may be construed as their examination, and should not diagnose, comment or make any suggestions to persons who participate in the program with him/her or call the program either on television or radio.
The psychiatrist should not suggest to any person he or she has examined or treated in the past, or is currently examining or treating, to participate in a program of a mass media organization or make a statement, and should not act as an intermediary between the mass media and the patient for such a coordination.
The psychiatrist should not be an intermediary and should not give permission to any images of his or her patients being taken with devices (pictures, videos, TV, cinema, etc.) in the clinical environment, which may result in patients being clearly seen or else interviews with patients for the purpose of being broadcast in audio, video, or published in press or mass media.

Principles of Informing the Public
Article 8. A psychiatrist should show interest in the correct and scientific enlightenment and education of the public in the subjects of mental disorder and mental health of the public, and should stand against any misleading or wrong information from being given to the public in any way or manner. When faced with the behavior of his or her colleagues of communicating misleading or wrong information, the psychiatrist should report this situation to the Branch of Psychiatric Association of Turkey in the region or else to the Regional Medical Chamber.

Principles of Introduction

Article 9. The psychiatrist should not advertise, become an instrument to commercial advertising, and should not give a commercial appearance to his or her work while practicing his or her occupation, and should not behave in a manner that may mislead, cause panic, or misguide people. In announcements, the psychiatrist may realize through broadcasting, he or she may state his or her area of specialization, accepted according to Medical Specialization by-law, if any, and his or her office days and hours.

Non-medical Practices and Methods

Article 10. The psychiatrist should not use methods which have not been accepted scientifically, for any examination or treatment initiative, and should not, under any circumstances, suggest non-medical practices to his or her patient for whatever reason, and should not direct them to person(s) that apply non-medical practices. The psychiatrist should explain to his or her patient that non-medical practices could be harmful or, at the least, that they could be “distracting”.

No Treatment without Examination

Article 11. The psychiatrist should not initiate treatment without examining his or her patient, excluding medical emergencies and compulsory situations.

To act as an Intermediary or Benefit from Intermediaries

Article 12. The psychiatrist should not send patients to other physicians or diagnostic-treatment institutions in return for material benefits, and should not benefit from intermediary persons with the purpose of eliciting patients.

No Self-Interest Based Relations with Industry

Article 13. Psychiatrists should not establish any self-interest based relations with industrial establishments. Relations oriented toward scientific research and education should be transparent and institutional. “Physician and Drug Introduction Principles” prepared by the Turkish Medical Association is valid in such relations.
With the exception of, a) support for participation in local, national and international congresses, symposiums and similar meetings held by scientific institutions with an undisputed scientific value, b) Scientific documents, c) Product reminder giveaways of insignificant material value, the psychiatrist may not accept gifts, cash or valuable goods from pharmaceutical and medical materials sectors, given with the purpose of recommending a product to their patients and, furthermore, should not participate in promotions of such.

Section Three (Patient Rights and Patient-Doctor Relations)

Right to Treatment

Article 14. The Psychiatrist should not prevent or delay the right to treatment of a person for any reason whatsoever.

Obtaining Informed Consent

Article 15. The psychiatrist should provide adequate information for the patient and, when necessary, to the patient’s family for any intervention that will be performed with the purpose of all types of evaluation, treatment, or research, and should receive their informed consent.

Voluntary Hospitalization

Article 16. The psychiatrist should make a special effort to direct the patient and his or her family to voluntary hospitalization in case compulsory hospitalization of the patient is in question due to the possibility of the patient inflicting substantial damage to him/herself or his or her environment due to the effect of the symptoms of the disease.

Involuntary Hospitalization

Article 17. In cases when the patient, or his or her representative, objects to hospitalization, the psychiatrist should then take the decision of involuntary hospitalization by evaluating medical-psychiatric justifications and based on his or her medical knowledge and conscience.

In case the patient has lost the faculty of proper judgment due to a mental disorder, it then becomes the duty of the psychiatrist to act pursuant to the laws of our country in the decision of involuntary hospitalization and application of treatment. The psychiatrist should meet with the family in order to secure the human dignity and legal rights of the patient, and if need be, should act as a guide in applying to the law. In case treatment is applied against the will of the patient, firstly the health of the patient should be considered; however, care should be taken with respect to human rights principles.

Right to Refuse Treatment

Article 18. The psychiatrist should recognize the right of the patient to refuse treatment in cases when there is no threat of danger to the patient or his or her environment.

Right to be Informed

Article 19. The relationship of the psychiatrist with his or her patient should be based on mutual trust and respect. The psychiatrist has the obligation to provide up-to-date information for the patient related to his or her disease.

In cases where the physician thinks that disclosing of diagnosis or findings may not be appropriate from the mental health perspective of the patient, he or she may limit the information to be provided.

Right to Not Being Informed

Article 20. In case the patient has stated that he or she does not wish to be informed with respect to his or her disease, the physician does not need to provide information. Informing of the family should be performed by achieving a consensus with the patient. The physician should decide as to whether the family should be informed for patients who do not have the faculty of distinction.

The Right not to Assume Treatment

Article 21. The patient has the right to refuse examination and treatment from the psychiatrist in a manner not preventing the right to examination and treatment of the patient, excluding situations when such examination and treatment carries vital importance. However, the patient and his or her family should be informed in such a situation and efforts should be made to ensure the patient’s visit or that he or she be taken to another physician.

Fee

Article 22. The patient may obtain prior information from the psychiatrist in the subject of fees. The psychiatrist should not take any fees below the base fees determined by the occupational organization for any examination, inspection or medical intervention.

Preventing Unnecessary Patient Expenditure

Article 23. The psychiatrist should not cause his or her patient unnecessary expenditures, regardless of the patient’s financial situation, and should not recommend an examination or treatment that he or she knows will provide no benefit.

Influencing the Patient

Article 24. Aside from medical purposes, the psychiatrist should not use his or her influence on the patient.

Principles of Respecting Patient-Doctor Relations

Article 25. The psychiatrist should not allow any type of relations between him/her and the patient outside of diagnosis and treatment purposes. The psychiatrist:
Should not have any sexual relationship with his or her patient.

Should keep possible social encounters with his or her patient limited within the ethical principles framework of medicine.
Should not expect, and should not accept if proposed, any material or other returns from his or her patient besides examination and treatment fees.
Should not enter into any relationship with his or her patient oriented toward achieving benefits or gaining advantages.

Section Four (Intraprofessional Relationships)

Respect Among Colleagues

Article 26. The psychiatrist should establish good relations with all physicians and members of other professions that are involved in human health, and should not behave in a debasing manner towards his or her colleagues or other health care workers.

Professional Solidarity

Article 27. The psychiatrist should protect his or her colleagues against professionally defamatory and unjust attacks.

Principle of Competence

Article 28. The psychiatrist may not present himself/herself as being a specialist or authorized in a subject contrary to facts, even if benefit or harm of a patient or a colleague may not be in question. In case a psychiatrist presents himself/herself as being a specialist or authorized in a subject contrary to facts and to the detriment of a patient or another psychiatrist, he or she should be aware that his or her ethical responsibility would also increase as well as his or her legal responsibility.

Section Five (Human Rights)

Necessity To Act In Conformance with International Treaties

Article 29. Each physician has the obligation to abide by all human rights documents and, primarily, the Universal Declaration of Human Rights, as well as common rules related to medicine.

Human Rights in Professional Practices

Article 30. Psychiatrists should practice as much as possible the least restricting treatment procedures, knowing that their patient is a free and independent person, and by respecting and trusting his or her personality.

Principal of Non-assistance in Torture

Article 31. The psychiatrist should be against torture under all circumstances and should attend to the treatment of tortured persons, who show signs of mental disorder, or should direct them to persons or institutions that will provide such treatment. No psychiatrist may participate or assist in torture or similar procedures, or draft reports that are contrary to facts. Each and every physician who is faced with cases of torture allegations should use his or her professional knowledge to bring out the truth.

Principle of Non Participation in Capital Punishment

Article 32. The psychiatrist should not be present at the execution of capital punishment, should not assist in an execution, and should not provide any medical service whatsoever for the execution of capital punishment.

Medical Aid to be Provided to Detainees and Convicted Persons

Article 33. The examination of detainees and convicted persons should be performed under conditions suitable for medical practice, respecting personal rights, just as is the case for other patients, and their right to confidentiality should be protected. The psychiatrist has the right and responsibility to claim from the concerned parties the provision of such conditions. The name, surname, diploma number, and signature of the physician must be affixed on the documents and reports that will be drafted as a result of the examination. In case the document or report has been written under pressure, the psychiatrist should notify this situation to his or her professional organization (TTB and TPD) in the shortest time possible.

Rejection of Medical Aid by Detainees and Convicted Persons

Article 34. The physician should explain to those detainees and convicted persons, who knowingly reject examination and treatment options, what the results of their behavior might be, and should neither try nor suggest examination and treatment by force.

Extraordinary Circumstances and War

Article 35. The physician impartially applies medical ethics rules that are of a universal nature in extraordinary situations and war. In circumstances where necessary medical aid cannot be given to all due to the high number of sick and wounded, the physician will give priority to serious cases with a high probability of treatment.

Section Six (Medical Research and Publication Ethics)

Properties of Scientific Study in Psychiatry

Article 36. The psychiatrist, who is a man of science, is obliged to follow the rules of science and research ethical principles found in the handbook “Ethical principles in Science” of the Turkish Academy of Sciences in his or her scientific research. He or she should also show special care in protecting the mental and physical integrity, as well as the independence of, psychiatric patients, due to their being especially sensitive as research subjects.

Research on Humans

Article 37. Clinical, experimental or epidemiological research to be conducted on humans may be performed subject to being approved by local ethics boards with the purpose of contributing to scientific knowledge. All research conducted on human beings are to be performed by persons who are adequate and competent from a scientific and professional point of view. The researcher bears the full responsibility of the research.

Requirement to Obtain Informed Consent of the Subject

Article 38. It is compulsory to provide each and every subject with sufficient information in a plain language that the subject can clearly understand about the purpose, methods, expected benefits and possible side effects of the research for all the research that will be performed on human beings. The subject is told that he or she may withdraw from the research, if he or she so wishes, after the study is initiated, and that he or she may revoke his or her consent, but that his or her following treatment and follow-up will not be disrupted due to this reason. Whether the subject has sufficiently understood being informed is evaluated following the informing.
After sufficient information is provided about the research, the written consent of the subject is obtained. Such consent should be based on the free will of the patient.

Incapacity to Discriminate

Article 39. The informed consent of parents or guardians should be taken with respect to minors and/or persons without the capacity to discriminate.

Protection of the Subject

Article 40. In medical research conducted on humans, the subject’s life, health and physical and mental integrity should be sustained over and above social or scientific interests at all times.

Respect of privacy of the subject and confidentiality of personal information should be ensured. The identity of the subject should be kept confidential in scientific research and publications, as well as presentations with an academic-scientific purpose.

The research should be halted in case there is any suspicion of serious threat to the subject during medical research, regardless of the expected contribution of such research.
Publication Ethics

Article 41. While evaluating research data and preparing it for publication, the physician should reflect the scientific facts. The names of persons who have personally not participated in the study may not appear in such publication. Data, cases and written works should not be used without providing references and obtaining permission.

Section Seven (Miscellaneous Provisions)

Article 42. Being a physician, each psychiatrist should act in accordance with “Medical Deontology By-law”, and “Turkish Medical Association Occupational Ethical Rules”, as well as the Ethical Rules of the Psychiatric Association of Turkey, as he/she is also a psychiatrist.

Article 43. When situations that are not covered by these rules are encountered, the physician abides by general ethical principles, national regulations, and provisions declarations and treaties of an international nature.

Article 44. Each psychiatrist, while knowing that he or she has to protect the honor of the medical and psychiatric profession and his or her colleagues, he or she should not, nevertheless, fall into a position that supports practices that are contrary to the ethical principles of medicine.

Article 45. The psychiatrist should report his or her colleagues to the relevant branch of the Psychiatric Association of Turkey, or the relevant chamber of medicine in case he or she witnesses any violation of ethical principles by such.

Section Eight (Application and Amendment Procedures of Ethical Rules)

Determining Psychiatric Ethical Rules

Article 46. Paths to follow and association members involved in determining or amending psychiatric ethical rules are as follows:
“Human Rights and Ethical Scientific Study Unit” found within the structure of the Psychiatric Association of Turkey has first-degree responsibility in drafting amendments to the provisions of “Psychiatry Ethical principles”. This study unit may commence studies ipso facto or upon a recommendation received from another study unit reporting to the association, Central Executive Unit, Central Discipline Committee, a branch management, or a TPD member. It is responsible to Central Management Board in its studies.

The "Human Rights and Ethical Scientific Study Unit " and “TPD Discipline Committee” work in coordination on the subject of ethical principles within the framework of international laws, agreements, declarations related to medical or psychiatric ethics, TTB, the World Health Organization, the World Medical Association, the European Medical Specialists Association, and the rules of the World Psychiatry Association.

The coordination and division of labor principles and rules between the “Human Rights and Ethical Scientific Study Unit" and the Central Discipline Committee are determined by a protocol to be executed between the Central Executive Committee, the Central Discipline Committee, and the Human Rights and Ethical Scientific Study Unit Coordinator. This protocol is kept by the Central Executive Committee.

After the draft text prepared according to this protocol is sufficiently discussed and developed by medical circles, the draft text is placed in the Central General Assembly agenda by the Central Executive Committee. The draft is accepted by majority vote in the Central General Assembly and becomes final.

Application of Ethical Principles of Psychiatry

Article 48. When there is an inconsistency between Medical Deontology By-law (TDT) or the Occupational Ethical Rules of the Turkish Medical Association (TTBMEK) and Psychiatry Ethical principles:

In case such an inconsistency regarding a principle, then TDT and TTBMEK shall be taken as the basis and the relevant amendments will be made to TPD Ethical principles at the first opportunity.

In case the definition in TDT and TTBMEK remains general and does not include details related to the practice of psychiatry, and provided such a situation is defined with its full details in TPD Ethical principles, then TPD Ethical principles are applied.

Entry into Force

Article 49. Application of ethical principles in its entirety falls under the individual and collective responsibilities of all the psychiatrists as well the entire psychiatric professional community. The Psychiatric Association of Turkey implements the applications related to these principles on behalf of the psychiatric occupational community. In case an application or a notification regarding noncompliance with ethical principles is in question, implementation is performed according to the procedures of Investigation – Inquiry – the Judgment of the Psychiatric Association of Turkey and Internal Regulation Concerning Central Disciplinary Committee procedures.

Enforcement

Article 50. It shall be effective as of the date it is announced to the psychiatric community, through TPD broadcasting tools following the acceptance of Psychiatric Ethical principles at the TPD Central General Assembly.