Psychiatry’s Small-World Problem: Ethical Challenges in Treating Multiple Patients from the Same Family or Household

AbstractTreating two patients who either are closely related or are members of the same household can raise a distinct set of ethical challenges. These challenges, which differ depending on whether or not the overlapping patients are aware of the common provider, may include ethics issues related to confidentiality, entanglement, objectivity, expectations, and potential manipulation. This article examines each of these issues and offers general guidance on how to manage such cases. While the focus is on psychiatric care, where these issues are often more pronounced, the reasoning applies to other medical subfields, including those in which overlapping care is either tolerated or sanctioned. The goal is to generate awareness about an underappreciated challenge that has not yet received significant consideration in either the medical or ethics literature.