Objective: Increased concern exists regarding non-prescription use of stimulants
in college populations such as for perceived enhancement of cognition and subsequent
improved academic performance or for recreational purposes. Psychiatrists face serious
clinical challenges in making a new diagnosis of adult ADHD in college-age patients and
distinguishing between students who have legitimate ADHD symptoms versus students
seeking secondary gain.
Methods: A hypothetical case will illustrate those challenges and an ethics-based framework
named dialectical principlism will be applied to the case to demonstrate how the competing
considerations can be balanced to inform a resolution for this clinical dilemma.
Results: The weighted considerations related to principles of autonomy, beneficence,
nonmaleficence, and distributive justice were balanced to favor not prescribing stimulant
medication in this hypothetical situation. Others might come to the opposite conclusion using
the same dialectical principlism model because their unique narrative and set of values may
lead to weighing the importance of these principles differently and thus altering the balance
in the other direction.
Conclusion: The method of dialectical principlism was applied to this hypothetical to
illustrate how practitioners can make clinical decisions guided by what is most ethical after
identifying, prioritizing, and balancing the competing considerations. Dialectical principlism
is primarily an aspirational model for practitioners, with the goal of empowering them with a
systematic approach to determine the best way to resolve complex challenges via an ethics