Medico-Legal and Cultural Influences on Ethical Attitudes in Psychiatry: A Cross-Sectional Comparison of U.S. and French Practitioners

Background: Ethical decision-making in psychiatry is shaped not only by bioethical principles but also by medico-legal frameworks and professional traditions. Comparative empirical data across practice systems remain limited. Methods: We conducted a cross-sectional anonymous survey of 578 psychiatrists practicing in predominantly U.S.-based anglophone (n = 428) and predominantly French-based francophone (n = 150) contexts. The questionnaire explored attitudes toward coercion, confidentiality, autonomy, diagnostic disclosure, assisted dying, and emerging therapeutic issues. Group comparisons were performed using chi-square tests and independent t-tests with Bonferroni correction for multiple comparisons. Results: Significant differences were observed across several domains. Compared with French respondents, U.S.-based psychiatrists reported lower thresholds for breaching confidentiality in imminent danger scenarios and distinct perspectives on coercive measures. Differences were also identified in autonomy framing and attitudes toward legalization of assisted suicide and euthanasia. These variations appeared associated with contrasting medico-legal and institutional environments. Conclusions: Ethical attitudes among psychiatrists vary across systems shaped by different legal and professional contexts. Recognizing contextual influences is essential for internationally informed dialogue in psychiatric ethics and for developing guidance sensitive to institutional diversity.