Ethical challenges in contemporary psychiatry: an overview and an appraisal of possible strategies and research needs

IF 73.3 1区 医学 Q1 Medicine
World Psychiatry Pub Date : 2024-09-16 DOI:10.1002/wps.21230
Silvana Galderisi, Paul S. Appelbaum, Neeraj Gill, Piers Gooding, Helen Herrman, Antonio Melillo, Keris Myrick, Soumitra Pathare, Martha Savage, George Szmukler, John Torous
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Abstract

Psychiatry shares most ethical issues with other branches of medicine, but also faces special challenges. The Code of Ethics of the World Psychiatric Association offers guidance, but many mental health care professionals are unaware of it and the principles it supports. Furthermore, following codes of ethics is not always sufficient to address ethical dilemmas arising from possible clashes among their principles, and from continuing changes in knowledge, culture, attitudes, and socio-economic context. In this paper, we identify topics that pose difficult ethical challenges in contemporary psychiatry; that may have a significant impact on clinical practice, education and research activities; and that may require revision of the profession's codes of ethics. These include: the relationships between human rights and mental health care, research and training; human rights and mental health legislation; digital psychiatry; early intervention in psychiatry; end-of-life decisions by people with mental health conditions; conflicts of interests in clinical practice, training and research; and the role of people with lived experience and family/informal supporters in shaping the agenda of mental health care, policy, research and training. For each topic, we highlight the ethical concerns, suggest strategies to address them, call attention to the risks that these strategies entail, and highlight the gaps to be narrowed by further research. We conclude that, in order to effectively address current ethical challenges in psychiatry, we need to rethink policies, services, training, attitudes, research methods and codes of ethics, with the concurrent input of a range of stakeholders, open minded discussions, new models of care, and an adequate organizational capacity to roll-out the implementation across routine clinical care contexts, training and research.
当代精神病学面临的伦理挑战:概述及评估可能的战略和研究需求
精神病学与其他医学分支有着相同的伦理问题,但也面临着特殊的挑战。世界精神病学协会的伦理守则提供了指导,但许多精神卫生保健专业人员并不了解该守则及其支持的原则。此外,遵循伦理守则并不总能解决因其原则之间可能存在的冲突,以及因知识、文化、态度和社会经济背景的不断变化而产生的伦理困境。在本文中,我们指出了在当代精神病学中对伦理提出挑战的课题,这些课题可能会对临床实践、教育和研究活动产生重大影响,并可能需要对该行业的伦理守则进行修订。这些议题包括:人权与心理健康护理、研究和培训之间的关系;人权与心理健康立法;数字精神病学;精神病学中的早期干预;精神疾病患者的临终决定;临床实践、培训和研究中的利益冲突;以及有生活经验者和家庭/非正式支持者在制定心理健康护理、政策、研究和培训议程中的作用。对于每一个主题,我们都强调了伦理方面的问题,提出了解决这些问题的策略,呼吁人们关注这些策略所带来的风险,并强调了需要通过进一步研究来缩小的差距。我们的结论是,为了有效应对当前精神病学面临的伦理挑战,我们需要重新思考政策、服务、培训、态度、研究方法和伦理准则,同时听取各利益相关方的意见,进行开放式讨论,建立新的护理模式,并具备足够的组织能力,以便在日常临床护理、培训和研究中推广实施。
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来源期刊
World Psychiatry
World Psychiatry Nursing-Psychiatric Mental Health
CiteScore
64.10
自引率
7.40%
发文量
124
期刊介绍: World Psychiatry is the official journal of the World Psychiatric Association. It aims to disseminate information on significant clinical, service, and research developments in the mental health field. World Psychiatry is published three times per year and is sent free of charge to psychiatrists.The recipient psychiatrists' names and addresses are provided by WPA member societies and sections.The language used in the journal is designed to be understandable by the majority of mental health professionals worldwide.
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