The ethics of exposure: Relational bioethics, responsibility, and systemic failure in psychiatry and mental healthcare

Abstract

Background

This study examines the ethical, institutional, and legal factors influencing psychiatric care in Italy, highlighting how systemic fragmentation, chronic underfunding, and increasing medico-legal liability contribute to moral distress among clinicians and the adoption of defensive psychiatric practices. The objective is to assess the impact of these factors on both patient outcomes and the capacity of healthcare professionals to deliver effective and ethically sound care.

Methodology

Using a qualitative, narrative-based, and reflexive methodology, the paper draws on the testimonies of the authors and a series of anonymized clinical narratives, including but not limited to cases of suicide. These accounts were selected for their paradigmatic value in revealing structural dynamics, rather than for statistical representativeness. The analysis combines narrative ethics and relational bioethics to examine how systemic vulnerability manifests in everyday psychiatric practice.

Discussion

Fear of litigation and institutional abandonment can significantly influence clinical judgment, resulting in excessive control measures, procedural overreach, and emotional exhaustion among healthcare professionals. Defensive practices – such as over-hospitalization, over-prescription, and hyper-documentation – arise not from negligence but as adaptive responses to institutional fragility.

Perspectives

The study offers three key contributions. First, it recalls the One Health paradigm as the only viable framework for bringing together mental healthcare and institutional ethics, highlighting the need for interdependent and ethically sustainable systems of care. Second, it situates the Italian case within a broader reflection on the erosion of meaning in mental health practice within systems that demand total accountability without offering protection to their professionals. Finally, it calls for institutional architectures capable of sustaining both clinical presence and shared responsibility.