Psychiatric EthicsPub Date : 2021-01-01DOI: 10.1093/MED/9780198839262.003.0007
R. Voren, R. Keukens
{"title":"The abuse of psychiatry","authors":"R. Voren, R. Keukens","doi":"10.1093/MED/9780198839262.003.0007","DOIUrl":"https://doi.org/10.1093/MED/9780198839262.003.0007","url":null,"abstract":"Abuse of psychiatry was in the Soviet Union, for several decades, a State policy to quell dissent, and was carried out in collaboration with the then leadership of Soviet psychiatry. Approximately one-third of all political prisoners were subjected to this practice. The Soviet case has been taken as the main example. However, this branch of medicine has been misused elsewhere, in particular, in the Eastern Bloc in the 1980s, and in the People’s Republic of China in the late 1990s. Before World War II, on the pretext of setting up a merciful euthanasia programme, the Nazi regime made medical and nursing staff kill, by injection and gassing, tens of thousands of patients suffering from an incurable physical or mental illness. The chapter ends with thoughts on how the political abuse of psychiatry can be prevented.","PeriodicalId":302592,"journal":{"name":"Psychiatric Ethics","volume":"101 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123078936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Psychiatric EthicsPub Date : 2021-01-01DOI: 10.1093/med/9780199234318.003.0004
R. Martinez, P. Candilis
{"title":"Narrative ethics","authors":"R. Martinez, P. Candilis","doi":"10.1093/med/9780199234318.003.0004","DOIUrl":"https://doi.org/10.1093/med/9780199234318.003.0004","url":null,"abstract":"Narrative ethics developed as a critique of analytic moral philosophy and the principles that shaped early developments in healthcare’s bioethics movement. It resulted in a method for understanding health care ethical dilemmas at the level of individual cases. This chapter reviews the various moral theories preceding narrative ethics, then provides a description of the narrative approach that places emphasis on the telling and listening to the patient’s story as a path toward moral reflection when patient and health care professional join on the occasion of the patient’s illness experience. Two cases illustrate the potential for narrative ethics to enrich the care of persons facing difficult emotional and psychological challenges, one a story of end-of-life decision-making, the other a case involving trauma and depression.","PeriodicalId":302592,"journal":{"name":"Psychiatric Ethics","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127549513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Psychiatric EthicsPub Date : 2021-01-01DOI: 10.1093/med/9780198839262.003.0002
L. Charland
{"title":"A historical perspective","authors":"L. Charland","doi":"10.1093/med/9780198839262.003.0002","DOIUrl":"https://doi.org/10.1093/med/9780198839262.003.0002","url":null,"abstract":"Studying the history of ethics in psychiatry through the chronological development of ethical codes does not do justice to the manner in which ethical themes and issues vanish and recur in that history. This chapter considers some aspects of the history of these codes, though its primary aim is to explore major ethical themes and issues in the history of psychiatry. The humanity of the ‘mad’ and the increasing manner in which persons with mental disorders are thought to be autonomous individuals are two themes that will occupy us. Increasing recognition and acceptance of the autonomy and self-determination of persons with mental disorders is the crowning ethical achievement of the history of psychiatry recounted here. However, there are also reasons to be concerned about possible excesses that may be emerging in this regard in some sectors of psychiatric treatment and research—new historical developments that merit careful ethical scrutiny.","PeriodicalId":302592,"journal":{"name":"Psychiatric Ethics","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125082380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Psychiatric EthicsPub Date : 2021-01-01DOI: 10.1093/med/9780198839262.003.0017
Georg Northoff
{"title":"Neuroethics","authors":"Georg Northoff","doi":"10.1093/med/9780198839262.003.0017","DOIUrl":"https://doi.org/10.1093/med/9780198839262.003.0017","url":null,"abstract":"Neuroethics, located at the interface of conceptual and empirical dimensions, carries major implications for psychiatry, such as the neuroscientific basis of ethical concepts as moral agency. Drawing on data in neuroscience, this chapter highlights issues central to psychiatric ethics. First, it addresses a reductionistic model of the brain, often conceived as purely neuronal, and then it discusses empirical data suggesting that the brain’s activity is strongly aligned to its respective social (e.g., relation to others) and ecological (e.g., relation to the environment and nature) contexts; this implies a relational rather than reductionist model. Second, it suggests that self (e.g., the experience or sense of a self) and personhood (e.g., the person as existent independent of experience) must also be understood in such a social and ecological and, therefore, relational and spatio-temporal sense. Ethical concepts like agency, therefore, cannot be limited solely to the person and brain, but must rather be understood in a relational and neuro-ecological/social way. Third, it discusses deep brain stimulation as a treatment that promotes enhancement. In sum, this chapter presents findings in neuroscience that carry major implications for our view of brain, mental features, psychiatric disorders, and ethical issues like agency, responsibility, and enhancement.","PeriodicalId":302592,"journal":{"name":"Psychiatric Ethics","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123916064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Psychiatric EthicsPub Date : 2021-01-01DOI: 10.1093/med/9780198839262.003.0023
G. Szmukler
{"title":"Community psychiatry","authors":"G. Szmukler","doi":"10.1093/med/9780198839262.003.0023","DOIUrl":"https://doi.org/10.1093/med/9780198839262.003.0023","url":null,"abstract":"Ethical dilemmas in community psychiatry are not novel, but they present in sufficiently different guises to warrant reconsideration in a new context. The models of care and the social climate in which they have developed are reviewed, as well as the key ethical challenges that have emerged. These include concerns about privacy, confidentiality, coercive practices (the range of treatment pressures, ‘involuntary outpatient commitment’ or ‘community treatment orders’), and conflicts of duty to the patient versus others. Approaches to dealing with these issues are presented. These include increasing patients’ involvement in their care (e.g., ‘crisis cards’, ‘joint crisis plans’, and advance directives), clarifying grounds for coercive interventions in the health interests of the patient (e.g., a decision-making-capacity-based approach, the influence of the UN Convention on the Rights of Persons with Disabilities), and considerations concerning the risk of harm to others, including duties to carers.","PeriodicalId":302592,"journal":{"name":"Psychiatric Ethics","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126733701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Psychiatric EthicsPub Date : 2021-01-01DOI: 10.1093/med/9780199234318.003.0008
J. Sabin, N. Daniels
{"title":"Allocation of mental health resources","authors":"J. Sabin, N. Daniels","doi":"10.1093/med/9780199234318.003.0008","DOIUrl":"https://doi.org/10.1093/med/9780199234318.003.0008","url":null,"abstract":"Resource allocation in mental health occurs at four levels. First, within the total allocation a society makes to health care, how much should go to mental health? In most societies, mental health services have been discriminated against. The quest for parity with medical and surgical services reflects the effort to undo this discrimination. In the Oregon priority-setting process, mental health conditions ranked high among community choices. Second, within the mental health sector, which conditions should receive priority? Some priority should be given to those with the most severe impairments, but no principles tell us just how much priority the sickest should receive. Third, within a particular area, such as schizophrenia, how much resource should be devoted to prevention, treatment of acute episodes, or rehabilitation of those with chronic conditions? Finally, in the care of individual patients, how much treatment is ‘enough’? Where and how is the line drawn between interventions regarded as ‘medically necessary’ versus interventions that are desirable but ‘optional’? In the absence of shared principles for making these allocational decisions, societies must establish fair decision-making processes, in which the rationales for policies and decisions are shared with the public, the rationales address meeting population needs in the context of available resources, and a robust appeals process allows patients, families, and clinicians to challenge decisions and policies. Because societies will develop their own distinctive approaches to resource allocation, progress requires looking at the allocation process in an international context.","PeriodicalId":302592,"journal":{"name":"Psychiatric Ethics","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125525183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Psychiatric EthicsPub Date : 2021-01-01DOI: 10.1093/med/9780198839262.003.0025
T. Levin, C. Ryan
{"title":"Consultation-liaison psychiatry","authors":"T. Levin, C. Ryan","doi":"10.1093/med/9780198839262.003.0025","DOIUrl":"https://doi.org/10.1093/med/9780198839262.003.0025","url":null,"abstract":"Ethics in consultation-liaison (C-L) psychiatry involves the intersection of medical illness and psychiatry. Because it is now clear that psychiatric illnesses and substance use also worsen medical outcomes, the field has broadened to a population level, overlapping with primary care. This brings distributive justice to the fore, as large-scale psychiatric screening requires adequate resources to treat identified populations. Ethical challenges masquerading as psychiatric problems or psychiatric issues masquerading as ethical dilemmas are common. Boundary issues, confidentiality, privacy, multiple loyalties in C-L settings, autonomy, decision-making capacity, and end-of-life conflict are frequent areas of ethical concern for the C-L psychiatrist.","PeriodicalId":302592,"journal":{"name":"Psychiatric Ethics","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128347124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Psychiatric EthicsPub Date : 2021-01-01DOI: 10.1093/med/9780199234318.003.0001
S. Bloch, S. Green
{"title":"The scope of psychiatric ethics","authors":"S. Bloch, S. Green","doi":"10.1093/med/9780199234318.003.0001","DOIUrl":"https://doi.org/10.1093/med/9780199234318.003.0001","url":null,"abstract":"Ethical decision-making is no easy matter, as absolutes of right and wrong, good and bad, should and ought, and other evaluative terms are elusive. Both providing the best attainable care for the patient and conducting scientific research guided by lofty ethical principles are paramount. This chapter, an introduction to the fifth edition of Psychiatric Ethics, outlines how the book aims to promote the moral agency of psychiatrists and mental health professionals when relating to patients and their families, colleagues, professional associations, and other organizations, and the society in which they work. It summarizes theoretical frameworks used in ethical decision-making and the range of topics discussed in the other 24 chapters, and offers guidelines to mental health students and graduate clinicians about how to master the field of ethics in psychiatry.","PeriodicalId":302592,"journal":{"name":"Psychiatric Ethics","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131400743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Psychiatric EthicsPub Date : 2021-01-01DOI: 10.1093/med/9780198839262.003.0012
C. Ryan, Jane Bartels
{"title":"Involuntary hospitalization","authors":"C. Ryan, Jane Bartels","doi":"10.1093/med/9780198839262.003.0012","DOIUrl":"https://doi.org/10.1093/med/9780198839262.003.0012","url":null,"abstract":"The chapter outlines a series of arguments designed to answer possibly the most important ethical question in psychiatry: under what circumstances, if any, is it ethically justifiable to treat people with clinical features of mental illness, despite their objection? We argue that involuntary inpatient treatment is ethically justified, but only in circumstances where: the objection to treatment was made without decision-making capacity; there is no reason to believe that the person would have objected had he or she been competent; the treatment will protect the person from serious harms (when balancing these with any harms associated with the treatment); and involuntary treatment represents the avenue for protection least restrictive of the person’s freedom. Having established a model for ethically justified involuntary inpatient psychiatric treatment, we examine how it can be applied to two real-world cases.","PeriodicalId":302592,"journal":{"name":"Psychiatric Ethics","volume":"94 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124616792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Psychiatric EthicsPub Date : 2021-01-01DOI: 10.1093/med/9780199234318.003.0014
G. Gabbard
{"title":"Boundary violations","authors":"G. Gabbard","doi":"10.1093/med/9780199234318.003.0014","DOIUrl":"https://doi.org/10.1093/med/9780199234318.003.0014","url":null,"abstract":"Professional boundaries can be described as the ‘edge’ or limit of appropriate behaviour by the practitioner in the clinical setting. The therapeutic frame comprised of this set of boundaries allows the clinician and the patient to interact in a safe and productive way. These boundaries can be violated by sexual contact between the practitioner and the patient or by nonsexual overinvolvement. The mental health clinicians who transgress boundaries may do so for different reasons, and there are varied characterological and symptomatic clinical pictures that lead to boundary violations. Detailed evaluation of each individual case is necessary to determine if the clinician can be rehabilitated or not. Rehabilitation generally involves psychotherapy, monitoring, practice limitations, continuing education, and supervision. The digital era has brought about new forms of boundary violations involving cyberspace and the relative ease with which information about patients can be accessed.","PeriodicalId":302592,"journal":{"name":"Psychiatric Ethics","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128874522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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