Psychiatric EthicsPub Date : 2021-01-01DOI: 10.1093/MED/9780198839262.003.0021
C. Oppenheimer, J. Hughes
{"title":"Psychiatry of the elderly","authors":"C. Oppenheimer, J. Hughes","doi":"10.1093/MED/9780198839262.003.0021","DOIUrl":"https://doi.org/10.1093/MED/9780198839262.003.0021","url":null,"abstract":"This chapter describes the ethical issues that arise in the setting of mental illness, and particularly dementia, in old age. It affirms the importance of understanding each older person as an individual, embedded in a unique history and in relationships which sustain their identity even in the face of cognitive decline. Autonomy and paternalism are discussed, and the alternative concept of ‘parentalism’ introduced. Decision-making capacity and competence are extensively analysed from both philosophical and practical viewpoints, with particular reference to the Mental Capacity Act 2005, and to mechanisms for decision-making for noncompetent patients. Topics briefly treated include predictive diagnosis and mild cognitive impairment, end-of-life care, truth telling, sexuality, and the UN Convention on the Rights of Persons with Disabilities. The text is aimed at old age psychiatrists and other practitioners in the field, as well as at those with an interest in ethical issues in old age.","PeriodicalId":302592,"journal":{"name":"Psychiatric Ethics","volume":"289 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120932644","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}
M. Jayaram, S. Farrand, D. Velakoulis, C. Pantelis
{"title":"Physical treatments","authors":"M. Jayaram, S. Farrand, D. Velakoulis, C. Pantelis","doi":"10.1201/b13311-23","DOIUrl":"https://doi.org/10.1201/b13311-23","url":null,"abstract":"Physical treatments in psychiatry form the mainstay of psychiatric treatments alongside other psychological therapies. Ethical decision-making in the best interest of the patient should always take precedence over any conflict of interest; however, this is a complex area given multiple competing interests and which requires careful evaluation and reflection. We explore the complex interplay between psychiatrists and the pharmaceutical industry with a particular focus on research, drug development and discovery, publication, and dissemination. We also focus on ethics relating to treatments in special groups such as those experiencing pregnancy and postnatal care, early intervention, pharmacogenomics, or treatment-resistant schizophrenia. We then discuss issues relating to consent that correlate with case law and precedents set, which have impact on daily clinical life. Ethical issues relating to neurostimulation including electroconvulsive therapy or newer treatments such as transcranial magnetic stimulation and deep brain stimulation are also explored, outlining historical issues and contemporary guidelines leading to improvements in care.","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":"133699388","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/9780198839262.003.0009
S. Green
{"title":"Psychiatry and the pharmaceutical industry","authors":"S. Green","doi":"10.1093/MED/9780198839262.003.0009","DOIUrl":"https://doi.org/10.1093/MED/9780198839262.003.0009","url":null,"abstract":"Conflicts of interest pervade the relationship between the psychiatric profession and pharmaceutical industry, threatening ethical standards of psychiatric care. They influence the quality and cost of treatment, the objectivity of research and educational activities, and the integrity of individual psychiatrists, as well as the profession in general. Various groups, apart from drug companies, bear responsibility for the prevalence of conflicts of interest, including individual practitioners and researchers, medical academe, professional organizations both within and external to psychiatry, and branches of the government. Reforming practices and policies that encourage such conflicts can only be contained by efforts aimed at educating the profession and public as to the relevant issues, as well as enlisting governmental action, in order to hold industry and the profession more accountable for potentially unethical collaborative activities.","PeriodicalId":302592,"journal":{"name":"Psychiatric Ethics","volume":"96 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":"115089619","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/9780198839262.003.0020
A. Sondheimer, N. Karnik, Peter Jensen
{"title":"Child and adolescent psychiatry","authors":"A. Sondheimer, N. Karnik, Peter Jensen","doi":"10.1093/med/9780198839262.003.0020","DOIUrl":"https://doi.org/10.1093/med/9780198839262.003.0020","url":null,"abstract":"Ethical dilemmas unique to child and adolescent psychiatry are consequences of the child psychiatrist’s duty to serve as advocate for child patients while simultaneously having professional responsibilities to the parents and guardians of the children, as well as to child-related institutions inclusive of schools, juvenile justice systems, and childcare agencies. In addition, awareness of developmental differences is paramount, as continuous maturation occurs from ages zero through eighteen years and beyond. With this in mind, the chapter first reviews ethical principles and reasoning and the influence of context on such ever-present matters as assent/consent/dissent, agency, assessment, treatments, and confidentiality, and then hones in on current and future dilemmas posed by the needs of transitional age youth and the impacts of social media, marijuana decriminalization, alternative sexual and gender expressions, minority vulnerabilities, and casualties of global conflicts. A separate section focuses on ethical considerations relevant to research performed with child subjects.","PeriodicalId":302592,"journal":{"name":"Psychiatric Ethics","volume":"41 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":"127567754","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/9780198839262.003.0022
P. Candilis, R. Martinez
{"title":"Forensic psychiatry","authors":"P. Candilis, R. Martinez","doi":"10.1093/med/9780198839262.003.0022","DOIUrl":"https://doi.org/10.1093/med/9780198839262.003.0022","url":null,"abstract":"Forensic psychiatry derives the ethics of the subspecialty from a review of its historical evolution. From its early origins in community psychiatry to its contemporary applications in cultural narrative and human rights, forensic ethics has come to recognize multiple perspectives in its theory and practice. Tools like narrative, cultural assessment, and self-reflection now characterize a professional ethics that adopts an integrative approach to the intersection of two very different value systems, those of Law and Medicine. As practitioners recognize the vulnerability of persons and values caught at this junction, innovative thinking about social justice and human rights enhances the ethical understanding of the profession’s goals and purpose.","PeriodicalId":302592,"journal":{"name":"Psychiatric Ethics","volume":"9 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":"128313581","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/9780198839262.003.0005
M. Laney, J. Sadler
{"title":"Psychiatric diagnosis","authors":"M. Laney, J. Sadler","doi":"10.1093/med/9780198839262.003.0005","DOIUrl":"https://doi.org/10.1093/med/9780198839262.003.0005","url":null,"abstract":"Prior discussions of ethics in psychiatric diagnosis have focused on the development of classifications of psychopathology and the social features and implications of the use of psychiatric diagnostic categories. This chapter focuses instead on the ethics and values involved in the conduct of psychiatric diagnostic assessment ethics in the practice of diagnosing in mental health. The authors build an account of ethics of diagnostic practice using virtue epistemology theory, undergirded by Pellegrino’s account of medical morality as helping, healing, caring, and curing. The authors develop a set of diagnostic virtues (receptivity, empathy, inquisitiveness, self-knowledge, rigour, resolve, fallibilism, fecundity, practical wisdom, and faithfulness) and apply them to an illustrative case scenario.","PeriodicalId":302592,"journal":{"name":"Psychiatric Ethics","volume":"11 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":"128470614","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/9780198839262.003.0024
M. Robertson, G. Walter
{"title":"Trauma and psychiatry","authors":"M. Robertson, G. Walter","doi":"10.1093/MED/9780198839262.003.0024","DOIUrl":"https://doi.org/10.1093/MED/9780198839262.003.0024","url":null,"abstract":"Over the last decade, psychological trauma has re-emerged as a critical factor in psychiatric discourse. The ubiquity of traumatic stress, extending from the hidden ‘epidemic’ of violence within families to the vexed challenges posed by the chaotic geopolitical challenges since 9/11, has forced psychiatry to engage again with the area. This chapter examines the ethical challenges arising from the reformulation of posttraumatic stress disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, trauma-informed care in health systems, recent progress in the understanding of the psychobiology of traumatic stress, and how psychiatrists must position themselves in an increasingly illiberal society that often fails to protect the most vulnerable people.","PeriodicalId":302592,"journal":{"name":"Psychiatric Ethics","volume":"12 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":"127894811","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/9780198839262.003.0016
C. Allan, A. Farmer, P. McGuffin
{"title":"Psychiatric genetics","authors":"C. Allan, A. Farmer, P. McGuffin","doi":"10.1093/med/9780198839262.003.0016","DOIUrl":"https://doi.org/10.1093/med/9780198839262.003.0016","url":null,"abstract":"The development of psychiatric genetics as a scientific discipline has provided extraordinary changes in our ability to understand the causes of psychiatric illness. Yet, any research that delves into our genetic code and the fundamentals of what it is to be human is bound to be accompanied by vigorous ethical debate. This has certainly been the case for psychiatric genetics. We offer an overview of the development of the discipline and its associated controversies, and a consideration of recent advances in psychiatric genetics that continue to provide lively debate. Key ethical issues including those relating to eugenics, consent, confidentiality, commercialization and direct to consumer testing, prenatal testing, and clinical use of genetic testing are considered in the hope of ensuring that future developments are accompanied by a well-reasoned conversation that ensures that technological and scientific advances are used for patient benefit in its broadest sense.","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":"128790588","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/9780198839262.003.0019
G. Adshead
{"title":"The psychotherapies","authors":"G. Adshead","doi":"10.1093/med/9780198839262.003.0019","DOIUrl":"https://doi.org/10.1093/med/9780198839262.003.0019","url":null,"abstract":"In this chapter I review some of the ethical dilemmas that arise during the practice of the psychological therapies, as well as aspects of the literature about how these dilemmas might be understood and resolved, including how traditional accounts of health care ethics apply to psychotherapy. I also discuss contemporary dilemmas in psychotherapy. I suggest that the practice of psychotherapy and ethical reasoning have in common attention to values and attention to self -reflection and the capacity to think about mental experience. This chapter is based on the chapter in the first edition which was written with Professor Jeremy Holmes, and I acknowledge here with gratitude his wisdom and influence on my thinking in this area.","PeriodicalId":302592,"journal":{"name":"Psychiatric Ethics","volume":"44 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":"114868445","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/9780198839262.003.0011
D. I. Joseph, M. Goldstein, J. Onek
{"title":"Confidentiality","authors":"D. I. Joseph, M. Goldstein, J. Onek","doi":"10.1093/med/9780198839262.003.0011","DOIUrl":"https://doi.org/10.1093/med/9780198839262.003.0011","url":null,"abstract":"Ethics involves wrestling with difficult, conflicting courses of action. Medical ethics, and psychiatric ethics in particular, is especially challenging, given the need to negotiate a course of action with patients and family. Confidentiality, which is at the centre of psychiatric practice, and is essential if psychiatric treatment is to be successful, has been challenged and even somewhat eroded by legal developments and social change. Psychiatrists cannot promise absolute confidentiality to their patients. While it is tempting to look to ‘the law’ to determine when breaking confidentiality is the ethical decision, psychiatrists must decide whether acting in accordance with the law is the more ethical choice to make when grappling with a difficult clinical situation. The need for strict confidentiality also places constant demands on the psychiatrist to be mindful lest inadvertent lapses in vigilance results in the unethical sharing of patient information. This chapter explores ethical dilemmas in confidentiality in a range of clinical situations involving hospitals, clinics, and private outpatient settings. The unique ethical issues that arise in the treatment of children, adolescents, families, and groups are discussed in detail. The chapter also examines the ethical dilemmas that are often encountered in academic settings, speaking, and publishing. Considerable attention is devoted to the implications of the Tarasoff decision in California and to the Health Insurance Portability and Accountability Act of 1996, which has had a profound impact on the practice of psychiatry in the United States, as well as influencing the law in other countries.","PeriodicalId":302592,"journal":{"name":"Psychiatric Ethics","volume":"10 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":"128461486","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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