The Psychiatrist as Moral Agent

I s h a l l t r y to show t h a t the p sych i a t r i s t ' s m o r a l problems are not n e a r l y as compl i ca ted as they seem. I f a person seeks psych ia t r i c help, the p s y c h i a t r i s t mus t decide whe the r , and on w h a t t e rms , to help h i m . In f ree societ ies, the p r i v a t e l y p r a c t i c i n g p s y c h i a t r i s t is f ree to accept or re jec t pa t i en t s as he desires. I n such societies, the i n s t i t u t i o n a l (or hospi ta l -employed) p s y c h i a t r i s t also r e m a i n s f ree — to t rea t v o l u n t a r y pa t i en t s on ly on t e r m s acceptable to h i m s e l f and to the pat ients , and to qu i t h is job i f his employe r requ i res h i m to engage i n acts w h i c h he considers to be m o r a l l y unacceptable . T h e c r u x of the p sych i a t r i s t ' s m o r a l d i l e m m a thus l ies i n his a t t i tude t o w a r d i n d i v i d u a l s deemed to be m e n t a l l y i l l who do not seek his services or who ac t i ve ly re jec t t h e m . T o w a r d such persons, the p sych ia t r i s t can adopt one of t w o a n t i t h e t i c a l pos tures : he can embrace coercion as compass ion and therapy , or he can re jec t i t as d isrespect fo r the r igh t s of o thers and c a p i t u l a t i o n to our c r a v i n g to con t ro l people. The f o r m e r pos ture is the o f f i c i a l pos i t ion of m o d e r n " sc i en t i f i c" p s y c h i a t r y the wor ld over. The l a t t e r pos ture expresses the sen t imen t s of the A m e r i c a n E n l i g h t e n m e n t , as e x e m p l i f i e d by T h o m a s J e f f e r s o n ' s b e a u t i f u l s ta tement of i t i n a l e t t e r to his g randson :