Ethical Issues In Mental Illness

This book is an attempt to address the ethical issues raised by mental illness and its treatment by focusing on the question of autonomy. The mentally ill may be regarded as non-autonomous by virtue of irrationality, which may result in treatment models which deny them a voice. As a counter to this, some have moved to the other extreme and argued that the mentally ill must be regarded as fully autonomous in all circumstances, and consequently that all their wishes regarding treatment must be respected. This book examines the ethical consequences of such simplistic approaches towards autonomy and mental illness, and considers the ethical issues raised by specific forms of treatment. It is suggested in conclusion that improvement in the care and treatment of the mentally ill requires not only a fundamental change in social attitudes but also a less impoverished conception of autonomy than some of those currently employed.

Why write another book on ethics? As practitioners we are involved both in the design and delivery of services to people with mental health problems. In common with all other professionals, our work has led to the experience of ethical dilemmas: typically, these have involved major confrontations, either with our col leagues or our consciences. This book, however, is not limited to a discussion of such major themes. Rather, we have tried to use a broader canvas: ethics, in our view, is really about the judgement of right and wrong in ordinary, everyday life. Ethics are highly personal: we fashion our own personal code from our experi ence of others, and from the 'tests' which bring meaning to our lives. Such experiences shape our individual values. We bring these codes and values to our work. We are not always aware of their influence in our dealings with people. Although we may not always be aware of it, all our actions pose an ethical question. Given that our work involves us in helping others to live ordinary, satisfying lives, this challenge heightens the intensity of our ethical dilemmas. This is most evident where our personal code conflicts with the implicit code of the health setting.

Studies involving children with mental, emotional, or behavioral problems--or their families--have to meet certain standards of research ethics. This book contains chapters on the kinds of ethical dilemmas that typically occur in different types of studies of children, and then presents 65 real-world cases from experts who study children's mental health. These experts offer practical suggestions for how to handle these dilemmas. Chapters on the perspectives of parents, regulators, and bioethicists provide additional points of view on these issues. Written in down-to-earth language, this book will be useful for professionals who study children, for those who train students in research methods, and for parents who are thinking about participating in research studies. In attempting to bridge the apparent gap between ethics and science, the editors close this volume on a note commonly sounded by researchers: more research is needed. Yet in this area, a new kind of research is required. The science of scientific ethics must be developed and expanded, and better understanding of the determinants and circumstances under which children can comprehend and evaluate risks and benefits is needed. Likewise, fuller knowledge of the contextual factors affecting children's and families' consent to participate in research is essential. In particular, development of scales to assess children's ability to comprehend risk-benefit issues, studies of families' reactions to research procedures, and empirical data on the impact of various forms of participant reimbursement will advance both science and ethics. This volume should spur further research, serving as a guide for current investigators, participating families, institutional review boards, and policymakers who shape the research enterprise.

Ethics, Culture, and Psychiatry: International Perspectives is a textbook that explores the best ways to promote the use of the Declaration of Madrid, which outlines ethical standards for psychiatric practice throughout the world. The book is written with two questions in mind, both easy to pose and difficult to answer: Is it possible to formulate a set of principles that will be valid for all psychiatrists, regardless of the cultures to which they belong or in which they live and practice, or are there as many sets of ethical principles as there are cultures? If there is such a set of principles, what should we do to ensure that psychiatry as a discipline makes a significant contribution to societal good without helping the evil? To facilitate the exploration of this territory, 15 experts from a variety of cultures examine the most pressing ethical issues prevalent within the current practice of psychiatry. Many of the dilemmas probed in this book are routinely encountered by clinicians who work in increasingly multicultural societies. The text covers issues that are broadly relevant to clinical practice and research, including: An overview of ethics and societies around the world Discussions of ethical practices and dilemmas specific to various cultural regions Transcultural debate on overarching issues, such as incompetent patients, informed consent, and mental health law reform The complete copy of The Declaration of Madrid printed in the appendix Readers will find that this is a textbook that stimulates and supports, rather than closes, the debate on ethical aspects of professional psychiatric behavior. Ethics, Culture, and Psychiatry: International Perspectives is much more than just a book on ethics -- it is a major contribution to understanding the impact of culture and history on the ethical practice of medicine around the world, and a continuous search for a consensus on how to live together and make contributions to the well-being of people with mental illness, their families, and the family of humans on our planet.

Ethics in Psychiatry: (1) presents a comprehensive review of ethical issues arising in psychiatric care and research; (2) relates ethical issues to changes and challenges of society; (3) examines the application of general ethics to specific psychiatric problems and relates these to moral implications of psychiatry practice; (4) deals with recently arising ethical problems; (5) contains contributions of leading European ethicists, philosophers, lawyers, historians and psychiatrists; (6) provides a basis for the exploration of culture-bound influences on morals, manners and customs in the light of ethical principles of global validity.

Ethical issues inherent in psychiatric research and clinical practice are invariably complex and multi-faceted. Well-reasoned ethical decision-making is essential to deal effectively with patients and promote optimal patient care. Drawing on the positive reception of Psychiatric Ethics since its first publication in 1981, this highly anticipated 5th edition offers psychiatrists and other mental health professionals a coherent guide to dealing with the diverse ethical issues that challenge them. This edition has been substantially updated to reflect the many changes that have occurred in the field during the past decade. Its 25 chapters are grouped into three sections which cover: 1) clinical practice in child and adolescent psychiatry, consultation-liaison psychiatry, psychogeriatrics, community psychiatry and forensic psychiatry; 2) relevant basic sciences such as neuroethics and genetics; and 3) philosophical and social contexts including the history of ethics in psychiatry and the nature of professionalism. Principal aspects of clinical practice in general, such as confidentiality, boundary violations, and involuntary treatment, are covered comprehensively as is a new chapter on diagnosis. Given the contributors' expertise in their respective fields, Psychiatric Ethics will undoubtedly continue to serve as a significant resource for all mental health professionals, whatever the role they play in psychiatry. It will also benefit students of moral philosophy in their professional pursuits.

This volume addresses gaps in the existing literature of global mental health by focusing on the ethical considerations that are implicit in discussions of health policy. In line with trends in clinical education around the world today, this text is explicitly designed to draw out the principles and values by which programs can be designed and policy decisions enacted. It presents an ethical lens for understanding right and wrong in conditions of scarcity and crisis, and the common controversies that lead to conflict. Additionally, a focus on the mental health response in “post-conflict” settings, provides guidance for real-world matters facing clinicians and humanitarian workers today. Global Mental Health Ethics fills a crucial gap for students in psychiatry, psychology, addictions, public health, geriatric medicine, social work, nursing, humanitarian response, and other disciplines.

A contemporary case-based discussion of ethical dilemmas faced by researchers in forensic mental health, this book offers useful guidance to anyone planning research in this field. It focuses on problems frequently encountered, such as issues of capacity to consent in forensic settings and the meaning of consent to participate. Chapters cover issues such as the procurement of consent among incarcerated people; the ability of young people to provide consent; the effects of culturally specific lay beliefs about mental illness; confidentiality; multidisciplinary approaches; and ethics in risk assessment research. The contributors address questions such as whether research can be therapeutic, and whether it is ever reasonable to compromise patient confidentiality for the wider benefits of publishing research. Based on empirical data from researchers' own experiences, this comprehensive book will be essential reading for anyone planning research in the area of forensic mental health, and all whose work is in this area.