Is Evidence Based Psychiatry Ethical

In this groundbreaking book, psychiatrist and ethicist Mona Gupta analyzes the basic assumptions of Evidence-based medicine (EBM), and critically examines their applicability to psychiatry. Highlighting ethical tensions between psychiatry and EBM, she asks the controversial question - should psychiatrists practice evidence-based medicine at all?

Since its addition to the medical lexicon in 1992, the concept of 'evidence-based medicine' (EBM) has captured the imagination of the medical world, attracting both passionate advocates and ardent opponents. EBM is defined clinically as "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients." Yet, its boldest claim is an ethical one: that EBM, rather than any other method, is the most effective way to fulfill our moral duty to help patients achieve better health. Academic debate on this point has been deeply polarized, from those who assert that ethical practice is evidence-based practice to those who argue that evidence-based practice impoverishes practice and robs it of ethical substance. Mainstream psychiatrists have endorsed EBM which holds out the promise of greater ethical legitimacy for psychiatric disorders and treatments through improved scientific substantiation. Evidence-based psychiatry arises through the straightforward application of EBM to the practice of psychiatry and thus shares the same ethical goal of EBM, to improve patients' health. Given the ethical debates that have framed psychiatry since its iii inception as a medical specialty, and the particular nature of mental disorders and their treatments, it is unclear if EBM can be applied to psychiatry, and therefore, whether it can deliver on its ethical promises. This thesis project involved two phases. The first, a conceptual phase, included an analysis of EBM's ethical commitments as they are represented in its two authoritative textbooks ('literal' EBM). This provisional analysis was then extended by a qualitative analysis of the views of three groups of participants concerning the ethics of EBM: (1) EBM developers; (2) mental health practitioners; and (3) philosophers or bioethicists. Combining the analyses from both phases, a more complete depiction of the ethics of EBM was developed in order to address the main thesis question. Evidence-based psychiatric practice cannot be ethical practice by itself. Instead, it can play a small ethical role in clinical practice, only if it is situated within the larger value structure of contemporary medicine and psychiatry.

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.

The practice of psychiatric care for those with severe mental disorders is the focus of this interdisciplinary work by a philosopher and a clinician. In elucidating the moral psychology and character called for by that setting, The Virtuous Psychiatrist offers a sustained application of virtue theory to the particular practice of psychiatry.

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.

Succinct, user-friendly, thoroughly referenced and prepared by leading experts in the field, this book is the only single textbook you will need to succeed in the Royal College of Psychiatrists' MRCPsych and other related higher examinations. Chapters follow the structure and syllabus of the examination ensuring that you receive the necessary essential information to pass and indeed succeed Approachable and succinct text with colour illustrations and key summary points further help to clarify complex concepts and provide you with useful revision tools The evidence-based approach used throughout is important to help you relate theory and research to clinical practice The book is carefully structured and sequenced to building upon the basic sciences underpinning psychiatry, through to an in-depth description of pharmacological and psychological treatments used.

Advances in the practice of psychiatry have occurred in "fits and starts" over the last several decades. These advances are evident to anyone long affiliated with the field and are best appreciated through direct experience of living through the times. These advances can also be gleaned from historical overviews in textbooks or the recollections of one's teachers and mentors. Returning to the original papers that have ushered in these changes is rarely done for various, mostly practical, reasons. Filtering through thousands of articles in psychiatry may prove daunting, access to the manuscripts may be limited (especially for papers not available electronically), and understanding their impact requires a broader context. Moreover, with so much active research currently occurring in various branches of psychiatry, current practitioners or trainees may find their attention focused on the present, and this is reinforced by electronic search algorithms, which return articles in reverse chronological order. Not surprisingly, citations for articles in virtually all fields decline precipitously for articles over five years old. As scholars and professionals, we are losing touch with our academic heritage. Yet navigating the future of psychiatry requires a firm understanding of its past. This resource serves as a guide for anyone seeking to understand the evolution of psychiatry as a scientific discipline. It does so by summarizing over 100 landmark papers in psychiatry and placing their scientific contributions within a historical context. An introductory section sets the stage for the major theoretical constructs within the field, with chapters devoted to ontology and nosology. Subsequent sections examine major facets of the theory and practice of psychiatry, such as pathogenesis of psychiatric illness, pharmacotherapy, psychotherapy, and somatic treatments. These sections are divided logically into chapters addressing important contributions to the understanding and treatment of specific disorders. A final section explores ethical considerations within each field. This framework echoes the complexity of psychiatry, which cannot be reduced to a single set of diagnoses or subspecialty categories. Highlighting the research trajectory of psychiatry, this resource will appeal to academics, trainees, and practitioners who desire a comprehensive, easy-to-read, up-to-date collection of psychiatry's pivotal moments. By understanding the challenges, inspirations, and insights from the past, readers will be better poised to address new and ongoing challenges within the field.