Ethics In Psychiatry Research Articles

Historical aspects of ethics in psychiatry : From the end of humanitarianism up to the Human Rights Convention

The establishment of academic psychiatry was completed around 1900. Simultaneously, in view of the societal crisis phenomenon the professional self-concept of the psychiatrist was shifted to aself-image, according to which psychiatry had to place its expertise at the service of the people and the country. This was particularly expressed in World WarI in the brutal dealing with the so-called war neurotics. In association with the so-called death by starvation of ca. 70,000 institution inmates, in the post-war period Karl Bonhoeffer debated a transformation of the term humanitarianism. The worst consequence of the rejection of humanitarian thoughts are the murders of invalids under National Socialism; however, legitimization of such crimes by alluding to collective ethics, as attempted by Karl Brandt, seems to be less than convincing. The reform of psychiatry initiated in the 1960s and the United Nations Convention on the Rights of Persons with Disabilities, which came into force in 2008, have achieved prerequisites for asupportive psychiatry with reduced coercion, whereby many questions also in the legal and social systems must still be clarified.

Historical comments on ethics in psychiatry : Challenges in the 19th century

With the emergence of an early psychiatry around 1800, anumber of questions arose on dealing with agroup of persons whose "alien", irritating and disruptive behavior was considered to be aphenomenon of being sick. In the context of the growing importance of human rights, the term humanitarianism attained ahigh relevance as the reference for early psychiatrists. Based on historical sources it is shown that despite amultitude of psychiatric beliefs on humanitarianism the established psychiatric practice was dominated by patriarchal order regimes up to the first decade of the twentieth century, later superimposed by the challenges of somatophysiological and experimental research as well as perceptions of biological racism. The associated new ethical questions were partially addressed within psychiatry but did not prevent an increase in the assessment of the mentally ill as "inferior".

What place for ethics in psychiatry?

At a time when healthcare establishments are facing sensitive financial and institutional challenges, how can ethics be given a place in psychiatry? Insociety, ethical debates focus on surrogate motherhood, active euthanasia or assisted suicide, and embryo research. In psychiatry, the question often crystallizes around violent incidents that are hardly representative of the daily lives of professionals and patients. Militant discourse prevails over listening to the people concerned. The law requires establishments to reflect on the ethical issues raised by the reception and medical care of patients, without specifying the boundaries. Ethics in healthcare facilities focuses on care situations - what is possible or desirable - with no single theoretical model to serve as an example to follow.

The Principles and Rules of Professional Ethics in Psychiatry

The Principles and Rules of Professional Ethics in Psychiatry

Politicization of psychiatry and the improvement of ethical standards in the 1970s.

The Code of Ethics for Psychiatry adopted by the World Psychiatric Association in 1977, also known as the Declaration of Hawaii, was a milestone in the development of ethical standards in psychiatry. The impetus for the development of the code came primarily from the politicization of psychiatry, first discovered in the USSR, and later in other countries of the socialist camp, such as Romania, Yugoslavia, and the People's Republic of China. The purpose of this article is to trace reasons for the lack of consolidation among Western psychiatrists against the politicization of psychiatry and their efforts to improve the ethical standards in this medical field. We analyzed unpublished documents from the Archive of the German Association for Psychiatry, Psychotherapy and Psychosomatics, the private archives of the West German psychiatrists Gerd Huber and Walter von Baeyer as well as research works. To examine these sources, we implemented the historical-critical method. The World Psychiatric Association made efforts to collect, analyze and discuss materials concerning psychiatric ethics in order to create the Code of Ethics for Psychiatry and establish an Ethical Committee. In general, the reaction of Western psychiatrists to the information about the internment of dissidents in psychiatric hospitals was restrained and focused on attempts to solve the issue together with the Soviet colleagues. The international policy of détente of the time as well as collisions between different medical concepts and ethical dimensions did not allow Western psychiatrists to condemn cases of politicization of psychiatry without proir clarification of the situation. The efforts of the World Psychiatric Association in the ethical field improved the ethical standards for psychiatry.

Ethics and Law.

Ethics and Law.

Avrupa Konseyi Biyoetik Komitesi'nin Psikiyatriye İlişkin Ek Protokol Çalışması Neler Söylüyor?

Psikiyatrik sorunlara ve psikiyatri pratiğine ilişkin etik duyarlılık örneklerini Dünya Psikiyatri Birliği’nin bildirgelerinde, ulusal hekim birliklerinin etik kodlarında ve uzmanlık derneklerinin konuya ilişkin metinlerinde görmek mümkündür. Bu bağlamda Türkiye Psikiyatri Derneği’nin ilke olarak benimsediği, “bilim, etik, dayanışma” söylemini ve 2002 yılında kapsamlı bir biçimde ortaya koyduğu “Ruh Hekimliği (Psikiyatri) Meslek Etiği Kuralları”nı görmek mümkündür. Bu çalışmada ülkemizin iç hukukunu biyoetik bağlamında “İnsan Hakları ve Biyotıp Sözleşmesi” ile etkilemiş olan Avrupa Konseyi’nin Biyoetik Komitesi’nin psikiyatriye ilişkin ek protokol çalışmalarının ortaya konulması ve tartışılması amaçlanmıştır. Protokol çalışmaları Biyoetik Komitesi tarafından yürütülmektedir. Süreç, hasta ve yakınlarının, hekimlerin ve ilgili diğer sağlık çalışanları ile insan hakları derneklerinin görüşlerinin alınarak ek protokol oluşturulması için organize edilmiştir. Ayrıca kamuoyu görüşlerinin alınması da önemsenmektedir. Protokolün üzerinde durduğu öncelikli konuların başında ülkelerin yasal düzenlemelerinde boşluklar olduğu görülen istem dışı yatış ve tedavi konusu yer almaktadır. Taslak protokolde istem dışı yatış ve tedavi kavramlarının, bunlara konu olan kişilerin durumunun, istem dışı yatış sürecinde değerlendirici olarak psikiyatristler ve yetkinlikleri konularının ayrıntılı şekilde ele alındığı görülmektedir. Ülkemizde henüz yasalaşmamış olsa da Türkiye Psikiyatri Derneği’nin önemli düzeyde katkı sunduğu “Ruh Sağlığı Yasası Taslağı” ile “Ruh Hekimliği (Psikiyatri) Meslek Etiği Kuralları” içerisinde konunun ayrıntılı biçimde yer almış olduğu dikkate değerdir.

An introduction to clinical ethics in psychiatry

SUMMARYThe Royal College of Psychiatrists’ continuing professional development (CPD) module on clinical ethics in psychiatry by Pearce & Tan describes some common ethical dilemmas in psychiatric practice and the work of clinical ethics committees in analysing these dilemmas. In this article we build upon their work and offer additional exploration of the nature of ethical dilemmas in psychiatry. We also build upon the models of reasoning that are described in the module and suggest ways for psychiatrists to think about ethical dilemmas when a clinical ethics committee is not available.

Teaching Ethics in Psychiatry: Time to Reset.

Teaching Ethics in Psychiatry: Time to Reset.

The Importance of Learning Ethics for and from Psychiatrists: A Teacher–Trainee Reflection

The Importance of Learning Ethics for and from PsychiatristsA Teacher–Trainee Reflection Cynthia Geppert (bio) and Hammam Yahya (bio) Teacher-Trainee It is our privilege to be invited to write a commentary on the "Interface of Ethics and Psychiatry: A Philosophical Case Consultation on Psychiatric Ethics on the Ground." The article presents an innovative collaboration between a philosopher and a psychiatrist reasoning together through the ethical aspects of three clinical cases. The case consultation also offers a unique opportunity to reflect on the teaching of psychiatric ethics in clinical settings. This commentary explores those areas of the article from the perspective of a teacher and trainee whose mentoring relationship is grounded in their shared interest in philosophy and psychiatric ethics. Teacher A quick search on PubMed and Google Scholar confirms my own clinical impression from performing hundreds of ethics consultations over decades. In comparison with medicine and surgery, ethics consultation has been relatively underused and studied in psychiatry, especially in the out patient and emergency psychiatry settings these authors examine. Most of the clinical work and academic literature on psychiatric and ethics consultation comes from my own specialty home of consultation-liaison psychiatry, that is, psychosomatic medicine (Preisman, 1999). It is non–mental health professionals especially in inpatient settings who request many of these consults. And although my colleagues and I have shown that psychiatrists play a leading and important role on ethics committees and ethic consultation services (Geppert & Cohen, 2006), it is somewhat ironic that role has not historically extended widely to their own species and terrain. It is not for lack of need or I suspect want on the part of psychiatrists and other mental health professionals that ethics consultation is not more frequently used. As this philosophical case consultation shows, perhaps no domain in health care is as replete with ethical concerns as psychiatry. The authors suggest what I think is a sound thesis. They claim that part of the explanation for the underuse of consultation lies in psychiatry's constrained social mandate to involve, or even [End Page 199] defer, to the law in so many ethical decisions. Most seasoned teachers of ethics will recognize, "What does the law say?", as a common, understandable but at times constricting, refrain from medical students and residents. But psychiatry, unlike either medicine or surgery, really has little choice in the matter; we are in a very real sense coerced to factor in legal considerations in much of our ethical deliberation. As the authors of this article underscore, the centrality of the law also likely contributes to a tendency of psychiatric residents to believe—usually because this is how they have been taught—that medical ethics begins and ends with the Georgetown Mantra. And although we are certainly not alone in medicine in our relative overreliance on these four principles, the very nature of psychiatry as elementally about the human condition makes this reliance even more misguided. These authors mention care ethics as a much-needed corrective to the principlist direction and Professors Radden and Sadler (2010) have made a persuasive case for the primacy of virtue ethics in psychiatry. But the poverty of ethical theory in psychiatric training is only part of the problem this "on the ground integrative approach" identifies. Even more critical is by whom and in what training settings psychiatric ethics content is taught. I recall a discussion with my own ethics teacher and pioneer in clinical ethics Richard Zaner, PhD, when the very first MD/PhD programs in philosophy and bioethics were being developed. He asked whether it is better to "teach a philosopher clinical medicine or a physician philosophy?" Obviously, both options are salutary and the combination as the article suggests may be optimal. But I will admit to agreeing with Dr. Zaner then and now that the ideal is to have at least some physicians with formal ethics and philosophy training. Part of the reason the philosopher in this case consultation could be integrated into the clinic not only without disrupting, but enhancing treatment, was her dedication to not just studying the science, but also getting practical experience in the art. There are other compelling arguments for dually...

Board Work Groups on Innovation, Wellness Have Synergistic Missions

Board Work Groups on Innovation, Wellness Have Synergistic Missions

Session on Goldwater Rule Elicits Diverse Reactions From Participants

Session on Goldwater Rule Elicits Diverse Reactions From Participants

Overview of Ethics in Psychiatry

This review of psychiatry ethics is intended for residents, fellows, and practicing psychiatrists. We provide an overview of the historical sources of ethical reasoning and give practitioners a structured method for analysis of ethical dilemmas typically encountered in the practice of medicine. Through the use of case examples, we explain how difficult situations often challenge received knowledge and superficial opinion about the ethical options present and justifiable in real-life situations. This review will appeal to the higher callings and traditions of medicine and encourage the physician who is faced with ethical decisions about which reasonable practitioners may disagree. Tools of ethical reasoning provide a means for making ethical decisions that are grounded in history and tradition. This review contains 1 figure, 6 tables, and 30 references. Key words: confidentiality, decision making, doctor-patient relationship, ethics, informed consent, narrative, principles, professionalism, respect, virtue

Has the Care in Psychiatry Other Characteristics than those it has in the Other Fields of Medicine

Everybody knows that Beauchamp and Childress have tried to define four principles in the domain of care ethics. Their definitions are rather rhetorical; but, on the whole, they satisfy the contemporaries in most of medicine fields. On the contrary, in psychiatry, it seems often difficult and sometimes impossible to apply them. The patient who does not know his illness and that is cured against his consent is not autonomous. He cannot understand the cure that imposes upon him while it is brought out as benevolent. Moreover, the question of justice does not raise as elsewhere in medicine. Specifically, the questions of security are put forward so that the cure is partly jeopardized. Conversely, the notions used to think ethics in psychiatry are not without any repercussion on the whole of care ethics. They point to the necessity of changing the ethical notions in view to match with the situations as they are everywhere in care ethics.

Teaching Medical Ethics in Graduate and Undergraduate Medical Education: A Systematic Review of Effectiveness

One objective was to identify and review studies on teaching medical ethics to psychiatry residents. In order to gain insights from other disciplines that have published research in this area, a second objective was to identify and review studies on teaching medical ethics to residents across all other specialties of training and on teaching medical students. PubMed, EMBASE, and PsycINFO were searched for controlled trials on teaching medical ethics with quantitative outcomes. Search terms included ethics, bioethics, medical ethics, medical students, residents/registrars, teaching, education, outcomes, and controlled trials. Nine studies were found that met inclusion criteria, including five randomized controlled trails and four controlled non-randomized trials. Subjects included medical students (5 studies), surgical residents (2 studies), internal medicine house officers (1 study), and family medicine preceptors and their medical students (1 study). Teaching methods, course content, and outcome measures varied considerably across studies. Common methodological issues included a lack of concealment of allocation, a lack of blinding, and generally low numbers of subjects as learners. One randomized controlled trial which taught surgical residents using a standardized patient was judged to be especially methodologically rigorous. None of the trials incorporated psychiatry residents. Ethics educators should undertake additional rigorously controlled trials in order to secure a strong evidence base for the design of medical ethics curricula. Psychiatry ethics educators can also benefit from the findings of trials in other disciplines and in undergraduate medical education.

The particular relevance of clinical ethics support in psychiatry: Concepts, research, and experiences

While Psychiatry is a field with documented susceptibility for ethical topics, the prevalence of clinical ethics support (CES), e.g. ethics consultation or moral case deliberation, observed in clinical institutions of mental healthcare in many countries, is rather marginal. This is the background and motivation for publishing this Thematic Issue on Clinical Ethics in Psychiatry. The characteristics of psychiatry as a professional healthcare domain give rise to various ethical challenges which are to a certain degree specific for psychiatry. One of these characteristics concerns the fact that, under specific conditions, mental healthcare professionals are entitled to use coercive measures which consist of, among others, limiting the freedom of patients or using forced psychopharmacologic treatments. Carefully defining and improving the quality of care within everyday practice necessarily involves facing ethical challenges; this is confirmed by recent empirical research and is also presented in this Thematic Issue. Dealing with ethical challenges requires a specific methodology. However, there are no universal standards for determining what is morally right, which means that moral disagreement does occur and may persist. Professional knowledge and results of evidence-based medical studies are certainly of help, but they do not exactly solve the ethical problems. In order to offer targeted guidance to understand and deal with ethical challenges, forms of clinical ethics support in psychiatry have been developed already beginning three decades ago. Recently, studies on CES in psychiatry seem to be increasing. However, insights into how CES in psychiatry is developing and how it actually works are still rare. Incidentally, some evaluation research reported that healthcare professionals and their managers appreciated ethics support. But in general, there is a lack of case studies, conceptual or programmatic papers and empirical (evaluation) research on CES in psychiatry. Furthermore, there is hardly any attention for the prevalence of various forms of CES and how they function within psychiatry. Finally, there seems to be some confusion about what distinguishes ethical from professional challenges, and how both the content and method of CES differ from psychological supervision. This thematic issue on CES in psychiatry aims at filling this gap in order to stimulate the use of CES in psychiatry and to discuss its particular relevance for psychiatry. In doing so, we want to stress that CES should not overtake the ethos and decisional responsibility of the healthcare professionals (this is why it is called ‘support’). Furthermore, we think that CES should not isolate the moral dimension of psychiatric practice as a separate entity, as if only within CES healthcare professionals were reflecting upon ethical challenges. Rather, paying attention to ethical challenges every now and then in an explicit and systematic way (as within CES) might also stimulate the way how regular meetings and reflections in daily practice are organised. In a vision, we can imagine a stepped-care for ethical challenges: regular, daily ethical reflections taking place in a rather natural and sometimes even implicit way, while more complex ethical challenges might be addressed in explicit CES meetings. One advantage of CES is that all healthcare professionals can participate on an equal basis since ethical insight and conclusions do not depend on hierarchical positions or professional expert roles. In this thematic issue, a broad overview of the particular relevance of CES for psychiatry is being presented by a variety of authors choosing different focuses. Reiter-Theil reflects upon initiating CES in various forms in psychiatry and maintaining its continuity. Ten tasks and relating challenges are formulated and illustrated by clinical examples each followed by a

Board Takes Action on Wide Range of Issues

Board Takes Action on Wide Range of Issues

The Editorial Leadership of Academic Psychiatry

Academic Psychiatry seeks to advance knowledge and the practice of education, leadership, administration, and ethics in psychiatry, as well as scholarship on professional development and wellness. With recent growth at the journal, including an increasing number of manuscript submissions and a move to an international publishing platform through Springer Science+Business Media, LLC, the editorial leadership of the journal has expanded significantly to enhance the journal’s service to authors and readers. The editorial leaders aim to promote a broad range of interests expressed by the journal’s audience, while upholding the highest standards of academic publication. Editors also contribute to an enhanced representation of the four sponsoring organizations of the journal: The American Association of Chairs of Departments of Psychiatry, the American Association of Directors of Psychiatric Residency Training, the Assoc ia t ion for Academic Psychia t ry, and the Association of Directors of Medical Student Education in Psychiatry. We introduce here the members of the Academic Psychiatry editorial team, who graciously give their time, knowledge, and skills to the continuing enrichment of the journal. Laura Weiss Roberts Editor-in-Chief

Resource Document May Provide Guide to Ethical Issues in Everyday Practice

Resource Document May Provide Guide to Ethical Issues in Everyday Practice

Comparative Survey About Doctor/patient Relationship with Emphasis On Confidentiality Principle in Islam Basic Morality and Professional Medical Ethics in Iran

Introduction Human has always required making a healthy and ethical relationship with the environment and this has been one of the basic human needs. According to Islamic view, Islamic morality seems as like as another accepted religions such as christianity fundamental to doctor and patients relationship to govern relations with God who is very confident . Moral virtues and its knowledge are required for the effective and suitable confidentiality whose study affects the pattern to introduce the Islamic ethics. Therefore, the study has been carried out to evaluate physician/patient relations with emphasis on the confidentiality principle. The study aims to present an appropriate step in the pattern of ethics of physician/patient relationships.in comparision of Islamic view and world accepted principalistic medical ethics rules. Material and Methods This research was carried out by library method and using books (including holy Quran),facts and declrations and articles from Conclusion confidentiality. In this study, necessity to new legislation for ethical rules and need for more researches is explained . Also, in order to more explanation this talk few application examples of confidentiality in doctor and patient relationship is mentioned. Ethical decision making in cases of such as psychiatric patients as like as Tarrasof low I-II cases or in cases of AIDS anger patient who will contaminate another by needle stick needed to clear support,. Our final result and home massage is 'Both two views medical & specialized psychiatry ethics and Islamic ethics are very closely similar for saving human basic rights of course each of them has exceptions’.