Psychiatric Ethics Research Articles

Examining the Mr Tsafendas enquiry trial: Current insights on forensic psychiatric assessment and ethics

On 6 September 1966, the prime minister of South Africa, Dr HF Verwoerd was killed by Mr Tsafendas, a Portuguese national of Greek descent, in parliament by stabbing him in the chest. Mr Tsafendas was a messenger in parliament. At the enquiry trial of Mr Tsafendas, he was found unfit to stand trial on the ground that he suffered from schizophrenia. The psychiatric evidence during the enquiry trial was reviewed and discussed under the following headings: Diagnosis of schizophrenia; Consideration of cultural factors in forensic psychiatric settings; Delusional infestation v. extreme overvalued beliefs; Simulation of psychosis; Ethical considerations in criminal capacity and trial competency assessments. Lessons from the Mr Tsafendas enquiry trial for forensic psychiatrists where a defendant previously diagnosed with schizophrenia commits a prominent political murder, are summarised. It is emphasised that the personhood of an accused referred for forensic observation should be respected and protected, instead of focusing exclusively on a specific diagnosis.

Psy le comité was told to us

Speaking on behalf of others is no easy task. When 30 members of a psychiatric hospital's ethics committee rely on three of them to explain its functions and roles to neophytes, and to put into words what the committee represents in their eyes, the mission is a delicate one. We have to remain as faithful to our own thinking as we are to the spirit of the group. Wewill try to answer these questions as best we can, to shed light on the origins, missions and specific features of an ethics committee in a psychiatric hospital, without betraying our own thinking or that of our colleagues.

Reframing Mental Health Ethics.

Mental health ethics has been classically focused on ethical concepts and problems in clinical mental health spaces. Psychiatric and psychotherapeutic ethics are main threads of analysis in this subfield of bioethics. However, ethical issues emerge around mental health and illness both within and beyond clinical settings. In particular, ethical quandaries arise in employment, education, family caregiving, and incarceration of people with mental health conditions outside of the clinical setting. Likewise, ethics are an important consideration within alternative care systems where mentally ill people seek support beyond biomedicine, psychotherapy, and case management. In this article, we argue that our understanding of "mental health ethics" should expand to be more inclusive of value questions and conflicts that arise in all areas of the lives of people with mental health conditions, rather than focusing more narrowly on how clinical practitioners and researchers should best respond to ethical quandaries in the delivery of mental healthcare. Community mental health is an ideal space in which to think about such ethical issues, as scholars and practitioners in the field strive to meet not only medical needs but the broader social needs of people with mental health conditions. We begin by providing an overview of psychiatric and psychotherapeutic ethics, and then describe broader applications of ethics in the lives of people experiencing mental illness. We encourage community mental health practitioners and researchers to reconceptualize disciplinary boundaries to consider the vast scope of ethical issues related to mental health in and out of the clinic.

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.

Ethical-deontological problems of therapy of mental disorders

In recent decades, psychiatric ethics has been an area of intensive research and reconsideration of established regulations. Basic principles of medical deontology do not cover ethical issues of modern psychiatric science and practice. The fundamental principle of ethical relationship between a physician and a patient in psychiatric practice is a voluntary informed consent that is based on three main criteria: voluntarism, decision-making capacity and information disclosure about proposed medical procedure. The principle of voluntary informed consent implies a dialogue between a psychiatrist and a patient that rely on the principles of patient's autonomy and does not allow the priority of the paternalistic approach. The physician is obliged to provide all available information on the proposed intervention in a comprehensive way and assess the degree of patient's awareness of this information. The main objective is to determine patient's ability to make decisions as accurately as possible. Many mental disorders affect cognitive processes of decision making and may impact patient's autonomy. It is unacceptable to consider psychiatric patients as incapable of making decisions in advance.

APA Calls on U.N. to Respond Urgently to Charges of Iranian Misuse of Psychiatry

APA Calls on U.N. to Respond Urgently to Charges of Iranian Misuse of Psychiatry

Ethics in Psychotherapy: Informed Consent, Digital Professionalism, and Sexual Misconduct.

Ethics in Psychotherapy: Informed Consent, Digital Professionalism, and Sexual Misconduct.

Compulsory Admissions of Patients with Mental Disorders in Europe: State of The Art on Ethical and Legislative Aspects

Globally, mental health legislation has been changing and evolving throughout time. Compulsory admission is when patients with mental disorders are admitted to a psychiatric unit against their own will to receive treatment. In Europe, as public attitudes and practices shifted, compulsory admission procedures were reformed to ensure patient rights and safety. Differences however exist for compulsory admission procedures between countries. In 2018, a survey was created and disseminated by the European Psychiatric Association Ethics Committee to National Psychiatric Associations within 40 European countries to learn more about the legislation, key actors involved, and reasons for admission. Results showed that approximately half of the responding countries required an independent medical expert, typically a psychiatrist, to be involved in the procedure. Most countries by law required the involvement of a court-appointed judge in making the decision about compulsory admission and to review the case after a certain period of time. All but one country have time limits on legal decisions for compulsory admission. Further, patients have the right to obtain legal counsel to assist them through the process of appeal or the decision in most countries. The primary reasons for admission were the patient being a danger to themselves or others. Despite continued efforts, stigma still surrounds mental health disorders. Public awareness and increased knowledge are needed to improve the perception of compulsory admissions. Moving forward, it is necessary to create educational courses, as well as written guidelines for key actors, to stimulate good practice and promote voluntary treatment (Wasserman et al. 2020; https://doi.org/10.1192/j.eurpsy.2020.79).DisclosureNo significant relationships.

Book Review: Psychiatric Ethics

Book Review: Psychiatric Ethics

Datafied Brains and Digital Twins: Lessons From Industry, Caution For Psychiatry

This paper asks what sorts of ethical caution ought to attach to increasingly data-driven approaches to understanding the brain. This is taken to be an important question especially owing to a likely near future of neuromonitoring and neuromodulation devices with applications in psychiatry. The paper explores this by i) sketching the concept of ‘digital twin,’ ii) drawing a schematic picture of ‘brain datafication’ in general, and iii) developing a means of understanding some challenges present in datafication through the lens of digital twins. One central concern arises from the role algorithmic processing of neural recordings plays in terms of neuroscientific objectivity, with knock on effects for psychiatric ethics. Essentially, this is owing to a way in which algorithmic processing in brain data construction appears to be deductive in character, but is in fact based on a particular scheme of inductive inference. The challenges explored urge ethical caution as they concern epistemological gaps in data-centered neuroscientific progress, as well as knock-on effects for psychiatry.

John Martin-Joy. Diagnosing from a Distance: Debates over Libel Law, Media, and Psychiatric Ethics from Barry Goldwater to Donald Trump.

J<scp>ohn</scp> M<scp>artin</scp>-J<scp>oy</scp>. <i>Diagnosing from a Distance: Debates over Libel Law, Media, and Psychiatric Ethics from Barry Goldwater to Donald Trump</i>.

Ethics and Law.

Ethics and Law.

Promoting physical distancing and not social distancing: When the words matter

As COVID-19 began to plague the world, the term ‘social distancing’ was frequently used, encouraging people to keep a safe physical distance from others to reduce the transmission of the virus. Despite being well-intended, the term has negative implications, further isolating vulnerable groups in society by evoking feelings of rejection and exclusion. For this reason, the members of the European Psychiatric Association Ethics Committee wrote an e-letter in response to an opinion piece published by Science (https://science.sciencemag.org/content/367/6484/1282/tab-e-letters), and also wrote to the European Psychiatry (https://doi.org/10.1192/j.eurpsy.2020.60) and the World Health Organisation explaining why the term ‘physical distancing’ should instead be used among policymakers, governments and the general public. Words are important and carry great meaning. Therefore, by using the term physical distancing and not social distancing the message becomes clear, individuals should remain physically distant but socially connected to protect the vulnerable communities in societies. The World Health Organisation, as well as the Lancet journals, adopting the term physical distancing in replacement of social distancing, was a rewarding and important step in the right direction.DisclosureNo significant relationships.

Philosophy of psychiatry: quarter of a century in discussions

The papers presents the discussion field of a young branch of the philosophy of science the philosophy of psychiatry. As an interdisciplinary platform in the dialogue of sciences, schools and individual professionals, it unites psychiatrists and philosophers, psychologists and social workers in discussing on crucial issues. The paper analyses a multiple field of discussion of the philosophy of psychiatry, separating two stages of its brief development: the stage of institutionalization and fixing of problems (1995‒2005) and the stage of expansion (2005 present). Modern discussions are studied on the most important thematic blocks: (1)the methodology of human research; (2)the philosophical basis of psychiatric classification; (3)psychiatric ethics. The work presents the first complete and specialized review of discussions of the philosophy of psychiatry in Russian.

Diagnosing from a Distance: Debates over Libel Law, Media, and Psychiatric Ethics from Barry Goldwater to Donald Trump by John Martin-Joy The Dangerous Case of Donald Trump: Updated Edition Edited by Bandy X. Lee Twilight of American Sanity: A Psychiatrist Analyzes the Age of Trump by Allen Frances Dangerous Charisma: The Political Psychology of Donald Trump and His Followers by

Diagnosing from a Distance: Debates over Libel Law, Media, and Psychiatric Ethics from Barry Goldwater to Donald Trump by John Martin-Joy The Dangerous Case of Donald Trump: Updated Edition Edited by Bandy X. Lee Twilight of American Sanity: A Psychiatrist Analyzes the Age of Trump by Allen Frances Dangerous Charisma: The Political Psychology of Donald Trump and His Followers by

International Society of Psychiatric Genetics Ethics Committee: Issues facing us.

Psychiatric genetics research is improving our understanding of the biological underpinnings of neurodiversity and mental illness. Using psychiatric genetics in ways that maximize benefits and minimize harms to individuals and society depends largely on how the ethical, legal, and social implications (ELSI) of psychiatric genetics are managed. The International Society of Psychiatric Genetics (ISPG) is the largest international organization dedicated to psychiatric genetics. Given its history, membership, and international reach, we believe the ISPG is well-equipped to contribute to the resolution of these ELSI challenges. As such, we recently created the ISPG Ethics Committee, an interdisciplinary group comprised of psychiatric genetics researchers, clinical geneticists, genetic counselors, mental health professionals, patients, patient advocates, bioethicists, and lawyers. This article highlights key ELSI challenges identified by the ISPG Ethics Committee to be of paramount importance for the ethical translation of psychiatric research into society in three contexts: research settings, clinical settings, and legal proceedings. For each of these arenas, we identify and discuss pressing psychiatric genetics ELSI dilemmas that merit attention and require action. The goal is to increase awareness about psychiatric genetics ELSI issues and encourage dialogue and action among stakeholders.

Spirituality and mental health: Implications for ethics, medicine, and public health

Summary The past few decades have witnessed major changes at the interface between spirituality and mental health. For example, research into religion and health outcomes has proliferated, spirituality is viewed as a risk or protective factor, and therapeutic approaches such as Twelve Step groups and mindfulness have become mainstream. However, no consensus exists on core competencies for clinicians in this area, and religiously reinforced mental health stigma persists. This paper examines the reasons for progress made to date as a basis for hope, and the implications for the place of spirituality in psychiatric ethics, medicine, and public health.

The psychiatric management of prisoners on hunger strike: developing a management algorithm using the Delphi technique

PurposeThe assessment and management of prisoners on hunger strikes in a custodial setting is complex. There is limited clinical guidance available for psychiatrists to draw upon in such cases. The purpose of this paper is to develop a management algorithm through expert elicitation to inform the psychiatric care of prisoners on a hunger strike.Design/methodology/approachA Delphi method was used to elicit views from Irish forensic psychiatrists, a legal expert and an expert in ethics using a structured questionnaire. Themes were extracted from the results of the questionnaire to propose a management algorithm. A consensus was reached on management considerations.FindingsFive consultant forensic psychiatrists, a legal expert and an expert on psychiatric ethics (n=7) consented to participation, with a subsequent response rate of 71.4 per cent. Consensus was achieved on a proposed management algorithm. Assessment for mental disorder, capacity to refuse food and motivation for food refusal are seen as key psychiatric tasks. The need to work closely with the prison general practitioner and the value of multidisciplinary working and legal advice are described. Relevant aspects of law included mental health, criminal law (insanity) and capacity legislation.Originality/valueThis study outlines a management algorithm for the psychiatric assessment and management of prisoners on a hunger strike, a subject about which there is limited guidance to date. Although written from an Irish perspective, this study outlines key considerations for psychiatrists in keeping with international guidance and therefore may be generalisable to other jurisdictions.

The UN Committee's interpretation of "will and preferences" canviolate human rights.

The UN Committee's interpretation of "will and preferences" canviolate human rights.

Why Psychiatric Ethics and Social Science Should Be Friends

Why Psychiatric Ethics and Social Science Should Be Friends Omar Sultan Haque (bio) The on-the-ground case conference at the interface of philosophical ethics and clinical psychiatry is an innovative idea that advances pedagogy in presenting a creative approach to teaching and practicing psychiatric ethics. In the current exercise of the proposed partnership, there was a generally positive outcome. The philosopher and the psychiatrist learned from each other, were able to find norms that made their collaboration productive, and found that clinical care was enhanced. My commentary aims to help others replicate this model, and preserve its virtues without its vulnerabilities. Define the Kind of Philosophical Knowledge Most Relevant to Collaboration with Psychiatrists Would a mathematical logician or philosopher of aesthetics be as good of a collaborator as a moral philosopher? Probably not. Consider restricting philosopher collaborators to those with expertise in moral philosophy, and/or philosophy of mind/psychiatry/psychology/neuroscience. Emphasize that "Knowledge by Acquaintance" Is Not Just More and Better Information, But Primarily Concerns Moral Imagination, Which Is the Actual Moral Basis for Future Deliberation Between Collaborating Professionals in Psychiatric Ethics The authors insightfully apply the distinction Bertrand Russell made between knowledge by description and knowledge by acquaintance to the realm of collaborative ethical reasoning in psychiatric practice. The authors explain how their collaboration shows how real-time, face-to-face, and experiential knowledge provided a sense of intrinsic properties of who a patient under consideration really is, and how this is more foundational knowledge than third-person descriptions of patients, as is found in research papers and studies. This claim seems to be almost certainly correct in the case of the described successful philosopher-psychiatrist collaboration. But it can be developed further to yield additional fruits for better collaboration. [End Page 211] It is difficult for explicit and abstract information and reflective beliefs to influence moral behavior. Knowledge of moral theory doesn't translate to more ethical behavior, as studies of the beliefs and behaviors of actual ethicists and moral philosophers suggest no effect of their knowledge on their behaviors (and in some cases negative ethical effects; Schwitzgebel, 2009; Schwitzgebel & Rust, 2009, 2010; Schwitzgebel, Rust, Huang, Moore, & Coates, 2012). Analogously, there is a danger of seeing the additional "knowledge by acquaintance" gained in the collaboration as merely more information to add to a theory of what is happening to the patient and how to respond in light of abstract ethical consideration. Rather, the main contribution of knowledge by acquaintance is not additional information, but of moral experience: of what it is like to be the patient in the midst of difficult to imagine crisis, the turmoil of loved ones of the patient, the sociality of suffering, and so on. Rather than being the final piece of an informational puzzle or theory of mental disorders, knowledge by acquaintance is the first step to any future moral deliberation between collaborating professionals and professors. The immersion in the phenomenology of clinical life should be the first step of any ethical discussion, not for better theorizing, but because knowledge by acquaintance is the ideal basis for cultivating cracks of moral imagination that allow for the application of compassion and attributions of human dignity to stigmatized patients with mental illness. Indeed, this understanding of knowledge by acquaintance as moral imagination can constrain—and in some cases even subvert (as in case 3)—the most logically scrupulous and theoretically compelling moral formulations that would be unhelpful, or even cruel, if straightforwardly implemented without moral imagination. Broaden the Participation Beyond Philosophers to Include Phenomenologically Oriented Social Scientists What does the philosopher add with their expertise, and why limit the psychiatric ethics team to adding only philosophers? The philosopher does add something unique and special. They add to the discussion knowledge of various theories of morality and their history, both as they relate to psychiatric practice, and beyond this domain. They also add a special concern for skeptical questioning...