Psychiatric Ethics Research Articles

Psychiatric Ethics for The 21st Century

Psychiatric Ethics for The 21st Century

The Excitement Point and Other Matters - Gill Caradoc-Davies interviewed by Malcolm Parlett

"Editor’s Note: In the following interview, conducted by telephone, Gill Caradoc- Davies, psychiatrist, Gestalt therapist and trainer, speaks about her work and her love of Gestalt, and describes the training offered by Gestalt Institute of New Zealand (GINZ), of which she was one of the founders. She talks inter alia about teaching Gestalt to psychiatric registrars, ethics, play and creativity, Maori attitudes to Gestalt therapy, and the need for new thinking about ‘energy’. Gill was born in 1944, in the Northern Transvaal, South Africa. She studied medicine at the University of Cape Town Medical School, where she also met her husband (to whom she has been married for 33 years). They emigrated to New Zealand in 1978, for ethical and political reasons. She studied with Dr Fred Grosse, and others, at Gestalt Associates in Dunedin. She was the last graduate before they closed. She was also an accredited supervisor for the NZ Association of Psychotherapists. She was Clinical Head of Psychiatric Services in Dunedin from 1987 until she left in 1995 to work full-time in private practice. She has served (for 6 years) on the Continuing Education Committee (Quality Assurance) of the Royal Australian and NZ College of Psychiatrists; published research articles (on drugs in schizophrenia, methadone use, and depression in Parkinson’s, among others); written articles for the Australian Gestalt Journal, created new hybrids of disa orchids commercially, played the harp, sung, gardened, and run a family. We in the British Gestalt Journal are proud to be publishing this exciting and informative interview."

A View to the Future

A View to the Future

Caring for the involuntarily hospitalized adolescent: the issue of power in the nurse-patient relationship.

The power relations between involuntarily hospitalized adolescents and their caregivers from the viewpoint of theory development in nursing and the concept of medicalization. To contribute to the development of nursing theories that can guide nursing care of involuntarily hospitalized adolescents by examining the power relations between the adolescents and their caregivers. Published literature in medical sociology, and nursing and psychiatric ethics. Nursing and psychiatric literature, in which Michel Foucault's theories are used to explicate the disciplinary power of psychiatry. To empower involuntarily hospitalized adolescents nurses must both recognize the inevitable power imbalance and seek guidance from the egalitarian ideals of nursing. Nurses can draw from postmodern thinkers who dismiss the idea that one theory can explain human relationships.

In Two Minds: a Casebook of Psychiatric Ethics. By D. Dickenson and B. Fulford. (Pp. 382; £27.50.) Oxford University Press: Oxford. 2000.

In Two Minds: a Casebook of Psychiatric Ethics. By D. Dickenson and B. Fulford. (Pp. 382; £27.50.) Oxford University Press: Oxford. 2000.

Modern psychiatric ethics

Psychiatry has a chequered past in the area of ethics and human rights, arguably always “in the rear and limping” in failing to keep up with societal changes—an accusation that has also been levelled at the law.1 When Phillipe Pinel symbolically unchained insane people during the French Revolution, he heralded a humanitarian change in attitude towards mentally ill individuals that was reflected in the UK by the ideology of moral treatment in the early 19th century. Unfortunately, overtaken by complacency and nihilism, compassionate treatment centres were transformed into little more than human repositories by the end of that century.

Book Reviews

Books reviewed:Teresa Chikako Maruyama, Hospice Care and Culture: A Comparison of the Hospice Movement in the West and JapanPeggy DesAutels, Margaret P. Battin and Larry May, Praying for a cure. When medical and religious practices conflictTod Chambers, The Fiction of Bioethics Cases As Literary TextsJanice M. Brencick and Glenn A. Webster, Philosophy of Nursing. A New Vision for Health CareSidney Bloch, Paul Chodoff and Stephen A. Green (eds.), Psychiatric Ethics, Third EditionMark J. Cherry, Persons and Their Bodies: Rights, Responsibilities, RelationshipsAlice Domurat Dreger, Intersex in the Age of Ethics

Philosophy of Mind in the Clinic: The Relation between Causal and Meaningful Explanation in Psychiatry

Conceptual dichotomies between mind and brain, psychology and neuroscience, meaning and causation, and fact and value confound thinking in philosophy of mind, clinical psychiatry, and psychiatric ethics. Paul Churchland's theory of eliminative materialism highlights these dichotomies, stating that advances in neuroscience have restricted, and eventually will eliminate, any need for psychology. The core principles of this theory are questionable, because psychiatrists still need psychology and perhaps always will. The main argument in this essay is that even in cases of well-defined brain pathology (where eliminative materialism seems most plausible), psychological concepts remain critical. Thus, philosophers and psychiatrists should generate conceptual models that lead not to eliminativism but to explanatory pluralism, which is the pragmatic integration of diverse concepts toward the end of better handling clinical challenges. The contributions of Karl Jaspers in opposition to eliminative materialism and in support of pluralism are discussed. Jaspers delineated the role of meaningful psychological explanation in a psychiatry rooted in neuroscientific explanation. However, his notion that meaningful states do not have causal power is disputable and has come under fire in recent philosophy of mind and cognitive neuroscience, which highlight the possibility that meaningful psychological states can be causally significant. This idea has implications for psychiatric ethics and the fact/value debate.

Psychiatric consultations and ethics consultations: Similarities and differences

Although consultation–liaison psychiatry and clinical ethics both developed largely in response to the problems engendered by the new medical technology and the dilution of the traditional doctor–patient relationship, they represent distinct fields that rely on different, but overlapping, domains of expertise. To be effective, ethics consultants often need to augment their own background with psychiatric knowledge and skills. Consultation–liaison psychiatrists are well prepared to contribute to clinical ethics but cannot serve effectively as ethics consultants without additional education and training. Several case examples are presented to elucidate these points and to illustrate the similarities and differences between psychiatric consultations and ethics consultations.

Psychiatric Ethics, 3rd ed.

Psychiatric Ethics, 3rd ed.

Book Review: Psychiatric Ethics, 3rd Edn.

Sidney Bloch, Paul Chodoff and Stephen A. Green (eds) Oxford: Oxford University Press, 1999 ISBN 0 19 262899 2 pp. 550 $59.95This third edition of Psychiatric Ethics has 29 contributors, 11 of whom...

Psychiatric Ethics

Psychiatric Ethics

Psychiatric ethics and health services research. Concepts and research strategies.

In a conceptual frame of reference a distinction is made between different aspects of coercion (formal, perceived and evaluated) and different levels of coercion (hospitalization, treatment and other measures). This frame of reference is used to analyse empirical data from interviews of representative samples of 100 formally committed, the 'probands', and 99 voluntarily admitted sex- and age-matched 'controls'. The results demonstrate that there are many different aspects of coercion; thus, discussions about psychiatric coercion should not be restricted to formally registered commitment. The data also indicate the need to survey the different perceptions of the persons involved in the process of care, in order to understand whether and how coercion has been applied. The results also exemplify the need to include, in all assessments of health care, questions of respect for patient autonomy and integrity.

The psychiatrist's dilemma: a conflict of roles in legal executions.

In the United States, a critical controversy is taking place in regard to psychiatrists' and other physicians' participation in legal executions. Under pressure from the criminal justice system and legislatures to expedite executions, some forensic psychiatrists have succeeded in loosening traditional prohibitions against such participation. Further, there has been a weakening of the prohibition against treatment designed to facilitate immediate execution of those condemned to death. The rationale offered for these departures from current psychiatric ethical codes is the novel notion that when a psychiatrist acts in the court or criminal justice situation, that individual is no longer a psychiatrist and is not bound by psychiatric ethics. Rather, the forensic psychiatrist, termed a 'forensicist', serves as an assistant in the 'administration of justice' or 'an agent of the State' and thus works in a different ethical framework from the ordinary psychiatrist. This justification has similarities to the rationale offered by physicians involved in human experiments and other criminal acts in Nazi Germany, as well as psychiatrists in the former Soviet Union who explained their involvement in psychiatric abuse as a result of being agents of the State and thus not responsible for carrying out orders. Clearly, this controversy could be eliminated by a campaign for the abolition of capital punishment, characterised by the American Psychiatric Association as 'anachronistic, brutalizing [and] ineffective'. Such a campaign should serve as a call for psychiatrists and other physicians to join in the struggle to uphold ethical and moral principles.

Ethics in Psychiatric Research

Controversy has arisen in recent years about the participation of psychiatric patients in questionably ethical research protocols. Consequently, academic psychiatrists have been called upon to enrich their understanding of the ethical aspects of research and to teach residents more intensively about these issues in scientific methodology. Toward these ends, the authors have assembled an extensive resource listing in the area of psychiatric research ethics. Articles were identified through MEDLINE and BIOETHICS LINE computerized searches and the authors' review of relevant literature through 1996. Emphasis was placed on those pieces with special historical value, empirical studies, and papers that provide background on the current controversies in psychiatric research ethics. The references were organized into five logical categories. Based on the resource review, the authors briefly discuss areas related to research ethics that merit greater attention in academic psychiatry.

Literature as an Introduction to Psychiatric Ethics

Responding to requests for an earlier introduction to psychiatric ethics, the authors added "An Introduction to Psychiatric Ethics Through Literature" seminar to their institution's first-year curriculum. The authors' primary objective was to increase the sensitivity of beginning psychiatric residents to ethical dilemmas. The 11-session seminar was co-led by a psychiatrist and a literary scholar. At each session, the group discussed a short story selected by the seminar leaders, with the discussion centering on ethical considerations raised by the story and their relevance to the practice of psychiatry. The residents gave the seminar high ratings for its increasing their ethical sensitivity and the stimulating content of the stories.

Complexity of Ethical Decision Making in Psychiatry

Psychiatric residents and psychiatrists have little difficulty in making judgments about a clinical course of action to take with patients. However, making ethical clinical decisions is more challenging, because psychiatric residents are usually provided little formal training in ethics. Further, many ethical dilemmas are complex, requiring knowledge of the psychiatric profession's ethics code, moral principles, law, and practice standards and of how they should be weighed in the decision-making process. The purpose of this article is to demonstrate this complexity in regard to the identification of potential ethical dilemmas, understanding the issues that these dilemmas raise, and formulating potential solutions to them. Two common but important areas of treatment in which ethical dilemmas arise (informed consent and competence of care) are used as examples for our presentation. The article demonstrates that to successfully engage in ethical analysis in psychiatry is impossible without substantial formal training in the process.

The status of ethics education in Australasian psychiatry.

To determine to what extent ethics is taught and how it is taught to psychiatrists-in-training across Australasia. Anonymous mail-out survey of training directors. The questionnaire was completed by 23 of 25 training directors (response rate = 92%) who reported on 625 trainee psychiatrists. Individual one-to-one case supervision was adopted by 96% of the programs for teaching ethics; formal teaching in seminars or lectures was chosen as the second most common method in 70% of programs. Topics most commonly taught in formal seminars were so taught in only 70% of programs or less. A uniform curriculum in psychiatric ethics is needed. The results are discussed in relation to identified needs for improvement.

Fifteen Years of Teaching Psychiatric Law and Ethics to Residents

In 1978, the authors, a psychiatrist and a lawyer, began a course in law and ethics for postgraduate year A psychiatry residents that continues today. The authors review the course in terms of its evolution, effect on residents and faculty during the course, evaluation by residents immediately after the course and since graduation, and future prospects of such a course being started at other institutions.

Book Reviews: 'The Carer's Handbook: How to be successful carer and look after yourself too', 'Health in Australia: Sociological concepts and issues', 'Psychiatric Ethics'

Book Reviews: 'The Carer's Handbook: How to be successful carer and look after yourself too', 'Health in Australia: Sociological concepts and issues', 'Psychiatric Ethics'