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Ethics in the mental health profession essay

Received 2005 Jun 21; Accepted 2005 Jun 22. This article has been cited by other articles in PMC. Abstract Mental disorders and their care present unusual problems within biomedical ethics. The disorders themselves invite an ethical critique, as does society's attitude to them; researching the diagnosis and treatment of mental disorders also presents special ethical issues. The current high profile of mental disorder ethics, emphasised by recent political and legal developments, makes this a field of research that is not only important but also highly topical.

The meeting was attended by policy makers, regulators, research funders, and researchers, including social scientists, psychiatrists, psychologists, lawyers, philosophers, criminologists, and others. This paper reports on the meeting by describing contributions from individual speakers and discussion sections of the meeting. At the end we describe and discuss the conclusions of the meeting.

As ethics in the mental health profession essay result, the text is referenced less than would normally be expected in a review. Psychiatry—meaning here all clinical mental health care disciplines—is unusually ethically problematic. Although some psychiatry is considered obviously and unusually problematic, however, other areas of the discipline are perceived as undifferentiated from the rest of medicine.

Bill Fulford Professor of Philosophy and Mental Health, University of Warwick argues that all medical diagnoses are value laden—that is, they incorporate value judgments; it is just that some psychiatric conditions are quantitatively more value laden than many other medical conditions. Further, conditions with a high values quotient have the potential to be more easily reframed into—for example, a sociological or criminological model. This does not imply abolition of obvious and difficult ethical and policy questions such as those originally posed by Szasz.

Rather, it suggests a reframing of how such questions might be approached. Much psychiatry abuts not just medical and social models but also legal models.

Hence, notions of civil capacity or criminal responsibility use psychiatry in ways that go beyond the use by society of medical specialties with more fact and less value within them. The state then uses psychiatry within an approach that may discriminate legally against those with mental disorder, as described by Chris Heginbotham and Genevra Richardson in their contributions see below. Yet the very definition of mental disorder is opaque.

Mental disorder ethics: theory and empirical investigation

As Eric Matthews argues again, see belowmaking the distinction between physical and mental disorder is at least problematic. It can—for example, address how actors operate within ethically sensitive clinical areas. Or it can address empirical questions directly in relation to a theoretical ethical framework. Mental disorder ethics Policy background: Chris Heginbotham Chief Executive, Mental Health Act Commission argued that mental health policy and care has been undergoing a transformation as new treatments become available, new service models are developed, and new policy frameworks are written.

He summarised that the National Service Framework 6 heralded a new era for mental health services but that many of its promises have still to be delivered. Two recently enacted or proposed pieces of legislation relating directly to mental disorder are founded on mutually contradictory philosophical bases, and are confusing both in themselves and in their operation.

Even within the Mental Capacity Act there are concerns regarding the civil rights protection of patients under the act. Ethics and the distinction between mental and physical disorder Observation of the disparity between legal provisions relating to treatment for physical and mental conditions led naturally to a presentation by a philosopher here, Eric Matthews Honorary Research Professor in Medical Ethics and Philosophy of Psychiatry, University of Aberdeen.

Matthews argued that much policy and law relating to mental disorder is not only discriminatory but also assumes that the distinction between mental and physical disorders, and between treatments of those disorders, is robust. Is this a reasonable working assumption?

There are contradictory attitudes to mental disorder in modern culture, creating uncertainty, which then bears on the ethics of psychiatric treatment. Also, philosophical confusion about the concept of the mental is a primary source of uncertainty; so that addressing this confusion philosophically can assist in clarifying ethical issues in mental health research.

In summary, it is hard to draw a sharp distinction between physical and mental disorder, instead what exists is a continuous spectrum ethics in the mental health profession essay states. In the biomedical model of disease, illness arises from an externally caused biological malfunction; this model, however, does not apply very well to mental disorder.

Many such disorders are departures from human norms rather than from normal biological function. Accepting the biomedical model generally for mental disorders means attempting to locate and eliminate an underlying biopathology, even if the individual does not self identify ethics in the mental health profession essay ill.

This then commits the practitioner to wholesale medical paternalism, which offends against individual autonomy. The philosophical basis of the biomedical model is Cartesian, and herein lies the root of the problem. Cartesian dualism leads to the idea of the mind as a substance separate from the body: It operates in terms of reasons, so it cannot be diseased in the way that the body can.

Mental illness is therefore self contradictory. Gilbert Ryle argued that the dualism debate turned on a category mistake. One possible way of overcoming this problem is to go back to the ordinary meaning and use of terms. Hence, we reveal our minds to each other in many ways voices, facial expressions etcwhich then lead to meaningful interactions.

To talk about minds therefore is to talk about people by focusing on their meaningful interactions. This transforms the terms in which we should view mental disorder. If mind is shorthand for the full range of meaningful interactions with other people, then mental disorder must be viewed as a deficiency in those interactions.

Mental disorder is therefore a disorder of a person's whole relation to the world and to others. And treatment of mental disorder should aim to restore the full range of meaningful interaction to the individual. Because, however, autonomy is perceived to have been lost in mental disorder, its restoration via psychiatric treatment does not simply mean following the patient's currently expressed wishes.

So we can act to restore autonomy even if we override patient refusal of our doing so. Ethics, research, and the legal framework Bringing legal disparities and theoretical ethics concerning the physical and mental together, Genevra Richardson Professor of Public Law, University of London examined the relationship between ethics, mental health, and the law.

She posed three questions. First, is the legal framework governing mental health care ethical? Second, is the practice of this branch of medicine ethical? Third, is the conduct of research relating to this branch of medicine ethical? In addressing the first and second questions, attention must focus again on the Draft Mental Health Bill and the Ethics in the mental health profession essay Capacity Act, which differ in several respects.

Some certainties are apparent in the application of each framework: In addressing the third question, one can ask whether research directed toward mental disorders is ever ethical. Is it ethical to conduct research within a branch of medicine itself governed by an unethical framework?

Also, does such research comply with usual ethical requirements; or is regulation in research ethics strangling relevant research in this field? Notwithstanding these concerns there are roles for philosophers, lawyers, and social scientists in investigating what an ethical legal framework for mental health care might look like, especially with respect to issues of autonomy and capacity.

Addressing such issues might ultimately lead to a more considered legislative framework for mental health care. Researching mental health and ethics: Introduced by Gwen Adshead Consultant Forensic Psychotherapist, Broadmoor Hospitalthis session began by considering the question addressed by Matthews—namely, can we validly distinguish between physical and mental conditions? The group highlighted most physical conditions as being at the high fact end of the fact: And hybrid conditions, including but not limited to mental disorders, are more open to interpretation as disorders, since they evidently incorporate value judgments.

Alternatively, acceptance of a person's values, and sense of self, can abolish any diagnosis of disorder, as suggested in a different group by Tan see below. Some participants ethics in the mental health profession essay that there is inherently a moral hierarchy of mental disorders; consequently, mental disorders have their own social labels. The boundary between a medical diagnosis and a social label was thought capable of being productively investigated by researchers.

However, the dichotomy has most significance and real meaning for service users who live within and across the boundary. Hence the group agreed that future research should include direct involvement of the views of service users, particularly, with regard to related risk assessment and stigma see also below.

Treatment and treatability of mental disorders: The case concerned one Joseph Wesbecker who had been prescribed the antidepressant drug in 1989 shortly before he shot 20 of his colleagues and then committed suicide. The legal case included argument over whether the manufacturers of Prozac had behaved ethically and legally in the manner in which they had established the safety and efficacy of the drug.

Treatment was a complex 'occasion' that could not be disaggregated into separate and autonomous parts. Complex medical conditions, such as Wesbecker's, had to be approached on their own terms. In other words she argued that the relations between biochemistry and mental health and illness should be understood to be a question rather than the question. This perspective stresses that facts and values are convolved, in contrast to ethical and scientific approaches that seek to distinguish them.

The group recognised that interdisciplinary approaches might not be appropriate for the full range of research questions in ethics and mental health and that, in some areas, there would be advantage in examining issues via a range of separate empirical approaches and theoretical perspectives. These studies might then form the basis for subsequent interdisciplinary collaborations.

Risk assessment and management of mental disorders: Concerning values, key questions include what level of false positives in risk assessment is acceptable and who should make that decision? Hence, Szmukler argued, the policy that mental health practitioners should subject all patients to risk assessment is both flawed and profoundly illiberal, because it accepts that many will have to be detained in order to prevent one seriously violent act.

The question then arises: There was general agreement that the current practice of asking first, whether a person has a mental disorder, and second, whether they are a risk to others, is to address matters the wrong way round. Rather, the primary question is: Thereafter, consideration of whether to intervene, and in what way, might properly depend upon their mental health status.

Risk assessment is routinely used outside of health services—for example, in the airline industry. In these settings, it is assumed that mistakes will occur, and human frailty is acknowledged. Risk management systems are therefore designed to take account of the inevitability of human error. The group decided that the overriding principle at stake in this debate was justice; and, while there might be justification for discrimination against the mentally disordered, such discrimination needed to be justified.

Is mental incapacity researchable and, if so, how? General hospital and old age psychiatrists are frequently asked to assess whether patients with physical illness have mental capacity to make decisions regarding medical treatment.

The research also found that incapacity occurs often in general medical contexts and originates in physical rather than functional mental illness, and that clinicians miss many cases of incapacity. Most still spoke, however, of difficulties in decision making. This disparity reflected the distinction between cognitive and evaluative disabilities contributing to incapacity. Tan identified some patients as having the ability to reflect on thought processes, but that those processes themselves seemed to be evidence of incapacity.

This picture contrasted with the general hospital study by Hotopf, in which if patients lacked capacity they usually did so as a result of cognitive deficits, arising in turn from physical rather than functional mental ill health.