Psychiatry Ethics Research Paper ⋆ Research Paper Examples ⋆ EssayEmpire

This sample Psychiatry Ethics Research Paper is published for educational and informational purposes only. Free research papers are not written by our writers, they are contributed by users, so we are not responsible for the content of this free sample paper. If you want to buy a high quality paper on argumentative research paper topics at affordable price please use custom research paper writing services.

Abstract

Deﬁning psychiatry as a praxeology or science of actions, the particular tension between facts, values, and beliefs that are present in research and care are emphasized. Psychiatric history shows clashes between the custodial and the therapeutic intervention in relation to mental and behavioral disorders. Also, it highlights different emphases on the somatic or the psychodynamic dimensions. Several aspects are relevant: research, care, teaching, counseling, policymaking, and advocacy. Each presents its own ethical challenges. The most relevant issues pertaining to psychiatry and bioethics are brieﬂy outlined.

Introduction

Beyond its condition as a medical specialty, psychiatry may be considered a complex praxeology, or science of actions (Lolas 1996, 2006). Medical identity incorporated it to mainstream medicine, based on the natural sciences, during the XIXth century, expecting that it would acquire respectability and be considered as a scientiﬁc endeavor. Its origins may be found in the need of human societies to isolate or control deviant behavior, such as crime, poverty, or abnormality according to cultural standards. It may be said that as a practical social tool to control these conditions, it began before its scientiﬁc or philosophical foundations were sought or established. In this sense, “practical” psychiatry (sometimes identiﬁed with asylums and isolation) precedes “academic” psychiatry, based on foundational sciences such as biology, physiology, sociology, or philosophical reﬂection.

Different aspects deserve attention from the standpoint of ethical reﬂection: (a) research-the constitution of new and reliable knowledge; (b) practice-the application of knowledge to human affairs both individually and socially; (c) teaching-the reproduction of skills, competencies, and attitudes in new members of the profession; (d) advocacy-compromise with rights and duties of patients and professionals; (e) counseling-advice to interested parties; (f) policymaking-advice to planners and legislators.

As different from other ﬁelds of medicine, ﬁrmly grounded on somatic and apparently “objective” data, psychiatry has always been subjected to changes in its epistemic base. Some outspoken critics contend that the medical model is not appropriate for psychiatry. Szasz (1974) and Torrey (1974), among others, observe that there is no clear deﬁnition of what “mental illness” is not nor how the causes and cures of conditions labeled as such can be ascertained. The comparison between mental hospitals with medical institutions reveals that they do not fulﬁll the same roles and that the use of psychiatric diagnosis, even in the judicial system, is a form of coercion and stigmatization. Diagnostic systems are based more on description and opinion than on universally agreed upon criteria. The introduction of so-called theoretical diagnostic systems, like the ones elaborated by the American Psychiatric Association since 1952 (Diagnostic and Statistical Manual in its versions 1–5), and the systems proposed by other groups of experts (like the ones developed in the context of the International Classiﬁcation of Diseases, ICD) are validated against expert opinion, cultural traditions, and scientiﬁc knowledge. The distinction between fact, belief, and value is particularly complex in psychiatry, and the deﬁnition of abnormality does not always coincide with the deﬁnition of illness, disease, or sickness that can be supported on factual or instrumental information. Its categories, like most health-related ones, are value laden. The emergence of evidence-based medicine has been inﬂuential in adopting an objectivistic point of view and heavily inﬂuenced by the interests of industry and politics.

Throughout its history, psychiatric theorization has oscillated between a “mindless physiology” and a “brainless psychology.” The emphasis on somatic processes as fundamental for behavior, mentation, and affect has clashed with philosophical and psychodynamic orientations that are as unilateral as a pure somatic stance. In recent decades, the social dimensions of mental disorders and the importance of mental health for health in general have been stressed. The relevance of culture and tradition for deﬁning and treating mental illness is now universally accepted (Alarcón 2013). The need for integration of different methods and outlooks has been continuously stressed (Bracken et al. 2012; Cacioppo et al. 2014).

Ethics In Psychiatry: Relevant Issues

Levels Of Axiological Reasoning: Regulations

In psychiatry, moral and nonmoral values are important. The ﬁrst relates to intrinsic features of the human condition and are universal, albeit differently expressed in different cultures. Nonmoral values are instrumental to good practice: efﬁcacy, truthfulness, honesty, transparency in data generation, among others. It may be said that in psychiatry, an axiological pluralism is essential for diagnosis, intervention, prognosis, and prevention.

While values are universals of meaning lending an axiological substrate to action in the areas delineated above, principles are prima facie mixtures of moral and nonmoral values. Autonomy, nonmaleﬁcence, beneﬁcence, and justice, along with solidarity and reciprocity incorporate moral and instrumental dimensions. Technical competence, for instance, is as essential as compassion and understanding for a correct performance in research and care.

Aside from principles related to research, practice, planning, and advocacy, other norms pertain to the professional obligations of psychiatrists. All professional societies have written codes of conduct for their members. In addition, the World Psychiatric Association – to which most psychiatric associations belong – have expressed concerns about different aspects of psychiatry worldwide, as reﬂected in the Madrid Declaration, dating back to 1996 and constantly revised by a standing committee on ethics. Other professional international groups, such as the World Association for Mental Health or the World Federation for Societies of Biological Psychiatry and the World Association for Social Psychiatry – among others – have also established permanent groups for the analysis of ethical problems.

Ethics, Human Rights, And Psychiatry

Similar interests can be discerned in the development of bioethical thinking in psychiatry and human rights theory. Both derive from historical events that caused public concern or horror and both relate to civilizatory and globalization processes. Scientiﬁc developments and an increase in the destructive potential of technologies, along with tensions between the private and the public spheres in social life have stimulated interest in values, professional conduct, the meaning of knowledge, and the goals of science and medicine. The distinction between facts and values is of permanent importance in medicine in general and in psychiatry in particular. Despite attacks from anti-psychiatric movements, attacking the profession because of its links with industry and politics in some cases, psychiatrists are committed to the respect of human dignity, to equity in access to care and to the beneﬁts of science, and to the improvement of the human condition (condemning participation of its members in torture, degrading treatments, or transgressions to the moral of the ethical professions).

Transcultural Issues

A strong development of global mental health has drawn attention to the fact that cultural competence and cultural coherence are essential components of psychiatric research and care. In point of fact, ethical issues are linked to a respect for cultures and human diversity. This includes a careful appraisal of diagnostic systems, avoiding stigmatization and discrimination without losing validity, reliability, and usefulness. Interventions are constantly examined for their cultural acceptability, rejecting the notion that a “one-size-ﬁts-all” posture, since diversity includes ethnic background, religious beliefs, economic conditions, and political contexts. The introduction of “culture-fair” concepts has been tackled in different versions of the most commonly used diagnostic systems. The use of language is socially shaped and what can be a normal behavior in Japan may not be the same in Western countries. Progress in the direction of a more inclusive diagnostic armamentarium has been made (Alarcón 2014). In transcultural approaches, the problem of outcome is important. It needs reﬂecting upon what a good outcome means for whom. There may be discrepancies about what an outcome is for professionals, health administrators, participants in research, or patients. Transcultural psychiatry also considers the timespan appropriate for considering that a problematic condition has been deﬁnitely solved or to prevent undesirable effects of interventions in the long run (Thornicroft and Slade 2014).

Novel Technologies

New developments in research and care need special attention. Innovations possess their own dynamics before they become part of the standard armamentarium of resources for investigative processes or for the treatment of persons affected with mental illness or conditions. Genomics, brain research, and social analysis of the impact of innovation pose particular problems. New diagnostic and intervention possibilities are in need of careful analysis by ethics committees and in a conceptual reformulation aimed at integrating different approaches and perspectives (Cacioppo et al. 2014). The developments, applications, and ethical implications of speciﬁc technologies in the ﬁelds of psychiatry and related disciplines are extensively discussed in a comprehensive Handbook of Neuroethics (Clausen and Levy 2015).

Abuses Of Psychiatry

In some parts of the world, psychiatric knowledge has been used for torturing people or for punishing political dissent. Diagnostic categories, when used inappropriately, may have devastating effects on the welfare of people (Lolas 2009). This situation, aside from developing and disseminating written codes of conduct, requires permanent examination of cultural and valoric competencies of researchers and practitioners. In some countries (e.g., former Soviet Union and China, bur probably widespread), psychiatrists have participated in tortures and “reeducation programs” under political pressure. Most psychiatric rules of conduct (e.g., APA code of ethics and the Madrid Declaration of the World Psychiatric Association) speciﬁcally address this form of censurable professional conduct.

There exists a conﬂict of interest whenever overt motivations and intentions are mixed with hidden, unexpressed ones. Philanthropic interests may be manifestation of economic or power motivations. While monetary conﬂicts are now routinely disclosed, it has to be realized that there are other forms of conﬂict. For instance, institutional prestige may sometimes be involved in avoiding bad publicity for mistakes or failures in research or healthcare practices. Paramount cases have involved individual and groups inﬂuenced by industry in the ﬁelds of pharmacological research and notiﬁcation of complications or side effects of interventions. Conﬂicts of interest are unavoidable in a complex ﬁeld such as psychiatry. The important point is to be aware of their existence and to take appropriate measures to uncover them. Sometimes conﬂicts are directly perceived by professionals and lay people. They may be not openly evident but are disclosed by interested parties. Almost every social practice may include some form of deception, deliberate or involuntary. Individual professionals and ethics committees must consider the risks and harms involved in conﬂicts of interest and regulate relations with industry, political power, and other professions.

Confidentiality

Both in research and psychiatric care, conﬁdentiality has become an important issue. Preserving anonymity of research participants may have implications in societies where some conditions lead to stigmatization or discrimination. The professional-client or doctor-patient relationship is always conﬁdential, except in those cases where legal authorities demand disclosure.

Personal Relationships

The relationship between a professional and a person requesting services is at the same time one of compassionate desires to help and endowed with equanimity and distance. Otherwise, technical skill can be hampered by emotional factors. Most codes of professional conduct in psychiatry stress the importance of limiting this relationship to only those aspects that demand technical competence and personal support. Intimacy or sexual relations are as a rule prohibited in view of the vulnerability of persons requesting assistance and the professional power accorded by the psychiatric profession.

Informed Consent

Since the time of the so-called Nurnberg Code, with its emphasis on voluntary acceptance of interventions on the mind and the body, it is an accepted practice in research and care that subjects must provide their informed consent for any intervention. Informed consent is a process of building trust and assuring full disclosure and acceptance of risks and possible harms involved. Information, provided in an understandable form, is an essential component of consent. In addition, subjects must be free to abandon research or treatment if they express this desire. Consent forms or other ways of obtaining consent are integral part of any action taken by professionals or institutions. The procedure must consider cultural diversity, educational level, and contexts. In some societies, for instance, traditional tribal groups in Africa or the Middle East, not all members are entitled to give individual consent, and the authority of others must be sought (elders, husbands, and tutors). In the case of minors, at least in Western societies, their personal assent is also required, despite the fact that in some cases they are considered noncompetent.

Some writers distinguish between legal competence and cognitive capacity to provide consent. Both researchers and caregivers are advised to familiarize themselves with adequate procedures for assessing capacity and with legal norms applicable in the countries where they work.

Therapeutic Misunderstanding

This condition exists when, during a research study, subjects may believe that their doctors act only in their best interest. The fact is that some stages of the research process, particularly in clinical and pharmacological trials, will not offer any direct beneﬁt to persons. Professionals should consider that in the social sphere, medical doctors are expected to always act in the beneﬁt of their patients and provide the best available treatment or intervention. This is coupled to the social role expected from medical and other professionals and should be clariﬁed by these when dealing with people acting as research participants. The classical distinction made by the original Declaration of Helsinki (1964) between therapeutic and nontherapeutic research was based on the personal beneﬁts obtained and expected by research subjects, and it opens a complex set of unresolved issues. The therapeutic misconception may be deliberate or involuntary, but it is a factor that should be taken into consideration in every research process. In particular, under conditions of cognitive impairment on the part of subjects, ethical questions raised must be resolved by careful appraisal of capacity, by resorting to substituted judgment or best-interest principle approaches either by consulting with a close relative, appointing a mentor, or judging according to the vital trajectory of the person involved.

Measures Taken Against The Will Of Persons

Psychiatrists may consider forced hospitalization in cases where there is danger for the person or for people around. This has aroused much discussion in different periods, and some countries demand that formal legal authorization is sought after. This seriously hampers professional autonomy and judgment of psychiatrists and should be analyzed according to context. By deﬁnition, some mental states preclude clear judgment and prevent informed consent.

Research Integrity

As in other ﬁelds of medical science, knowledge must be acquired respecting basic principles of truthfulness and honesty. Plagiarism, falsiﬁcation, or fabrication of data are damaging to the profession in its knowledge base. They should be prevented through proper training and information about accepted practices in the scientiﬁc literature: rules for authorship, deﬁnition of plagiarism, fabrication, or falsiﬁcation of data.

Placebo And Nocebo

In medical and clinical research, the effects not due to an intervention or drug – and sometimes related to symbolic aspects or expectations – must be ruled out in order to correctly assess effectiveness and efﬁcacy. It should be noted, however, that in psychiatry the placebo effect may be consciously used as part of therapeutic interventions and that trust and self-conﬁdence on the part of the practitioner may increase the therapeutic efﬁcacy of interventions. This is not to be confused with deceiving patients or increasing false hopes but may constitute part of the necessary skills for application of knowledge. In psychiatric research, as different from other forms of medical research, placebo effects may be more difﬁcult to handle. During a clinical trial, for instance, the increased attention given to participants may have an impact on their responses to treatment. In addition, some investigations may be aimed not at evaluating efﬁcacy but at uncovering modes of action of medications.

Care should also be exercised when evaluating side effects or negative effects produced by correctly prescribed drugs or interventions. Nocebo effects are to be considered both in research and in clinical practice.

Conclusion

Ethical reasoning in psychiatry covers problems and dilemmas in many different areas: clinical practice, research, teaching, advocacy, and policymaking. This ethical dimension is considered at the level of committees designed to help clinicians, to orient researchers, and to govern personal conduct of practitioners and researchers. Psychiatry is considered to be more than a medical specialty, since it has become a specialized profession. Although following the imperatives and duties of medicine in general, several problem areas acquire in psychiatry a particular aspect.

Critics of the psychiatric enterprise contend that the medical model is not adequate to the goals of an ethical profession and suggest it be replaced by educational and preventive strategies. This chapter reviews some of the most salient problems confronting researchers and clinicians in the psychiatric ﬁeld, insisting that deliberation and stakeholders’ participation are needed at every level of the psychiatric enterprise when dealing with its axiological dimensions. Psychiatric axiology refers both to moral and nonmoral values, the latter being those related to instrumental or technical aspects, the former pertaining to universal features of human nature. The growing ﬁeld of neuroethics considers the applications and moral implications of novel technologies and imposes a reappraisal of traditional ethical dilemmas. Prima facie principles like autonomy, beneﬁcence, and justice are considered mixtures of moral and nonmoral values adapted to circumstance and persons.

Bibliography :

Alarcón, R. D. (2013). Cultural psychiatry. Basel: Karger.
Alarcón, R. D. (2014). Cultural inroads in DSM-5. World Psychiatry, 13, 310–313.
Bracken, P., Thomas, P., Timimi, S., et al. (2012). Psychiatry beyond the current paradigm. The British Journal of Psychiatry, 201, 430–434. doi:10.1192/bjp. bp.112.109447.
Cacioppo, J. T., Cacioppo, S., Dulawa, S., & Palmer, A. A. (2014). Social neuroscience and its potential contribution to psychiatry. World Psychiatry, 13, 131–139.
Clausen, J., & Levy, N. (Eds.). (2015). Handbook of neuroethics. Dordrecht: Springer.
Lolas, F. (1996). Theoretical medicine: A proposal for reconceptualizing medicine as a science of actions. The Journal of Medicine and Philosophy, 21, 659–670.
Lolas, F. (2006). Ethics in psychiatry: A framework. World Psychiatry, 5, 185–187.
Lolas, F. (2009). The axiological dimension in psychiatric diagnosis. Acta Bioethica, 15, 148–150.
Szasz, T. (1974). The myth of mental illness. Foundation of a theory of personal conduct (revised edition). New York: Harper Row.
Thornicroft, G., & Slade, M. (2014). New trends in assessing the outcomes of mental health interventions. World Psychiatry, 13, 118–124.
Torrey, E. F. (1974). The death of psychiatry. Radnor: Chilton Book Company.
Bloch, S., Chodoff, P., & Green, S. A. (1999). Psychiatric ethics. New York: Oxford University Press.