Ethical issues are pivotal to the practice of psychiatry. Anyone involved in psychiatric practice and mental healthcare has to be aware of the range of ethical issues relevant to their profession. An increased professional commitment to accountability, in parallel with a growing "consumer" movement has paved the way for a creative engagement with the ethical movement. The bestselling 'Psychiatric Ethics' has carved out a niche for itself as the major comprehensive text and core reference in the field, covering a range (...) of complex ethical dilemmas which face clinicians and researchers in their everyday practice. This new edition takes a fresh look at recent trends and developments at the interface between ethics and psychiatric practice. Coming ten years after the third edition, the editors have observed several emerging aspects of psychiatric practice requiring coverage, as a result, 5 new chapters have been added, including cutting edge topics - such as neuroethics. All other chapters have been fully revised and updated. The book will continue to be essential reading for psychiatrists, psychologists, other mental health professionals, and bioethicists, as well as of interest to policy makers, managers and lawyers. (shrink)

Informed consent is reviewed as it applies to psychiatric patients. Although new legislation, such as the Mental Health Act 1983, provides a useful safeguard for the protection of the civil rights of patients, it could actually reduce their humane care unless applied with sensitivity for the nature of their unique difficulties. In order to guard against this possibility, we suggest that legal requirements should be considered in light of the ethical principles which underlie them. Three principles are considered: those of (...) autonomy (freedom); beneficence (paternalism); and the fiduciary principle (partnership). Psychotherapy is offered as a model for informed consent, which might be generalised to other clinical situations. (shrink)

In Codes of Ethics and the Professions 12 contributors, including philosophers, historians, lawyers, nurses, psychiatrists, and a journalist seek answers to a range of tough questions. Do we need codes of ethics? How do we go about creating them? Can codes of ethics be misused and abused? How should they be enforced, regulated and revised?

Previous literature on advice-resistance in medicine and welfare has tended to focus on patients’ or callers’ inexplicit resistance. But clients also raise explicit objections, which put up a firmer barrier against the advisor’s efforts. In a novel look at resistance, we show that one important distinction among objections is their epistemic domain: whether the client’s objection is in their own world, or in the world of the practitioner. We show that the practitioner may try to manoeuvre the objection onto grounds (...) where their own expertise will win the day, in five ways: conceding the objection’s validity as a preface to moving on; proposing a ‘work-around’ that effectively repeats the original advice; selecting an aspect of it that could be remediated; correcting the client’s understanding of the challenges of the advice; and stressing the urgency of the original course of action. We discuss the distinction between objections to solicited and unsolicited advice, and the role of objections in revealing, and affirming, a service-user’s personal life-world contingencies. (shrink)

Thoroughly revised and updated, the new edition of this highly popular introduction features two new chapters, one on brief, focal psychotherapy and another on child therapy. As in the first edition, the contributors each take a particular form of psychotherapy and describe its goals, techniques, and applications, using a down-to-earth approach that blends theory with practical aspects. From reviews of the first edition: "An excellent book....Could not be done better in a brief presentation."--American Journal of Psychiatry. "A smoothly edited and (...) technically well-produced synopsis of psychotherapeutic techniques....Useful for senior medical students and junior residents seeking a rapid overview."--Hospital Community Psychiatry. (shrink)

Sparse knowledge exists about measuring spiritual, religious, and existential (SRE) constructs in children. Well-validated questionnaires measuring such concepts are necessary when researchers want to quantitatively investigate the spiritual lives of children. We aimed to identify questionnaires measuring SRE constructs in children and assess their psychometric properties. We conducted literature searches in four electronic databases. Studies were included if they described the use of a questionnaire measuring SRE constructs in children under 12 years. Systematic data extraction and assessment of the studies (...) using standardized COSMIN guidelines were performed. A total of 17,681 records were screened. Twenty-seven articles assessing 18 different questionnaires met the inclusion criteria. In total, 16 structural validity, 20 internal consistency, 4 measurement invariance, and 16 construct validity studies were found. We identified no high-quality content validity studies. The Meaning in Life in Children Questionnaire by Shoshani and Russo-Netzer showed promising measurement properties. However, all included instruments need further content validity testing before being recommended for use. (shrink)

This paper defines natural hierarchies of function and relation classes □i,kc and Δi,kc, constructed from parallel complexity classes in a manner analogous to the polynomial-time hierarchy. It is easily shown that □i−1,kp □c,kc □i,kp and similarly for the Δ classes. The class □i,3c coincides with the single-valued functions in Buss et al.'s class , and analogously for other growth rates. Furthermore, the class □i,kc comprises exactly the functions Σi,kb-definable in Ski−1, and if Tki−1 is Σi,kb-conservative over Ski−1, then □i,kp is (...) completely parallelizable. All functions in □i,kc are Σi,kb-definable in Rki; this suffices to show that if the known Σi,kb conservativity between R3i and S3i−1 extends to R2i and S2i−1, then NC = NC1 relative to an oracle in PH. We prove a KPT-style witnessing theorem for Ski using constantly many rounds of □i,kc interactive computation, and thus show that if Ski ≡ Rki+1 then the bounded arithmetic hierarchy collapses, provably in Ski. (shrink)

This paper was given as a talk at the Venice Biennale on 9 December 1977. It was part of a symposium on "The Freedom of Science--Problems of Science of Scientists in Eastern Europe". Dr Bloch details some of the problems of psychiatry and its vulnerability to improper use and thus the dilemmas which must ensue in day to day practice. He looks at psychiatry in the USSR and the system within which Soviet psychiatrists must work. The Communist Party and career (...) advancement for psychiatrists would appear to be closely related and it is suggested that, in all probability, the majority of psychiatrists are as perturbed at the misuse of their profession as their Western colleagues, but act compliantly out of fear. Severe punishments have been imposed on those psychiatrists who have dared to speak out against the régime and the system as operated. Dr Bloch concludes by urging Western psychiatrists to do all they can to help their Soviet colleagues to initiate a return to an independent and automous psychiatric profession. (shrink)

Consideration of ethics has established a firm place in the affairs of psychiatrists. An increased professional commitment to accountability, together with a growing "consumer" movement has paved the way for a creative engagement with the ethical movement. Psychiatric Ethics has carved out a niche for itself as a major comprehensive text and core reference covering the many complex ethical dilemmas which face clinicians and researchers in their everyday practice. This new edition takes a fresh look at recent trends and developments (...) at the interface between ethics and psychiatric practice.For this edition, Sydney Bloch and Paul Chodoff are joined by Stephen Green, a clinical professor in ethics and psychiatry at Georgetown University, in leading 29 of the finest scholars in the field from around the world. Eleven new contributors join the team of authors. They include Drs. Beauchamp, Gutheils, Sabin, McGuffin, Szmulter, Gabbard and Holmes. Since the second edition, the editors have observed several emerging aspects of psychiatric practice requiring coverage. As a result, six new chapters have been added covering the ethical aspects of community psychiatry, managed care, psychiatric genetics, resource allocation, codes of ethics and boundary violations. All others chapters have been fully revised and updated.The book will continue to be essential reading for psychiatrists and other mental health professionals, as well as of interest to ethicists, policy makers, managers and lawyers. (shrink)

This title includes the following features: Presents a comprehensivediscussion of the central issues of psychiatric ethics, defining and exploringeach of these issues; Contains essential readings for each of these central issues, providing in onevolume readings that would otherwise be difficult to obtain; Includes introductory essays that provide a comprehensive overview of eachissue, efficiently and effectively organizing the reader's approach to theselected readings; Draws on the success of the well-known and respected 'PsychiatricEthics'.

The potential role of the psychotherapist as ethical interventionist is considered with reference to a patient who presented with a writing block. The case for the therapist to act paternalistically is followed by the counterargument which revolves around the respect for autonomy. A bridge between these two opposing positions is then offered which depends on viewing informed consent as a dynamic process. As part of this procedure it is made clear that while autonomy is the desired end-state of psychotherapy, it (...) is not the be all and end all of treatment. Therapy is necessarily value-laden since it aims for the enhancement of the patient's state of autonomy; it is value-free inasmuch as the therapist desists from guiding the patient in how she should live her life. (shrink)

Book reviewed in this article: Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness. By Elliot S. Valenstein. Ethical Issues in Psychosurgery. By John Kleinig.