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)

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)