This book equips readers with a sound understanding of the value-base of mental health care and provides them with the skills and knowledge to demystify complex values in decision-making in order to reach outcomes which are focused on the needs of service users. Engaging case examples and exercises link theory and practice throughout.

In recent years there has been increased recognition of the global burden of mental disorders, which in turn has led to the expansion of preventive initiatives at the community and population levels. The application of such public health approaches to mental health raises a number of important ethical questions. The aim of this collection is to address these newly emerging issues, with special attention to the principle of prevention and the distinctive ethical challenges in (...) mental health. The collection brings together an interdisciplinary group of experts in bioethics, mental health, public health, and global health. (shrink)

This work provides an overview of traditional and contemporary ethical perspectives and critically examines a range of ethical and moral challenges present in ...

Is it ethical to treat a death row inmate only to stabilize him or her for eventual execution? What happens when a military provider receives highly sensitive intelligence from a client? How can clinicians refuse costly gifts from clients without damaging the therapeutic relationship? Should a therapist disclose a client's suicidal intent to the authorities? In Ethical Conundrums, Quandaries and Predicaments in Mental Health Practice, these and other real-life scenarios constitute a comprehensive and definitive ethics casebook (...) for mental health professionals. Inspired by the many difficult situations they themselves have faced, an eminent group of accomplished mental health clinicians provide first-hand accounts of ethical problems that defy boilerplate solutions. Each chapter begins with a compelling and ethically complex case followed by an illustrative yet succinct analysis of the key ethical issues present and a personal reflection on the case itself, along with the process of ethical reasoning used to arrive at a final decision. Every case concludes with key recommendations for promoting ethical practice within an often challenging work setting. Highlighting the human aspect of ethics in mental health practice through the use of mesmerizing narratives while also provoking the reader to reflect upon what is the "right" thing to do, Ethical Conundrums, Quandaries and Predicaments in Mental Health Practice offers trainees and seasoned professionals alike invaluable informative models for dealing with ethical dilemmas, as well as the inspiration to confront seemingly insurmountable clinical problems. (shrink)

Global mental health in a changing world -- Contemporary humanitarianism -- Humanitarian ethics -- Professional and personal challenges in humanitarian work -- Managing ethical challenges in global mental health -- Aspirational guidance : principles of humanitarian assistance -- Operational guidance : IASC guidelines -- Ethical dilemmas : damned if you do and damned if you don't -- Ethically questionable practices -- Safety imperative and self-care -- Values-based ethical framework and core competencies in global (...) mental health -- Ethical considerations for refugee mental health providers in the United States -- Conclusion and future directions. (shrink)

Those whom the gods wish to destroy, they first make mad, says a Nigerian proverb. These words of wisdom re-echo in traditional approaches to mental health ethics in sub-Saharan Africa. Among many cultures in Nigeria, it is customary to subject persons with mental health illness, especially those who present with violent behavior, to physical restraint and beatings. The belief is that such subjugation could restore mental health in the early stages of madness. Physical restraint (...) and beatings only form a part of the healing process, as it also has communitarian cum spiritual aspects. The healing process is carried out by family members or community, who share in the life of the mentally ill person. Their... (shrink)

Beyond Clinical Dehumanisation Toward the Other offers a rare and intimate portrayal of the moral process of a mental health clinician that interrogates the intractable problem of systemic dehumanization in community mental health care, and looks to the notion of 'wonder,' and the visionary relational ethics of Emmanuel Levinas, for a possible cure. This book is an ethical primer for mental health professionals, researchers, educators, advocates and service users working to re-imagine and (...) heal a broken system by challenging the underpinnings of entrenched dehumanization and standing with those they "serve". (shrink)

Is it ethical to treat a death row inmate only to stabilize him or her for eventual execution? What happens when a military provider receives highly sensitive intelligence from a client?

Psychologists today must deal with a broad range of ethical issues--from charging fees to maintaining a client's confidentiality, and from conducting research to respecting clients, colleagues, and students. As the field of psychology has grown in size and scope, the role of ethics has become more important and complex whether the psychologist is involved in teaching, counseling, research, or practice. Now this most widely read and cited ethics text in psychology has been revised to reflect the ethics questions and (...) dilemmas that psychologists encounter in their everyday work. Ethics in Psychology has been completely updated in response to evolving trends in psychological research and practice, as well as extensive changes in the American Psychological Association's ethics code. Gerald P. Koocher and Patricia Keith-Spiegel take a practical, commonsense approach to ethics in modern-day psychological practice, and offer constructive suggestions for both preventing problems and resolving ethical predicaments. In this book, their main intent is to present the full range of contemporary ethical issues in psychology as not only relevant and intriguing, but also as integral and unavoidable aspects of the profession. The authors make extensive use of actual case studies in order to illustrate how the APA guidelines apply to specific situations, such as fee setting, advertising for clients, research ethics, sexual attraction, classroom ethics, managed care issues, confidentiality, and much more. The most recent ethics code of the American Psychological Association (1992) is used here only as a starting point. The authors go well beyond the APA code and incorporate the input of many experts. In addition to the analysis of a wide variety of general situations, new problematic areas are identified and explored. The book includes two appendixes - Ethical Principles of Psychologists and Code of Conduct, adopted by American Psychological Association, Rules and Procedures of the Ethics Committee of the American Psychological Association - both in an easy-to-use format. In addition, each chapter lists summary guidelines along with current and valuable references. Highly readable, the book unites a straightforward, lively writing style with humorous anecdotes that highlight the human side of ethics and make the book a pleasure to read. Ethics in Psychology will be an indispensable guide to ethical decision-making for all psychologists and students in psychology. (shrink)

Coercion in mental health care gives rise to many ethical challenges. Many countries have recently implemented state policy programs or development projects aiming to reduce coercive practices and improve their quality. Few studies have explored the possible role of ethics in such initiatives. This study adds to this subject by exploring health professionals’ descriptions of their ethical challenges and strategies in everyday life to ensure morally justified coercion and best practices. Seven semi-structured telephone interviews were (...) carried out in 2012 with key informants in charge of central development projects and quality-assurance work in mental health services in Norway. No facilities used formal clinical ethics support. However, the informants described five areas in which ethics was of importance: moral concerns as implicit parts of local quality improvement initiatives; moral uneasiness and idealism as a motivational source of change; creating a normative basis for development work; value-based leadership; and increased staff reflexivity on coercive practices. The study shows that coercion entails both individual and institutional ethical aspects. Thus, various kinds of moral deliberation and ethics support could contribute to addressing coercion challenges by offering more systematic ways of dealing with moral concerns. However, more strategic use of implicit and institutional ethics is also needed. (shrink)

Background Mental health nurses advocate for patients through a person-centered approach because they care for people experiencing mental distress who tend to be limited to exercising their human rights and autonomy through interpersonal relationships. Therefore, it is necessary to provide high-quality person-centered care for these patients by identifying the influencing factors. Aim This study aims to identify the factors affecting mental health nurses in performing person-centered care for patients. Research design This study had a cross-sectional, (...) descriptive-correlational survey design. Participants and method Nurses ( N = 166) working at psychiatric wards in Korea completed an online questionnaire on moral sensitivity, attitudes toward people with mental illness, and person-centered care. The t-test and stepwise multiple regression analysis were used. Ethical considerations Ethical approval for the study was obtained from the relevant ethics committee. Findings Moral sensitivity was a significant factor correlating with the provision and perception of person-centered care. Attitudes toward patients had no effect on person-centered care. The predictor variables for the provision of person-centered care (R2 = 0.247) were moral sensitivity (β = 0.33), having a professional qualification (β = 0.19), marital status (β = 0.18), and closed ward (β = −0.15). The predictor variables for the perception of person-centered (R2 = 0.150) care were closed ward (β = −0.25), moral sensitivity (β = 0.23), and marital status (β = 0.18). Discussion and conclusion Mental health nurses can strengthen person-centered care by improving moral sensitivity related to the ethical aspect of nursing and professional competence to address the complex needs of patients. Person-centered care needs to be applied more carefully in closed wards where human rights issues may arise. Through these efforts, the dignity of patients can be protected. (shrink)

In three parts, this volume in the AP-LS series explores the phenomena of captivity and risk management, guided and informed by the theory, method, and policy of psychological jurisprudence. The authors present a controversial thesis that demonstrates how the forces of captivity and risk management are sustained by several interdependent "conditions of control." These conditions impose barriers to justice and set limits on citizenship for one and all. Situated at the nexus of political/social theory, mental health law and (...) jurisprudential ethics, the book examines and critiques constructs such as offenders and victims; self and society; therapeutic and restorative; health; harm; and community. So, too, are three "total confinement" case law data sets on which this analysis is based. The volume stands alone in its efforts to systematically "diagnose" the moral reasoning lodged within prevailing judicial opinions that sustain captivity and risk management practices impacting: (1) the rights of juveniles found competent to stand criminal trial, the mentally ill placed in long-term disciplinary isolation, and sex offenders subjected to civil detention and community re-entry monitoring; (2) the often unmet needs of victims; and (3) the demands of an ordered society. Carefully balancing sophisticated insights with concrete and cutting-edge applications, the book concludes with a series of provocative, yet practical, recommendations for future research and meaningful reform within institutional practice, programming, and policy. (shrink)

Acting on what started as a hunch, Dr. Francis Martin has cataloged well over 20,000 distinct approaches to counseling and psychotherapy that are advertised on the webpages of licensed, practicing mental health providers. No doubt some portion of them are harmful, but the sheer volume of advertised practices and techniques, often with names deceptively similar to actual evidence-based practices, should be cause for concern among all stakeholders in the helping professions - from educators and researchers to policy makers (...) and insurance companies and, especially, consumers. Based on this significant original study, and drawing from other research and supports, Therapy Thieves describes a near-universal crisis in the field and recommends ways to rescue mental health care from itself. The crisis is caused by declining competence among counselors and psychotherapists who have failed to regulate themselves and who, therefore, deliver inadequate - if not harmful - services. In presenting a simple, yet powerful indictment of the field, Dr. Martin advocates for major reforms in several areas of mental health care, including how prospective licensees are trained, supervised and licensed, a major reworking of professional ethics, and the need to establish regulations for mental health care providers. In short, the book calls for major, specific, and urgently needed reforms. (shrink)

Ethical Considerations at the Intersection of Psychiatry and Religion aims to give mental health professionals a conceptual framework for understanding the role of R/S in ethical decision-making and serve as practical guidance for approaching challenging cases. Part I addresses general considerations, including the basis of therapeutic values in a pluralistic context, the nature of theological and psychiatric ethics, spiritual issues arising in diagnosis and treatment, unhealthy and harmful uses of religion, and practical implications of personal spirituality. (...) Part II examines how these considerations apply in specific contexts: inpatient and outpatient, consultation-liaison, child and adolescent, geriatric, disability, forensic, community, international, addiction and disaster and emergency psychiatry, as well as in the work of religious professionals, ethics committees, psychiatric education, and research. Thick descriptions of case examples analyzed using the framework of Jonson and Winslow show the clinical relevance of understanding the contributions of religion and spirituality to patient preferences, quality of life, decision making, and effective treatment. (shrink)

Morality and mental health are now inseparably linked in our view of character. Alcoholics are sick, yet they are punished for drunk driving. Drug addicts are criminals, but their punishment can be court ordered therapy. The line between character flaws and personality disorders has become fuzzy, with even the seven deadly sins seen as mental disorders. In addition to pathologizing wrong-doing, we also psychologize virtue; self-respect becomes self-esteem, integrity becomes psychological integration, and responsibility becomes maturity. Moral (...) advice is now sought primarily from psychologists and therapists rather than philosophers or theologians. This book asks: are we replacing morality with therapy, in potentially confused and dangerous ways, or are we creatively integrating morality and mental health? According to the book, it's a little bit of both. It surveys the ways in which morality and mental health are related, touching on practical concerns like love and work, self-respect and self-fulfillment, guilt and depression, crime and violence, and addictions. Terming this integrative development “the therapeutic trend in ethics,” the book uses examples from popular culture, various moral controversies, and draws on line of thought that includes Plato, the Stoics, Freud, Nietzsche, and contemporary psychotherapeutic theories. The book develops some interesting conclusions, among them that sound morality is indeed healthy, and that moral values are inevitably embedded in our conceptions of mental health. In the end, the book shows how both morality and mental health are inextricably intertwined in our pursuit of a meaningful life. (shrink)

BackgroundSexual boundary violations in healthcare are harmful and exploitative sexual transgressions in the professional–client relationship. Persons with mental health issues or intellectual disabilities, especially those living in residential settings, are especially vulnerable to SBV because they often receive long-term intimate care. Promoting good sexual health and preventing SBV in these care contexts is a moral and practical challenge for healthcare organizations.MethodsWe carried out a qualitative interview study with 16 Dutch policy advisors, regulators, healthcare professionals and other (...) relevant experts to explore their perspectives on preventing SBV in mental health and disability care organizations. We used inductive thematic analysis to interpret our data.ResultsWe found three main themes on how healthcare organizations can prevent SBV in mental health and disability care: setting rules and regulations, engaging in dialogue about sexuality, and addressing systemic and organizational dimensions.ConclusionOur findings suggest that preventing SBV in mental health and disability care organizations necessitates setting suitable rules and regulations and facilitating dialogue about positive aspects of sexuality and intimacy, as well as about boundaries, and inappropriate behaviors or feelings. Combining both further requires organizational policies and practices that promote transparency and reflection, and focus on creating a safe environment. Our findings will help prevent SBV and promote sexual health in mental health and disability care organizations. (shrink)

The public, mental health consumers, as well as mental health practitioners wonder about what kinds of values mental health professionals hold, and what kinds of values influence psychiatric diagnosis. Are mental disorders socio-political, practical, or scientific concepts? Is psychiatric diagnosis value-neutral? What role does the fundamental philosophical question "How should I live?" play in mental health care? In his carefully nuanced and exhaustively referenced monograph, psychiatrist and philosopher of psychiatry John Z. (...) Sadler describes the manifold kinds of values and value judgements involved in psychiatric diagnosis and classification systems like the DSM. Professor Sadler takes the reader on a fascinating conceptual tour of the inner workings of psychiatric diagnosis, considering the role of science, culture, sexuality, politics, gender, technology, human nature, patienthood, and professions in building his vision of a more humane psychiatric diagnostic process. (shrink)

Battle lines have been drawn over involuntary treatment. On one side, there are those who oppose involuntary psychiatric treatments under any condition. Activists who take up this cause often don't acknowledge that psychiatric symptoms can render people dangerous to themselves or others. They also don't allow for the idea that the civil rights of an individual may be at odds with the heartbreak of a caring family. On the other side are groups pushing for increased use of involuntary treatment. These (...) proponents are quick to point out that people with psychiatric illnesses often don't recognize that they are ill, which (from their perspective) makes the discussion of civil rights moot. They may gloss over the sometimes dangerous side effects of psychiatric medications, and they often don't admit that patients, even after their symptoms have abated, are sometimes unhappy that treatment was inflicted upon them. In Committed, psychiatrists Dinah Miller and Annette Hanson offer a thought-provoking and engaging account of the controversy surrounding involuntary psychiatric care in the United States. They bring the issue to life with first-hand accounts from patients, clinicians, advocates, and opponents. Looking at practices such as seclusion and restraint, involuntary medication, and involuntary electroconvulsive therapy--all within the context of civil rights-- Miller and Hanson illuminate the personal consequences of this controversial practice through voices of people who have been helped by the treatment they had as well as those who have been traumatized by it. The authors explore the question of whether involuntary treatment has a role in preventing violence, suicide, and mass murder. They delve into the controversial use of court-ordered outpatient treatment at its best and at its worst. Finally, they examine innovative solutions--mental health court, crisis intervention training, and pretrial diversion--that are intended to expand access to care while diverting people who have serious mental illness out of the cycle of repeated hospitalization and incarceration. They also assess what psychiatry knows about the prediction of violence and the limitations of laws designed to protect the public. (shrink)

In the first work of investigative journalism in decades to give a comprehensive view into contemporary psychiatric incarceration and forced interventions, Your Consent Is Not Required exposes how rising numbers of people from many walks of life are being subjected against their will to surveillance, indefinite detention, and powerful tranquilizing drugs, restraints, seclusion, and electroshock.

Armies know all about killing. It is what they do, and ours does it more effectively than most. We are painfully coming to realize, however, that we are also especially good at killing our own ''from the inside out, '' silently, invisibly. In every major war since Korea, more of our veterans have taken their lives than have lost them in combat. The latest research, rooted in veteran testimony, reveals that the most severe and intractable PTSD -- fraught with shame, (...) despair, and suicide -- stems from ''moral injury.'' But how can there be rampant moral injury in what our military, our government, our churches, and most everyone else call just wars? At the root of our incomprehension lies just war theory -- developed, expanded, and updated across the centuries to accommodate the evolution of warfare, its weaponry, its scale, and its victims. Any serious critique of war, as well any true attempt to understand the profound, invisible wounds it inflicts, will be undermined from the outset by the unthinking and all-but-universal acceptance of just war doctrine. Killing from the Inside Out radically questions that theory, examines its legacy, and challenges us to look beyond it, beyond just war. (shrink)

Background Seven wards from three Norwegian mental health care institutions participated in a study in which regular ethics reflection groups focusing on coercion had been implemented and evaluated. This article presents a thematic overview of the ethical challenges identified based on a systematic qualitative analyses of 161 ethics reflection groups and some general observations on these ethical challenges. Results The ethical challenges are divided into four main thematic categories: formal coercion, informal coercion, uncertainty related to (...) the Norwegian legislation on coercion and professional role and identity. Some ethical challenges did not fit into these categories. Only 36% of the ethical challenges were related to the use of formal coercion or the interpretation of the health law. Conclusion Even within coercion regulated by law, weighing different moral values remains important to reflect upon the appropriateness of the possible use of coercion. (shrink)

This new edition of Professionalism and Ethics: Q & A Self-Study Guide for Mental Health Professionals thoroughly updates the highly regarded and groundbreaking first edition, offering the contemporary reader clinical wisdom and ethical guidance for challenging times. As with its predecessor, the second edition features commentaries by leaders in psychiatric ethics, plus two foundational chapters on ethics and professionalism in the field of mental health. These commentaries and introductory chapters provide an overview of essential (...) class='Hi'>ethical principles and concepts, the professional obligations of the mental health clinician, common ethical tensions found in practice, ethical aspects of caring for special populations, and ethical issues in professional training and research. The introductory chapters are followed by case-oriented questions and answers on core concepts and topics in clinical care, medical research, and interactions with colleagues and trainees. Topics explored in-depth include authorship, disclosure, and ethical peer review for scientific publications; assisted suicide and euthanasia; professional voyeurism versus patient privacy online and on social media; the appropriate process for reporting an impaired colleague; and problems of burnout, work-life balance, and professional well-being. Professionalism and Ethics: Q & A Self-Study Guide for Mental Health Professionals poses and plumbs critically important ethical dilemmas in a compelling, down-to-earth way for today's practitioners and learners. (shrink)

Mental health professionals face many complex questions in the course of their work with clients and patients. Among the most difficult are dilemmas that involve ethical issues. This book presents a forthright exploration of these dilemmas and the ethical considerations they raise. Drawing on extensive interviews, the author identifies common ethical problems that practitioners encounter. What happens, for example, when personal interests intrude into therapy? How can the therapist make an accurate assessment of his or (...) her appropriateness as a care provider for a particular patient? What about confidentiality? How are problematic financial arrangements best addressed? The author goes on to show how these dilemmas may be intensified by the unique assumptions of different therapeutic orientations--individual, group, family, marital, and organizational--and how professionals can learn from such experiences to better understand and apply their particular approach. This analysis--and the words of the therapists themselves--provide both a guide to practice and a unique store of experience for the growing number of researchers and students concerned with ethical problems in psychotherapy. (shrink)

Psychotherapy is a well-established, efficacious, and fully accepted treatment for mental disorders and psychological problems. Psychotherapy is an interpersonal practice engaging patient values, interests, and personal meanings at every step. Thereby, psychotherapy abounds with moral issues. In psychotherapy ethics, numerous moral issues converge, including self-determination or autonomy, decision-making capacity and freedom of choice, coercion and constraint, medical paternalism, boundaries between health and illness, insight into illness and the need for therapy, dignity, under- and overtreatment, and much (...) more. The Oxford Handbook of Psychotherapy Ethics covers the whole range of ethical issues in the heterogenous field of psychotherapy, closing a commonly perceived gap between ethical sensitivity, technical language, and knowledge among psychotherapists. The primary audience is psychotherapists in clinical practice. Furthermore, the Oxford Handbook of Psychotherapy Ethics addresses the whole range of professionals providing mental health services beyond psychology and medicine including counselors, social workers, nurses, or ministers. The Oxford Handbook of Psychotherapy Ethics is not only intended for a clinical audience but also for a philosophical/ethical audience. The goal of the is to explicitly link the two disciplines by fostering a productive dialogue between them, enriching both the psychotherapeutic encounter and the ethical analysis and sensitivity within and outside the clinic. (shrink)

When clinical services aspire to quality improvement, creative and innovative approaches to old problems are needed to drive such change. Whilst new ef orts should be applauded, information on this topic can be somewhat grey from an ethical and research point of view. Within the mental health profession there is currently an expectation to routinely evaluate care and disseminate i ndings. The notion of service enhancements under the guise of routine practice is an interesting and untested (...) class='Hi'>ethical issue. Should clinical innovation continue to enjoy such impunity as patient autonomy is often compromised as they are often compelled to accept treatment under the coercion of mental health legislation? We believe that it should not. All involvement in any form of research is voluntary, thus patients should also have the right to decline participation in quality projects if they wish to do so. (shrink)

The Handbook of International Psychology Ethics discusses the most central, guiding principles of practice for mental health professionals around the world. For researchers, practicing mental health professionals, and students alike, the book provides a window into the values and belief systems of cultures worldwide. Chapters cover ethics codes from psychological associations and societies on five continents, translating each code into English and discussing vital questions around how the code is put into practice, what it means to (...) association members and society at large, as well as how the code was developed within its unique historical, political, and cultural context. (shrink)

Some of the most difficult clinical ethics consultations involve patients who have both medical and mental health needs, as these cases can result in considerable moral distress on the part of the bedside staff. In this article we examine the issues that such consults raise through the illustrative example of a particular case: several years ago our ethics consultation service received a request from a critical care attending physician who was considering a rarely performed psychosurgical intervention to (...) address intractable and life-threatening agitation and aggression in an adolescent patient for whom standard treatments had proven unsuccessful. We consider strategies that may be useful in addressing not only the ethical dilemmas or the clinical problems, but also the emotional, social, and moral distress that arise in delivering care in such complex cases, in which standard routine practices of care have been exhausted. In addition, we explore the processes that led to this situation and suggest ways to promote early recognition and intervention for similar cases in the future. (shrink)

William F. Doverspike, PhD, is a licensed psychologist who holds a Diplomate in Clinical Psychology (ABPP) and he is also board certified in Neuropsychology (ABPN). He is an Associate Faculty member of the Georgia School of Professional Psychology, where he teaches graduate courses in professional ethics. As an independent practitioner, he maintains privileges at several local hospitals. He is a member of the Ethics Committee of the Georgia Psychological Association. Dr. Doverspike is Editor of the Georgia Psychologist magazine and has (...) authored over 50 articles and chapters. He conducts seminars on ethics, risk management, and diagnostic consultation. (shrink)

This volume encompasses deeply critical dialogues that question how the field of psychology exists within and is shaped by the current neoliberal political context. Spanning from psychoanalysis to post-colonial theory, these far-reaching discussions consider how a greater ethical responsiveness to human experience and sociopolitical arrangements may reopen the borders of psychological discourse. With the understanding that psychology grows in the soil of neoliberal terrain and is a chief fertilizer for neoliberal expansion, the interviews in this book explore alternative possibilities (...) for this field of study might function. By offering their own unique responses regarding the current condition of their respective disciplines, these scholars critically consider the current conceptual frameworks that set the theoretical boundaries of psychology, and contemplate the ethical responsibilities currently affecting the field. This book will prove essential for scholars and students across several disciplines including psychology, philosophy, ethics, and post-colonial and socio-cultural studies, as well as practicing mental health professionals with an interest in the importance of psychological and social theory. (shrink)

Background:Textbooks are central for the education of professionals in the health field and a resource for practitioners already in the field.Objectives:This article focuses on how 12 textbooks in psychiatric nursing and psychiatry, published in Norway between 1877 and 2012, describe and present people with psychosis.Research design:We used qualitative content analysis.Ethical considerations:The topic is published textbooks, made available to be read by students, teachers and professionals, and no ethical approval was required.Findings:The analysis shows that all 12 textbooks describe (...) and present people who are considered as psychotic from a ‘perspective from above’. In this perspective, the readers are learning about psychosis in the professional’s language and from the author’s viewpoint. Most often the textbooks communicate a universal image of people with psychosis, a description that fits with the diagnostic criteria. The analysis also shows that two textbooks in psychiatric nursing combined this perspective with a ‘perspective from within’. Here, the readers are learning about psychosis from the patients’ own viewpoint. The authors communicate a personal, psychotic universe that differs from various people, even if they have the same diagnosis, and the descriptions are focusing on the patient as a whole person.Discussion and conclusion:Drawing partly on Rita Charon’s writings about narrative knowledge in the health field, and partly on insights from Martha Nussbaum and her concept of narrative imagination, we argue that mental health professionals need to learn about, understand and fathom what patients go through by reading, listening to and acknowledging the patients’ own stories and experiences. Cultivating the capacity for empathy and compassion are at the very heart of moral performance in the mental health field. A valuable moral resource in that regard is leading textbooks and how they describe and present people with severe mental illness. (shrink)

Mental health apps bring unprecedented benefits and risks to individual and public health. A thorough evaluation of these apps involves considering two aspects that are often neglected: the algorithms they deploy and the functions they perform. We focus on mental health apps based on black box algorithms, explore their forms of opacity, discuss the implications derived from their opacity, and propose how to use their outcomes in mental healthcare, self‐care practices, and research. We argue (...) that there is a relevant distinction between functions performed by algorithms in mental health apps, and we focus on the functions of analysis and generation of advice. When performing analytic functions, such as identifying patterns and making predictions concerning people's emotions, thoughts, and behaviors, black box algorithms can be better than other algorithms to provide information to identify early signs of relapse, support diagnostic processes, and improve research by generating outcomes that lead to a better understanding of mental health. However, when carrying out the function of providing mental health advice, black box algorithms have the potential to deliver unforeseen advice that may harm users. We argue that the outcomes of these apps may be trustworthy as a complementary source of information, but express caution about black box algorithms that give advice directly to users. To reap the benefits of mental health apps based on black box algorithms and avoid unintended consequences, we critically need to know whether these algorithms are fulfilling the function of providing mental health advice. (shrink)

The entwined history of humans and elephants is fascinating but often sad. People have used elephants as beasts of burden and war machines, slaughtered them for their ivory, exterminated them as threats to people and ecosystems, turned them into objects of entertainment at circuses, employed them as both curiosities and conservation ambassadors in zoos, and deified and honored them in religious rites. How have such actions affected these pachyderms? What ethical and moral imperatives should humans follow to ensure (...) that elephants are treated with dignity and saved from extinction? In Elephants and Ethics, Christen Wemmer and Catherine A. Christen assemble an international cohort of experts to review the history of human-elephant relations, discuss current issues of vital concern to elephant welfare, and assess the prospects for the ethical coexistence of both species. Part I provides an overview of the vexatious human-elephant relationship, from the history of our interactions to understanding elephant intelligence and sense of self. It concludes with a discussion of the issues of stress, pain, and suffering as experienced by elephants in human care and the problems inherent in assessing these subjectively. The second part explores how humans use elephants as tools and entertainment. It reviews domestic uses in Asia, examines the history and roles of elephants in zoos and circuses, and discusses the methods and ethics of training and caring for captive elephants. In Part III the contributors examine the fragile and conflict-filled world of human-elephant interactions in the wild. Each chapter delves into a different angle of the "elephant problem" -- the all-too-human problem of our growing populations taking over space that was historically the domain of these pachyderms. The chapters explore attempts to tame and "train" elephants in populous areas, the struggle over balancing species preservation while maintaining biodiversity in protected areas, and the conundrums posed by hunting, tourism, and human-elephant competition on rural land. That the future health and survival of elephants is dependent on human actions is irrefutable. In addressing these issues from multiple perspectives, Elephants and Ethics promotes mutual understanding of the cultural, conservation, and economic difficulties at the root of the many troublesome human-elephant interactions and poses new questions about our responsibility toward these largest of land mammals. (shrink)

The aim of the present study was to investigate the association between work-related moral stress, moral climate and moral sensitivity in mental health nursing. By means of the three scales Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire and Work-Related Moral Stress, 49 participants’ experiences were assessed. The results of linear regression analysis indicated that moral stress was determined to a degree by the work place’s moral climate as well as by (...) two aspects of the mental health staff’s moral sensitivity. The nurses’ experience of ‘moral burden’ or ‘moral support’ increased or decreased their experience of moral stress. Their work-related moral stress was determined by the job-associated moral climate and two aspects of moral sensitivity. Our findings showed an association between three concepts: moral sensitivity, moral climate and moral stress. Despite being a small study, the findings seem relevant for future research leading to theory development and conceptual clarity. We suggest that more attention be given to methodological issues and developing designs that allow for comparative research in other disciplines, as well as in-depth knowledge of moral agency. Copyright © 2011 by SAGE Publications. (shrink)

Science is a force for good in the world--at least usually. But sometimes, when obsession gets the better of scientists, they twist a noble pursuit into something sinister. Under this spell, knowledge isn't everything, it's the only thing--no matter the cost. Bestselling author Sam Kean tells the true story of what happens when unfettered ambition pushes otherwise rational men and women to cross the line in the name of science, trampling ethical boundaries and often committing crimes in the process. (...) The Icepick Surgeon masterfully guides the reader across two thousand years of history, beginning with Cleopatra's dark deeds in ancient Egypt. The book reveals the origins of much of modern science in the transatlantic slave trade of the 1700s, as well as Thomas Edison's mercenary support of the electric chair and the warped logic of the spies who infiltrated the Manhattan Project. But the sins of science aren't all safely buried in the past. Many of them, Kean reminds us, still affect us today. We can draw direct lines from the medical abuses of Tuskegee and Nazi Germany to current vaccine hesitancy, and connect icepick lobotomies from the 1950s to the contemporary failings of mental-health care. Kean even takes us into the future, when advanced computers and genetic engineering could unleash whole new sways to do one another wrong. Unflinching, and exhilarating to the last page, The Icepick Surgeon fuses the drama of scientific discovery with the illicit thrill of a true-crime tale. With his trademark wit and precision, Kean shows that, while science has done more good than harm in the world, rogue scientists do exist, and when we sacrifice morals for progress, we often end up with neither. (shrink)

The interface between mental health services and the criminal justice system presents challenges both for professionals and patients. Both systems are stressed and inherently complex. Section 136 of the Mental Health Act is unusual being both an aspect of the Mental Health Act and a power of arrest. It has a long and controversial history related to concerns about who has been detained and how the section was applied. More recently, Section 136 has had (...) a public profile stemming from the use of police cells as places of safety for young, mentally disturbed individuals. This paper explores the current state of health of this piece of legislation. Specifically, we consider whether alternative approaches are more suitable for those individuals in crisis and/or distress who come into contact with the police. This requires careful thought as to the proper role of both health and criminal justice professionals who are daily grappling with an ethically contentious domain of multiagency work. (shrink)

The Oxford Handbook of Psychotherapy Ethics explores a whole range of ethical issues in the heterogenous field of psychotherapy. It will be an essential book for psychotherapists in clinical practice and valuable for those professionals providing mental health services beyond psychology and medicine, including counsellors and social workers.

In this chapter we argue that the four principles of medical ethics -- beneficence, non-maleficence, respect for autonomy and justice (Beauchamp & Childress, 2001; Gillon, 1985), a new Family Interest Principle (introduced below) and a consideration of ‘capacity’ provide a reasoned practice guide for work with mothers experiencing health problems, focussing here on mental health when a parent is a patient. Our concern is the relationship of the clinician with a parent and through the parent their child. (...) Ethics of service provision or services planning (e.g. Culyer, 2001; McLachlan, 2005; see also Newbigging and Paul, chapter xxx), or the provision of other services (e.g. education, child protection) although intensely relevant to this area are not addressed in this chapter nor will we deal with the complex aspects of medical ethics relating to the treatment of children (Baines, 2008). We use the term ‘parent’ to refer to any adult person who fulfils a substantive parental role with a child. Defining what counts as a family will in certain circumstances be contentious. There are diverse patterns of family arrangements that may be influenced by cultural, political economic and temporal factors. For the purposes of our discussion, we define a family in terms of its role in childrearing, as a group of at least one adult and at least one child, living together in long term relationships on an ongoing basis with vested interest in the well being of each of the family members. (shrink)

This book considers coercion within the healing and ethical framework of therapeutic relationships and partnerships at all levels, and addresses the universal ...

The ability to reason ethically is an extraordinarily important aspect of professionalism in any field. Indeed, the greatest challenge in ethical professional practice involves resolving the conflict that arises when the professional is required to choose between two competing ethical principles. Ethical Reasoning in the Mental Health Professions explores how to develop the ability to reason ethically in difficult situations. Other books merely present ethical and legal issues one at a time, along with case (...) examples involving "right" and "wrong" answers. In dramatic contrast, Ethical Reasoning in the Mental Health Professions provides you with the needed background in methods of ethical reasoning and introduces an innovative nine-step model of ethical decision-making for resolving ethical dilemmas. Ethical Reasoning in the Mental Health Profession discusses the ethical codes of both psychology and counseling. This interdisciplinary approach promotes a better understanding of the similarities and differences in the points of emphasis in the two codes, which, in turn, enriches your understanding of the range of ethical considerations relevant to the practice of the mental health professions. (shrink)

본 연구의 목적은 트랜스휴머니즘 시대의 약리학적 도덕교육의 방향에 대해 비판적 성 찰을 제공하고는 것이다. 즉 인류의 도덕성을 향상시키기 위한 방안 중 하나인 약리학적 방식으로 도덕적 능력을 향상시키는 방안을 살펴보고자 한다. 약리학적인 접근은 이론적 으로 의료화 또는 생의료화 현상과 깊은 연결성을 가지는데, 최근의 생의료화 접근은 치료 를 목적으로 하는 것을 넘어서 생명공학이 도덕적 생명향상에 초점을 두고 있다. 이것은 자연이나 사물을 향했던 기술이 이제 인간 자신을 향하게 되었지만 기술의 영향이 생의료 화 현상과 관련하여 주의할 필요성이 있게 된 것이다. 이 때문에 본 연구에서는 (...) 약리학의 의료화 생의료화가 정신건강과 행복교육의 영역을 먼저 어떻게 식민화화하면서 어떤 한 계를 표출하였는지를 살피고자 하였다. 이러한 한계는 도덕적 향상의 영역, 덕성 강화의 영역에서도 연결되면서 어떤 기술적 한계를 가질 수 있음을 살펴볼 것이다. 뿐만 아니라 윤리학적으로도 도덕판단에서 감정의 중요성과 역할에 초점을 맞추고 있는 약리학적 인간 향상 연구의 동향이 일면적 한계를 갖고 있음을 밝히면서 덕윤리학의 입장을 통해 인간의 감정에 대한 완벽한 조작가능성의 한계가 무엇인지 제시하고자 하였다. 비록 첨단 과학기 술을 통해 치료와 향상의 경계선이 불분명한 상황이지만 치료뿐만 아니라 향상의 추구가 상당한 한계를 갖고 있음을 제시하였다. 결국 트랜스휴머니즘의 도덕성 향상 기획중 약리 학적 접근은 아직 인간의 도덕적 행위능력을 고양시키지 못한다는 점을 강조하였으며, 의 료화와 생의료화의 경향이 강화되는 현실에서 오히려 역발상적 태도도 필요함을 제시하였다 즉 덕교육적 접근을 통해 전통적 도덕교육을. 제대로 시도해야 할 필요성이 있음을 제시하였다. (shrink)

The field of mental health continues to struggle with the question of how best to structure its diagnostic systems. This issue is of considerable ethical importance, but the implications for public health approaches to mental health have yet to be explored in any detail. In this article I offer a preliminary treatment, drawing out several core issues while sounding a note of caution. A central strand of the debates over diagnosis has been the contrast (...) between categorical and dimensional models, with renewed attention due to recent publication of the DSM-5, launch of the RDoC, and ongoing work on the ICD-11. This dispute involves an interesting assortment of ethical and empirical considerations, many with direct relevance for public health. It has been proposed, for example, that dimensional diagnosis may be morally preferable because it can help reduce the stigma associated with mental disorder. This is a pressing concern, as preventive strategies are expanded in mental health, often operating under dimensional assumptions that target various risk factors. But this type of proposal relies upon an empirical claim and the scientific status of dimensionality remains unresolved, including its relation to stigma. I suggest, then, that the current state of the evidence does not yet warrant clear adjudication between competing frameworks, and thus any implications for public mental health remain highly provisional. More research is needed to help resolve these issues, including ethical analysis. (shrink)

Plato, Aristotle, and the Stoics identify mental health with moral virtue. Are they right? We might be inclined to disagree with him if we believe that mental health is good for the agent, whereas virtues of character are good for other people. These philosophers answer that the mental features of the virtues of character are also features of a person's good. Still, their demands for psychic unity and cohesion might appear to exaggerate reasonable conditions (...) on mental health. In the view of these philosophers, our conception of mental health should make us aware of the aspects of agency that we value. We do not refer to different characteristics when we think of mental health and when we think of moral virtue. The main question is not about whether we choose to confine the expression "mental health" to the minimal condition, but about what makes the minimal condition valuable. It turns out to be difficult to explain why the minimal condition is valuable without also endorsing the moral virtues. (shrink)

Climate change, pollution, and deforestation have a negative impact on global mental health. There is an environmental justice dimension to this challenge as wealthy people and high-income countries are major contributors to climate change and pollution, while poor people and low-income countries are heavily affected by the consequences. Using state-of-the art data mining, we analyzed and visualized the global research landscape on mental health, climate change, pollution and deforestation over a 15-year period. Metadata of papers were (...) exported from PubMed®, and both relevance and relatedness of terms in different time frames were computed using VOSviewer. Co-occurrence graphs were used to visualize results. The development of exemplary terms over time was plotted separately. The number of research papers on mental health and environmental challenges is growing in a linear fashion. Major topics are climate change, chemical pollution, including psychiatric medication in wastewater, and neurobiological effects. Research on specific psychiatric syndromes and diseases, particularly on their ethical and social aspects is less prominent. There is a growing body of research literature on links between mental health, climate change, pollution, and deforestation. This research provides a graphic overview to mental healthcare professionals and political stakeholders. Social and ethical aspects of the climate change-mental health link have been neglected, and more research is needed. (shrink)

All investigators funded by the National Institutes of Health are now required to receive training about the ethics of clinical research. Based on a course taught by the editors at NIH, Ethical and Regulatory Aspects of Clinical Research is the first book designed to help investigators meet this new requirement. The book begins with the history of human subjects research and guidelines instituted since World War II. It then covers various stages and components of the clinical trial process: (...) designing the trial, recruiting participants, ensuring informed consent, studying special populations, and conducting international research. Concluding chapters address conflicts of interest, scientific misconduct, and challenges to the IRB system. The appendix provides sample informed consent forms. This book will be used in undergraduate courses on research ethics and in schools of medicine and public health by students who are or will be carrying out clinical research. Professionals in need of such training and bioethicists also will be interested. (shrink)

Values in dialogue offers a practical and theoretical model for ethics in care, that has grown from experience and research. The foundation of this ethical model is laid in the care relationship and in relational personalism. It consists of three pillars: values, dialogue, and attitudes. On this basis, a practical model for ethical reflection is developed. The aim is to empower professionals in their own ethical reflection and responsibility in concrete care situations. The model is applied on (...) several topics, such as collaboration between professionals, collaboration with clients and significant others, restriction of freedom and use of coercion, and exchange of information and confidentiality. 'Values in dialogue' is written for care professionals in their daily practice and in ethics commitees, but also for teachers and students in ethics courses. It focuses in particular on mental healthcare, support for people with mental disabilities, and care for elderly persons. (shrink)

Coercive medico-legal interventions are often employed to prevent people deemed to be unable to make competent decisions about their health, such as minors, people with mental illness, disability or problematic alcohol or other drug use, from harming themselves or others. These interventions can entail major curtailments of individuals' liberty and bodily integrity, and may cause significant harm and distress. The use of coercive medico-legal interventions can also serve competing social interests that raise profound ethical, legal and clinical (...) questions. Examining the ethical, social and legal issues involved in coerced care, this book brings together the views and insights of leading researchers from a range of disciplines, including criminology, law, ethics, psychology and public health, as well as legal and medical practitioners, social-service 'consumers' and government officials. Topics addressed in this volume include: compulsory treatment and involuntary detention orders in civil mental health and disability law; mandatory alcohol and drug treatment programs and drug courts; community treatment orders; the use of welfare cards with Indigenous populations; mandated treatment of seriously ill minors; as well as adult guardianship and substituted decision-making regimes. These contributions attempt to shed light on why we use coercive interventions, whether we should, whether they are effective in achieving the benefits that are offered to justify their use, and the impact that they have on some of society's most vulnerable citizens in the names of 'justice' and 'treatment'. This book is essential reading for clinicians, researchers and legal practitioners involved in the study and application of coerced care, as well as students and scholars in the fields of law, medicine, ethics and criminology. The collection asks important questions about the increasing use of coercive care that demand to be answered, and offers critical insights, guidance and recommendations for those working in the field. (shrink)

In this chapter we outline ethical issues raised by the application of public health approaches to the field of mental health. We first set out some of the basics of public health ethics that are particularly relevant to mental health, with special attention to the ongoing debate over the traditional presumption of non-infringement, increased recognition of the social determinants of health, and the concept of prevention. Then we turn to the moral (...) particularities of mental health, focusing on questions concerning coercion and treatment pressure, personal identity and sociocultural factors (including stigma), and unresolved conceptual and methodological issues in psychiatry that complicate its extension into the domain of public health. (shrink)