Justifying involuntary psychiatric treatment on the basis of a judgment that a person lacks capacity is usually expressed in terms of a person’s ability to make a decision about his or her health and treatment. Typically, this relates to the ability to refuse treatment. Exactly what “capacity” means, however, and how one determines when another individual lacks capacity, or lacks sufficient capacity, in this context is particularly controversial, with the United Nations Committee on the Rights of Persons with Disabilities insisting (...) that involuntary treatment be abandoned altogether and capacity tests avoided.Capacity is a concept that has multiple meanings and applications across different disciplines and... (shrink)

This second paper reports on a small ethnographic study of Argentine psychiatrists. A carefully selected group of six psychiatrists currently practicing in Buenos Aires participated in an in-depth semi-structured interview. The transcripts of the interviews were coded and a thematic analysis method was applied to construct a local theory of the professional values constructed by Argentine psychiatrists, and the circumstances in which such values were constructed. Our analysis indicated that Argentine psychiatrists constructed a number of values, frequently perceived as obligations (...) to their professional group and the needs of their patients. The two main strategies employed by Argentine psychiatrists were the diagnostic act and advocacy. We also identify that these values emerge in the context of recent broad historical and cultural inl uences upon the profession of psychiatry in Argentina, and the Argentine population in general. (shrink)

“[T]he current state of professional ethics instruction leaves much to be desired. In most law schools, it is relegated to a single required course that ranks low on the academic pecking order. Many of these courses, which focus primarily (and uncritically) on bar disciplinary rules, constitute the functional equivalent of ‘legal ethics without the ethics', and leave future practitioners without the foundations for reflective judgment. Although ethical issues arise in every subject, that would not be apparent from the core curriculum (...) …”1. (shrink)

Methods of ethical reasoning in psychiatry -- Psychiatric professional ethics and the social -- Communitarian ethics and the social -- Moral agency in psychiatry -- Involuntary psychiatric treatment -- Psychiatry across cultures -- Neoliberalism -- Psychiatry and popular culture -- Psychiatric ethics in the light of neuroscience -- Reappraisals -- Power and knowledge in psychiatry.

In lieu of an abstract, here is a brief excerpt of the content:Ethics CommentaryMichael Robertson, Senior Research FellowThe French philosopher Michel Foucault once recounted the story of the English King, George III, being restrained by his guards at the direction of his physician Dr. Willis. King George, presumably deranged by a psychotic mania consequent upon porphyria, was incapable of self-rule and his power was usurped by the medical profession in an act of coercion tantamount to treason. This for Foucault was (...) a profound metaphor of psychiatric power.1The plight of Mdm. W yokes the two most emotive issues in psychiatry — involuntary treatment and the administration of ECT. Whilst only utilised at an extremity of clinical practice, both of these are the most misunderstood of actions performed by the psychiatric profession. Yet, in many circumstances, they are life-saving.In essence, we are confronted with a profoundly depressed woman, whose illness is seemingly resistant to first line treatment and poses a serious, credible risk of harm. Most psychiatrists would regard this as somewhat of a psychiatric emergency. We are informed that Mdm. W’s family has transcended any cultural taboos about mental illness and is engaged in her care, has an extensive lived experience of her severe mood disorder and accepts, indeed welcomes, the use of ECT to terminate a severe episode of depression. In the course of a psychotic depression, Mdm. W is suffering profound distress and presents a risk of either suicide or serious medical complications if the episode persists. Despite the minimal discomfort during the actual administration of ECT, Mdm. W’s distress will be compounded by the further restraint needed to prevent from her eating and drinking prior to anaesthesia.It is difficult to know what Mdm. W’s experience of this situation would [End Page 230] be. Through the prism of her disturbed mental state, with its derangements in thinking, cognitive functioning and apprehension of reality, she would likely experience the situation as one of fear or terror; she would likely interpret ECT and the enforced restriction of oral intake prior to the procedure as punitive — further evidence of her “sins”, reinforcing her delusional guilt and nihilism. Yet to speak to Mdm. W in circumstances of euthymia or normal mood, where such derangements no longer occur, might reveal an utterly different perspective on the situation. Like many people with episodic mental illnesses, Mdm. W might, when such a scenario was put to her, consent to future treatment with ECT without equivocation. Indeed, many patients with bipolar disorder formulate advance directives in regard to the specific management of their possible future episodes of illness.If the clinical and legal aspects of this situation are so clear, why is there a sense of a dilemma in the realm of clinical ethics? Beyond the emotive nature of the situation, we see a deeply distressed woman being provided potentially life-saving treatment, which is being denied to her by the profound impairments of insight and judgement consequent upon her illness.In Singapore, such detention and enforced treatment under the Mental Capacity Act (2010) applies to a person with a mental illness or disorder who lacks capacity to make decisions in their own best interests based upon impairment of mind or brain. This would be considered a “capacity” based mental health law. In other jurisdictions, the legal test and evidentiary justification for such care may be predicated upon risk of harm to self or others. In either setting, Mdm. W’s clinical situation provides adequate legal justification for such enforced care.The moral justification of such laws falls into two general categories — the “risk” argument and the “capacity” argument. In mental health legislation, the “harm principle”, as first elaborated in John Stuart Mill’s On Liberty,2 is usually defined in terms of the construct of “risk”. Risk is a term that has multiple meanings in different disciplinary contexts, although all approaches to “risk” attempt to apply knowledge to an area of uncertainty.3 The notion of “risk assessment” is usually considered as the process of categorising individuals by their perceived likelihood of causing serious harm to themselves or harm to others. In the insurance industry, actuarial assessment is a mathematical discipline aimed at computing a probability of adversity... (shrink)

It is generally assumed, without argument, that legal theory, legal philosophy, philosophy of law, and jurisprudence all mean the same thing. This paper rejects that assumption, and in particular the assumption that jurisprudence is the same thing as legal philosophy. This assumption has recently been challenged by Roger Cotterrell in his article “Why Jurisprudence Is Not Legal Philosophy,” and I seek to build on his arguments by adding insights found in the work of Stanley Fish.

This second paper explores psychiatrists’ ethical obligations in the face of the failure of the social contract – inherent failures in distributive justice, the failure of the sovereign and the reconstitution of the social contract in post-conflict societies. Such situations present many sources of ethical tension between the professional ethical obligations of psychiatrists to their individual patients and to their society.

These two papers consider the concept of social justice and the ethical obligations psychiatrists may have in its regard. In this first paper, the concept of social justice is defined in terms of the successful function of the social contract. Basic conceptions of justice are then considered.

Fish's writings on philosophy, politics and law comprise numerous books and articles produced over many decades. This book connects those dots in order to reveal the overall structure of his argument and to demonstrate how his work in politics and law flows logically from his philosophical stands on the nature of the self, epistemology and the role of theory. Michael Robertson considers Fish's political critiques of liberalism, critical theory, postmodernism and pragmatism before turning to his observations on political substance and (...) political practice. The detailed analysis of Fish's jurisprudence explores his relationships to legal positivism, legal formalism, legal realism and critical legal studies, as well as his debate with Ronald Dworkin. Gaps and inconsistencies in Fish's arguments are fully explored, and the author provides a description of Fish's own positive account of law and deals with the charge that Fish is an indeterminacy theorist who undermines the rule of law. (shrink)

This is the definitive study of the history and accomplishments of the Frankfurt School. It offers elegantly written portraits of the major figures in the school's history as well as overviews of the various positions and directions they developed from the founding years just after World War I until the death of Theodor Adorno in 1969.The book is based on documentary and biographical materials that have only recently become available. As the narrative follows the Institute for Social Research from Frankfurt (...) am Main to Geneva, New York, and Los Angeles, and then back to Frankfurt, Wiggershaus continually ties the evolution of the school to the changing intellectual and political contexts in which it operated. He also interweaves these accounts with incisive summaries of substantive works by Horkheimer, Adorno, Benjamin, Fromm, Kirchheimer, Lowenthal, Marcuse, Neumann, Pollock, and Habermas.The book is self-contained and can serve as a general introduction to critical theory, but it also has a wealth of new material to offer those who are familiar with this tradition but would like to learn more about its history and context.Studies in Contemporary German Social Thought. (shrink)

Neuroethics is a relatively novel field of investigation. Applied to mental health practice and research, neuroethics would seem to enlighten many traditional ethical connundra. This editorial introduces this symposium on neuroethics in the Journal of Bioethical Inquiry.