Overview of Psychiatric Ethics III: Principles-Based Ethics

Abstract

Objective: The aim of this paper is to consider the application of principle-based medical ethics to psychiatry.

Conclusions: Principles-based medical ethics is a useful tool for resolving ethical dilemmas in psychiatryin that clinical aspects of ethical dilemmas can be better articulated then in other methods. The ethical dilemmas unique to psychiatry, such as those related to impairment of autonomy, present a challenge to the method. After considering a case example, we conclude that psychiatrists can best utilise a principles based approach to ethical dilemmas when they combine this with a level of critical reflection in the light of other ethical theories, such as virtue ethics, as well as close consideration of the clinical and social context of the ethical dilemma.

Keywords

Ethics principle-based ethics psychiatry

Get full access to this article

View all access options for this article.

References

1. Beauchamp

Childress

. Principles of Biomedical Ethics5th edn. Oxford University Press, New York 2001.

2. Beachamp

. Methods and principles in biomedical ethics. Journal of Medical Ethics 2003; 29: 269–274.

3. Gillon

. Medical ethics: four principles plus attention to scope. British Medical Journal 1994; 309: 184–188.

4. Pincoffs

. Quandary ethics. Mind 1971; 75: 552–571.

5. Ross

. The Foundation of Ethics. Clarendon Press, Oxford 1939.

6. Gert

. Morality: Its Nature and Justification. Oxford University Press, New York 1998.

7. Dawson

Garrard

. In defence of moral imperialism: four equal and universal prima facie principles. Journal of Medical Ethics 2006; 32: 200–204.

8. DeMarco

. Principlism and moral dilemmas: a new principle. Journal of Medical Ethics 2005; 31: 101–105.

9. Atkinson . Autonomy and mental health. Ethical Issues in Mental Health, Barker

Baldwin

. Stanley Thornes, Cheltenham 1991; 103–126.

10.

10. Feinberg

. Autonomy. The Inner Citadel: Essays on Individual Autonomy, Christman

. Oxford University Press, New York 1989; 27–53.

11.

11. Kant

. Groundwork of the Metaphysic of Morals. Harper and Row, New York 1964.

12.

12. Mill

. On Liberty. WW Norton, New York 1975.

13.

13. Korsgaard

. The Sources of Normativity. Cambridge University Press, New York 1996.

14.

14. Radden

. Personal identity, characterization identity, and mental disorder. The Philosophy of Psychiatry, Radden

. Oxford University Press, New York 2004; 133–146.

15.

15. Gillon

. Ethics needs principles. Journal of Medical Ethics 2003; 29: 307–312.

16.

16. Holm

. Not just autonomy – the principles of American biomedical ethics. Journal of Medical Ethics 1995; 21: 323–324.

17.

17. Veatch

Gaylin

Steinbock

. Can the moral commons survive autonomy? (includes commentaries) In Search of the Good Society: The Work of Daniel Callahan. Hastings Center Report 1996; 26: 41.

18.

18. MacIntyre

. Notes from the moral wilderness” I. The MacIntyre Reader, Knight

. University of Notre Dame Press, Notre Dame 1998; 31–40.

19.

19. Campbell

. The virtues (and vices) of the four principles. Journal of Medical Ethics 2003; 29: 292–296.

20.

20. Aksoy

, Tenik

. The ‘four principles of bioethics’ as found in 13th century Muslim scholar Mawlana's teachings In: BMC Medical Ethics. 2002, http://www.biomedcentral.com/1472-6939/3/4 , (accessed 12 November 2006).

21.

21. Tsai

. Ancient Chinese medical ethics and the four principles of biomedical ethics. Journal of Medical Ethics 1999; 25: 315–321.

22.

22. Serour

. Islam and the four principles. Principles of Healthcare Ethics, Gillon

. John Wiley and Sons, Chichester 1994; 75–92.

23.

23. Kasenen

. African ethical theory and the four principles. Cross Cultural Perspectives in Medical Ethics2nd edn, Ceatch

. Jones and Bartlett, Boston 1989; 347–357.

24.

24. Steinberg

. A Jewish perspective on the four principles. Principles of Healthcare Ethics, Gillon

. John Wiley & Sons, Chichester 1994; 65–74.

25.

25. Pellegrino

. Is truth telling to the patient a cultural artifact?. Journal of the American Medical Association 1992; 268: 1734–1735.

26.

26. Ishiwata

Sakai

. The physician–patient relationship and medical ethics in Japan. Cambridge Quarterly of Healthcare Ethics 1994; 2: 45–47.

27.

27. Miyaji

. The power of compassion: truth telling among doctors in the care of dying patients. Social Science and Medicine 1993; 36: 249–264.

28.

28. Young

. Morals, suicide, and psychiatry: a view from Japan. Bioethics 2002; 16: 412–424.

29.

29. Tichtchenko

Yudin

. Towards a bioethics in post-Communist Russia. Cross-Cultural Perspectives in Medical Ethics, Veatch

. Jones and Bartlett, London 2000; 220–232.

30.

30. Chen

X-Y

. Clinical bioethics in China: The challenge of entering a market economy. Journal of Medicine and Philosophy 2006; 31: 7–12.

31.

31. Clouser

. Common morality as an alternative to principlism. Kennedy Institute of Ethics Journal 1995; 5: 219–236.

32.

32. Callahan

. Principlism and communitarianism. Journal of Medical Ethics 2003; 29: 287–291.

33.

33. Callahan

. Individual good and common good. Perspectives in Biology and Medicine 2003; 46: 496–507.

34.

34. Callahan

. The social sciences and the task of bioethics. Daedalus 1999; 128: 275–294.

35.

35. Clouser

Gert

. A critique of principlism. Journnal of Medicine and Philosophy 1990; 15: 219–236.

36.

36. Engelhardt

. The Foundations of Bioethics2nd edn. Oxford University Press, New York 1996.

37.

37. Trotter

. Moral acquaintances: a promising new synthesis of pluralism and liberty. The Journal of Medicine and Philosophy 2002; 27: 107–114.

38.

38. Harris

. In praise of unprincipled ethics. Journal of Medical Ethics 2003; 29: 303–306.

39.

39. Bloch

Green

. An ethical framework for psychiatry. British Journal of Psychiatry 2006; 188: 7–12.

40.

40. Dworkin

. Autonomy and the demented self. Millbank Quarterly 1986; 64: 4–16.