Abstract
This third edition of Psychiatric Ethics has 29 contributors, 11 of whom are new. It is a mark of developments in this field and the corresponding need for a third edition that this volume contains chapters on six new topics that did not need special attention in the previous editions published in 1981 and 1991. The six topics are boundary violations, codes of ethics in psychiatry, ethics and community psychiatry, ethical issues in health resource allocation, managed mental health care and psychiatric genetics.
Professional boundaries refers to the limits of appropriate behaviour by the psychiatrist in the clinical setting, the most serious examples of boundary violation being sexual contact with patients. In 2000 it seems inconceivable that the 1991 edition of Psychiatric Ethics could have been published without a chapter devoted to boundary violations. Glen Gabbard's contribution suggests that psychiatrists have until recently conceived of the issue as a few corrupt, bad apples who need to be removed from the profession, instead of a hazy boundary between the personal and the professional which presents risks to all clinicians. Gabbard provides a clear explanation of the problem using concrete examples and a rationale for where to draw the line, as well as practical strategies for prevention. There is a curious asymmetry in that he has written a section entitled ‘Assessment and Rehabilitation of Accused Clinicians’ with no corresponding section on patient victims. This chapter is important reading not only for clinicians dealing with their own countertransference, but for clinicians supervising other clinicians and trainees.
Still in this edition is an updated version of Walter Reich's excellent chapter ‘Psychiatric Diagnosis as an Ethical Problem’. He describes the intrinsic limitations of the process of diagnosis which lead to misdiagnosis. He focuses on the seductive beauty of diagnosis as a way of solving or avoiding complex human problems. Ethical ambiguity permeates the most basic assumptions in psychiatric practice.
As in previous editions, this one has a useful appendix containing important international codes of ethics covering the practice of psychiatry. Co-editor
Sidney Bloch and Russell Pargiter have contributed a chapter on ‘Codes of Ethics in Psychiatry’ which describes the value and the limitations of codes in guiding ethical practice.
Only two contributors are women. Catherine Oppenheimer's chapter from the second edition has been extensively revised to become ‘Ethics in Old Age Psychiatry’. She addresses the demanding dilemmas of assessing the competence of demented patients to make their own decisions. She describes the ethical interplay between patient, family, psychiatry and the law (in Britain) when substitute decisions have to be made.
Most chapters are as relevant to psychologists working in mental health services as to psychiatrists. The book will also be of interest to other mental health professionals and students of bioethics. The contributions are uniformly well written and accessible. The book is ideally suited as a text for teaching a professional ethics module to postgraduate students in psychiatry, psychology and related fields.
Appreciation of ethical issues intrinsic to psychiatric practice is no longer optional. Psychiatric Ethics is an essential text.