This is a time in psychiatry when the ethics of our profession face great scrutiny and controversy. From a positive viewpoint, many patients are benefiting from a vastly improved armamentarium of treatments with effective outcomes. With this increased ability to treat our patients, however, we are also confronted with a dwindling share of the health care dollar. Obliged to ask for our patients’ fair share against other equally beneficial medical treatments, psychiatrists continue to experience differential and discriminatory practices. It is in the best interest of all of us to have a thorough review of ethical issues in their historical and emerging forms to face these current ethical quandaries.
This third edition of Psychiatric Ethics serves as an anchoring point examining both the history of psychiatric ethics and the most current ethical controversies facing psychiatry. It is composed of chapters from authors in the United States, the United Kingdom, Australia, Israel, and Canada. These international, although decidedly Western, writers provide some interesting and unique perspectives. Reich’s chapter on psychiatric diagnosis, describing ethics gone astray in the former Soviet Union, exemplifies the unethical psychiatric abuses of the past. This serves as an important reminder of the need to be grounded in ethics principles that supersede situational and political exigencies.
New chapters related to resource allocation in mental health dilemmas in managed care offer some chilling parallels. Chapters that address genetics, boundaries, and community psychiatry allow us to look into the future and consider some of the ethical issues that we will be facing in this millennium. Other chapters deal eloquently with ethics theory and application in specific situations, e.g., forensic psychiatry and research. Some chapters provide good descriptions of specialized areas of psychiatry, but with less emphasis on ethical dilemmas. Because of differences between the societal value systems that affect medical and psychiatric ethics, there may be some content areas where readers from one country might not fully appreciate the complexities of another. This is especially true in the descriptions of resource allocation and managed care. There also is an emphasis on psychiatric practice relying on a psychoanalytic background. Although this relates to unique applications of ethics, it may not be fully representative of other modes of practice. Underlying ethical principles remain constant, but their application may differ in various practice settings.
This new edition is a scholarly compendium of psychiatric ethics. It provides the context within which the interested reader can frame ethical questions, review ethical history, and continue to deliberate ethical paths to follow. The editors should be congratulated for continuing to update previous editions with increased focus on current ethical dilemmas framed by a clear and concise understanding of the past.
