Drs. Green and Bloch Reply

To the Editor: We very much appreciate Dr. Mender’s kind and thoughtful remarks on our article. We have no quarrel with a Kantian perspective and appreciate Dr. Mender’s marshaling of appropriate arguments. He correctly portrays one elaboration of the categorical imperative: highlighting the collective aspects of that elaboration. He does not mention a crucial second iteration of Kant’s position—namely, to treat individuals as ends, not as means. We could argue that flawed systems fail to treat people as “ends” and are inherently neglectful in this regard. Thus, establishing categorical imperatives for psychiatric practice is undoubtedly a noble goal and could possibly assume the form advocated by Dr. Mender. Clearly, several ethical justifications are available for what we argue. Our basic concern is that practitioners strive to correct or improve flawed systems. Any theoretical framework that can contribute to promoting that goal is welcome.