What is Psychiatric Ethics?
Psychiatry is a branch of medicine, so the principles that hold in medical ethics in general also apply to psychiatry. However, there are broadly speaking two different ways in which ethics of psychiatry can be different from other fields of medicine. The first way is differences in degree; and the second is differences in nature.
Differences in degree can occur in psychiatry, where some ethical issues applicable to other branches of medicine may be more problematic when it comes to psychiatry in particular. For example, the principle of doctor-patient confidentiality is as relevant to psychiatry as other specialties. However, confidentiality can be a great deal more complex to consider in psychiatry because many people who suffer from psychiatric disorders require considerable help and support or even supervision by family members or partners, and depending on the nature and severity of the mental disorder there can be other concerns such as risk to self or, much more rarely, risk to others. For these reasons, family members or partners who are carers may need to be consulted and kept informed about a patient's condition in a way that is neither necessary nor appropriate for other types of illnesses.
Differences in nature can also occur in psychiatry, which can make the ethics of psychiatry different from the ethics of other branches of medicine. As the discipline of disorders of the mind, the nature and definition of psychiatry itself is philosophically problematic. Research shows that there are clear neurological, neurochemical and neurophysiological bases for mental disorders. However, we do not as yet fully understand the underlying mechanisms for most mental disorders. Therefore, mental disorders are largely defined by behaviours or symptoms relative to what is considered ‘normal'. This can cause problems both in practical matters such as diagnosis and theoretical matters such as conceptualisation of the nature of a mental disorder. This is particularly the case for the diagnoses that are less typical of mental disorders, such as personality disorders and addictions. Mental disorders can also raise ethical and philosophical problems in areas such as attribution of responsibility for thoughts, intention, words and actions when a person is well and unwell; issues of personal identity, personhood and agency when people change due to mental disorders; and difficulties in balancing autonomy and individual rights against the protection of others and of patients themselves from harm.