CLINICAL HANDBOOK OF SCHIZOPHRENIA

CHAPTER 61ETHICSABRAHAM RUDNICKCHARLES WEIJERHealth problems and health care frequently raise ethical issues of various types. Thediscipline that addresses such ethical issues is currently called bioethics, a field of practice,research, and education that influences public policymaking and legislature, as wellas clinical research and care. It is grounded in philosophy, law, and social sciences, as wellas in health care sciences, such as medicine and nursing. Contemporary bioethics involvessocial institutions such as bioethics committees, bioethics consultants, professional codesof bioethics, associations of bioethics, and texts of bioethics (Beauchamp & Childress,2001).Ethics in general, including bioethics, addresses moral problems, sometimes calledethical dilemmas. Moral problems primarily comprise conflicts of accepted principles orvalues that arise in particular situations. In health care, such situations are frequently relatedto the end of life, such as in euthanasia (mercy killing for people with terminal illnesses),when the value of preserving life conflicts with the value of reducing suffering, orto the beginning of life, such as in abortion, when the conflict is commonly stated as prolife(protecting the fetus) versus pro-choice (protecting the pregnant woman). Moralproblems are commonly resolved by applying ethical theories, as well as moral intuitions,preferably by engagement in a process of deliberation and dialogue with the parties involved(Rudnick, 2002b). Well-known ethical theories used in bioethics include utilitarianism,which addresses the consequences of actions; deontology, which addresses duties;and virtue ethics, which addresses character traits and intentions. Perhaps the mostcommonly used bioethical approach is principlism, which combines some of these wellknowntheories while balancing the principle of respect for persons (addressing autonomyor self-determination of the patient), the principle of beneficence and nonmaleficence(addressing maximal benefit and minimal harm to the patient), and the principleof justice (addressing fairness to the patient and to others).Mental health problems and care raise various ethical issues or moral problems, asreflected in areas such as involuntary commitment and substitute decision making. Someof these issues have been addressed in other chapters in this book. This chapter focuses624