Seattle University Collaborative Projects - International Academy of ...

Equity of Mental Health Care: Moral Implications and Future DevelopmentsChristina M. van der Feltz-Cornelis, Tilburg University (c.m.vdrfeltz@tilburguniversity.edu)In medicine, autonomy of the patient, beneficence of the physician, non-maleficence of thephysician and justice are four leading ethical principles and several Medical Associations as wellas Psychiatric Associations have published Codes of Ethics in which the physician-patientrelationship is considered to be at the heart of medical and psychiatric practice. In recentdevelopments, the patient’s perspective is taken into account more often, i.e. in Shared DecisionMaking and patient preference as leading principles in the choice mental health treatment. Theeconomic framework of mental health care should follow the principle of equity even more in atime of economic recession. If ethical decisions are taken that make it impossible to sustainmedical treatment for economic reasons, unethical injustice in the division of means wouldresult. Therefore, viability and economic sustainability have ethical implications in and ofthemselves. However, ethical decisions should also be based primarily upon sound moral valuesand their acceptability in a given cultural context. Limitation of access to mental health carebased upon economic considerations, as imposed by the government of the Netherlands due tothe economic recession, poses specific ethical challenges, as it intrudes upon the patient-doctorrelationship and the equity of division of means. Moral implications of the influence ofpharmaceutical companies and governmental policies are described and possible solutions onmicro-, meso- and macrolevels are suggested. For an ethical approach to the economy ofpsychiatry, not only should the principle of equity be followed, but allocation of money orresources should always lead toward an ethically sound destination.60. EthicsA Framework for Trustworthiness in the Medical ProfessionKatinka Morton, North Western Mental Health Program, Parkville, Australia(Katinka.Morton@mh.org.au)The importance of trust for the medical profession seems beyond question. There is a growingsociological literature examining the factors which influence levels of interpersonal andinstitutional trust in the medical profession. Trust without the guarantee of trustworthiness isassociated with risk, however. Although there is undoubtedly much trustworthy conduct withinthe medical profession, there has been little attempt to define what trustworthiness is in thiscontext. Philosophy's interest in trust and trustworthiness has been relatively recent, but there arenow a spectrum of descriptions of trust and trustworthiness. In this presentation I examine theavailable considerations of trust and trustworthiness. I argue that it is only one form oftrustworthiness that is appropriately considered for the doctor patient relationship. I define thesestandards in the doctor patient relationship, and present a Framework of Trustworthiness for the149