An Overview of Psychiatric Ethics

Normative Ethical Theories and Psychiatry1Kant’s conception of autonomy is therefore profoundly different from the more modern conception ofautonomy as the right to negative liberty, i.e. the freedom to pursue one’s own ends, to satisfy one’sdesires, and to exercise independence of choice without the undue interference of others or thestate. In Kant’s “Kingdom of Ends” each moral agent is both a moral self-legislator and beholden toa common law. Kant did not believe in individual autonomy existing at the expense of the rule of law.The issue of duty is defined in Kant’s ethics as the notion of the “Categorical Imperative” (CI),articulated in the Groundwork. Kant argued that, in day-to-day dilemmas, we develop maxims thatguide decision. The universalisability of moral maxims is tested against the Categorical Imperative.The CI has multiple formulations. The First Formulation articulates the principle of universalisabilityby directing:“Act only according that maxim whereby you can at the same time will that itshould become a universal law” (p.421)13The Second Formulation of the CI is the injunction:“Act as if the maxim of your action were to become through your will a universallaw of nature” (p.421).Arguable, this formulation of the CI seeks to define a relationship between the laws of natureand the moral law.Kant’s Third Formulation of the CI is often dubbed the “formula of humanity”. It reads:“Act in such a way that you treat humanity, whether in your own person or inthe person of another, always at the same time as an end and never simply as ameans” (p.429)If ethics are a guide to relations between individuals, then this is the most important of Kant’sethics. The purpose of good actions is respect for people as beings who are intrinsically valuable.To understand how the CI works, one must first define a moral law which is universalisable andin some way naturalistic. Kant wrote of the specific example of lying. Even though a lie may havedesirable consequences, it does not occur in accordance with good will and is therefore unethical.Based upon the application of the CI to lying, the person develops a set of maxims (specific rulesfor different situations) that they apply to their moral agency. The third test is whether these maximsvalue humans intrinsically or not. One can see a contrast here between Kant’s view of ethicsand that of the utilitarians. It may be quite feasible to lie in the eyes of a utilitarian, if the desiredresult maximizes preferences or pleasure. To Kant, lying is never permissible, regardless of theconsequences.Kant’s formula of humanity is his main argument against suicide. Kant argues that destroyingoneself in order to avoid pain or achieve another end violates the formula of humanity. He arguesin the Groundwork:“To annihilate the subject of morality in one’s person is to root out the existence ofmorality itself from the world as far as one can, even though morality is an end initself. Consequently, disposing of oneself as a mere means to some discretionaryend is debasing humanity in one’s person” (p.423)The intrinsic value of persons, core to the practice of psychiatry, is justified in the fourth formulationof the CI. This defines “the idea of the will of every rational being as a will that legislates universallaw”(p.431). To Kant, individuals are intrinsically valuable because they are free, rational (orautonomous) agents. This reflects the original view of Aristotle, who saw that human functioningwas ultimately based on their capacity for reason. It is also significant in the context of psychiatricethics, given the impairment of reason that is a fundamental part of severe mental illness. Much ofpsychiatric ethics is focused upon situations where self-legislation and reason are impaired, and soKant’s formula of autonomy is arguably diminished in the context of mental illness. In other words,the formula of humanity, the basis of our ethical obligations to persons, is compromised in thecontext of mental illness.IMET AN OVERVIEW OF PSYCHIATRIC ETHICS