An Overview of Psychiatric Ethics

Normative Ethical Theories and Psychiatry1Applied to psychiatry, this process may be deployed to understand differences in how societiesapproach issues related to autonomy, such as involuntary treatment, psychiatric diagnosis, allocationof health care resources or forced breaches of confidentiality. Where this approach collapses is indefining what the basic goods of psychiatry are. The whole notion of good in ethics has provedelusive, and this is also the case in psychiatric ethics. G.E. Moore 26 recognised this in arguing for theintuitionist position that a moral good is a simple, non-natural, indefinable quality of certain things,such as interpersonal attachment or the aesthetic appreciation of beauty. Perhaps the only attemptto define a good in any bioethical context is Pellegrino’s assertion that the good in medicine is thegood of the patient. 163 Even here, how to define the good of the patient is slippery – Pellegrinopostulates the existence of biomedical, patient-defined, and human-defined conceptions of thegood.POST-MODERN PROFESSIONAL ETHICSOverview“Postmodernism” is a term variably used to describe any intellectual activity, from art to architecture,which appears to break with the rationalist traditions of the Enlightenment, or “modernism”.Jean-Francois Lyotard 164 summarized the core of postmodernism as being “incredulity tometanarratives”, or the rejection of grand, unified conceptual schemes. Psychiatry is argued tobe “a quintessentially modernist project” because of its embrace of scientific paradigms. 165 Thepostmodern approach to knowledge has been applied to psychiatry, 166 which argued that thingsare more complex than depicted in the modernist project of positivism (rejecting metaphysics) andempiricism (knowledge based upon observation and experience).Applied to ethics, Hugman argued that the postmodern approach seeks to move away fromoverarching theoretical structures into individualizing relationships which have virtues in thebackground. 167 Hugman nominates the work of MacIntyre, 77-79 Foucault 168 and Bauman 169 asbeing the key works in postmodern ethics applied to the helping professions.27Bauman’s Post-Modern EthicsLike many postmodern theorists Zygmunt Bauman’s, intellectual position resulted from thedisillusionment with the horrors of the Twentieth Century. He was a Polish writer working in theshadow of the Holocaust and saw ethics as a process involving “a moral party of two (p.82)”. LikeMacIntyre, Bauman’s post modern approach to morality is his response to the failings of post-Enlightenment European moral philosophy. He saw the Holocaust as arising out of the ideas of suchphilosophy, in particular that of Hobbes. 170 Indeed, as MacIntyre points out, alá Arendt, Eichmannwas able to reconcile his crimes with his adherence to the deontic tradition of Kant. 82 As such,Bauman insisted that our moral responsibility cannot be reduced to the fulfillment of a limited set ofsocially constructed, arbitrary rules. He argues human morality can only be grounded in the “moralimpulse”.Bauman’s postmodernism was:“…modernity without illusions... (t)he illusions in question boil down to the beliefthat the “messiness” of the human world is but a temporary and repairable state,sooner or later to be replaced by the orderly and systematic rule of reason (p.32)” 169Bauman described the “aporetic” (confused or difficult to verify) nature of human relations and inthe face of this, he rejects the idea of a socially constructed morality. As such, Bauman was criticalof bureaucracy and systems. Concerns about bureaucracy are not new. The Nineteenth Century171, 172sociologist Max Weber warned of the destructive effects of large bureaucratic institutions.Such institutions focused on outcomes, rather than values, and as such had lost touch with socialvalues. To Weber, individuals who were subject to the influence of bureaucracies were in an “ironcage” and that society had dipped into a “polar night of icy darkness”.Foucault’s Post-Modern EthicsMichel Foucault’s writings covered many aspects of knowledge and power. His oeuvre madefrequent reference to psychiatry. In the tradition of post-modernism, Foucault’s ethical projectrejected the notions of religious, scientific or conventional moral codes as being the basis of anyIMET AN OVERVIEW OF PSYCHIATRIC ETHICS