An Overview of Psychiatric Ethics

Applied Psychiatric Ethics3most compelling examination of the question “how did this happen?”, although the “why did thishappen” remains elusive. This is the most critical question, as any attempt to prevent recurrence ofsuch crimes requires a clear articulation as to why they occurred, so that such preconditions canbe identified and prevented in the future. Dudley and Gale noted that the “why?” emerged througha process of peer pressure, uncritical devotion to duty, careerism, denial facilitating deceptivelanguage, and the influence of a faceless bureaucracy. 360The intellectual origins of the Nazi doctors require some consideration in order to try to frame thekind of ethical oversight that would prevent such crimes from re-occurring. Many bioethicists havegrappled with the apparent intellectual preconditions to the Nazi project. As described previously,the sociologist Max Weber warned us that bureaucracies had lost sight of values and concernedthemselves only with outcomes. This loss of values led to humans in the social system being placedin a moral void, or what he described as a “polar night of icy darkness”. 172 Despite the contributionof an amoral, pragmatic bureaucracy in the Nazi era, the eugenic movement remains the mainculprit in the crimes of the Nazi doctors. Malthus had warned humanity that expanding populationsthreatened the very existence of human-kind on the planet. 361 Malthusian ideas encouraged theviewpoint that the intrinsic value of human beings was negotiable. Eugenics was by no meansunique to German psychiatry. The British academic Francis Galton was so enamoured of theseminal thesis of Darwin, that he called for all public policy to be based upon the notion of naturalselection. 362 Eugenic ideas permeated American psychiatry contemporaneously with Germanpsychiatry. 363 In 1913, the German psychiatrist Alfred Ploetz founded the “German Society for RacialHygiene”. Another psychiatrist, Ernst Rüdin referred to the cause of removing inferior genetic stockfrom the population as ”Schädlingsbekämpfung” (pest control). In 1918, Emile Kraeplin called forstrong political leadership to effect ‘a decline in mental debility’. 36451Hitler’s moral philosophy was predicated upon Darwinian principles. Many leading Darwinianbiologists and social thinkers in Germany believed that Darwinism had superseded traditionalJudeo-Christian and Enlightenment ethics, in particular the value such philosophies placed uponall human life. The moral relativism which emerged from the exaltation of the evolutionary “fitness”of the species as the source of a moral good was at the core of this “pseudo-ethics”. 365 O’Mathúnaargued that five key ideas were central to the actions of the Nazi doctors – moral relativism, blurreddistinctions between animals and humans, the existence of human inequality, the notion that somelives have no value and natural selection as a valid determinant of human dignity. 366Regardless of the intellectual bankruptcy of Nazi racial ideology, Darwinian ideas and evolutionarypsychiatry are still popular. Indeed, there is a strong evolutionary psychiatry movement, whichseeks to understand human psychopathology in terms of the natural history of our species. 367Moreover, the conceptualization of psychiatric disorder is moving inexorably towards the molecularlevel, 368 where depression or anxiety may be defined more in terms of the possession of particularalleles of genes, rather than the traditional verstehende Psychologie of Jaspers. 369 Whilst it is notreasonable to assume a moral equivalence between the current, somewhat reductionist paradigmsof evolutionary psychiatry or genetics, there is a need to reflect upon neuropsychiatry potentiallylosing sight of the intrinsic value of humans. Kant’s notion of “Menscheit” refers to the humanpotential for autonomy, or unconstrained rational self–governance. 370 This is one approximation ofthe intrinsic value of humans, even the most irrational or intellectually disabled person. Kant’s formulaof humanity has it that humans must be ends in themselves, and never a means to such an end. 59Such notions were clearly lost in the Nazi era, a fact made all the more tragically ironic in that AdolfEichmann, the Nazi functionary who was responsible for the so-called “Final Solution”, proudlyproclaimed at his trial for crimes against humanity that he was a Kantian. 74Losing sight of the essential value of humans seems to be at the core of the of the Nazi doctors’crimes. The moral philosophy which emerged in the aftermath of the Holocaust, through theworks of Baumann 170 and Levinas, 371 emphasized that the crisis in Western ethics brought aboutby the Nazi era resided in the perceived loss of the value of human beings, no matter what theirbackground.A common method of argument in bioethical debate is to position a particular issue with reference toNazism. Polemicists like Peter Singer, whose advocacy for termination of grossly deformed fetusesis often compared to the excesses of Nazism, contribute to such emotive debates. What is not clearare the specifics of the fundamental moral failure of the Nazi doctors. Many rationalizations wereIMET AN OVERVIEW OF PSYCHIATRIC ETHICS