Mental Health Ethics

The Human Context

Phil Barker, Phil Barker

• Publisher: Routledge
• Year: 2010
• ISBN:
  9781136881930
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

All human behaviour is, ultimately, a moral undertaking, in which each situation must be considered on its own merits. As a result ethical conduct is complex. Despite the proliferation of Codes of Conduct and other forms of professional guidance, there are no easy answers to most human problems. Mental Health Ethics encourages readers to heighten their awareness of the key ethical dilemmas found in mainstream contemporary mental health practice.

This text provides an overview of traditional and contemporary ethical perspectives and critically examines a range of ethical and moral challenges present in contemporary 'psychiatric-mental' health services. Offering a comprehensive and interdisciplinary perspective, it includes six parts, each with their own introduction, summary and set of ethical challenges, covering:

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• fundamental ethical principles;

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• legal issues;

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• specific challenges for different professional groups;

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• working with different service user groups;

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• models of care and treatment;

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• recovery and human rights perspectives.

Providing detailed consideration of issues and dilemmas, Mental Health Ethics helps all mental health professionals keep people at the centre of the services they offer.

Section 1
Ethics and mental health

Section preface

Phil Barker

As we shall discover, most dictionaries define ethics as ‘dealing with what is good or bad, right or wrong’. When applied to professions, ethics is concerned with ‘moral duties or obligations’ – what the professional ought to do in any given situation: the principles of conduct or standards of professional behaviour. Although professional ethics might appear special it is, in effect, merely a narrow description of the kind of ‘moral conduct’ considered ‘right’ or ‘good’ when applied to people in general.

The key lies in the word ‘conduct’, indicating how people conduct their affairs, both in relation to themselves, other people, the animal kingdom, if not also the planet that sustains us all. ‘How should I act?’ is the most ubiquitous ethical question, which might be asked in any situation. Although it is an unfashionable view, most human behaviour involves conduct. Aside from the small proportion of reflex behaviours, everything else that we ‘do’ involves choice or the possibility of choice.

Unfortunately, ‘choice’ has become something of a weasel word in the mental health field, where the idea is peddled that ‘choice’ is something that can be given or otherwise ‘facilitated’, when in reality it can only be restricted. Or at least, that is the case where people are free to conduct their lives, in whatever way they see fit.

This reminds us that the idea of ‘psychiatric’ or ‘mental health’ ethics is problematic, if not a contradiction in terms. In principle, ethics is only meaningful where people – or groups of people – are self-governing and have the opportunity to make choices free from any coercion. Rarely is this the case in the mental health field. The limits imposed on a person’s exercise of freedom – however explicit – continue to haunt contemporary practice.

In this opening section, I seek to set the scene for the detailed examination of specific ethical dilemmas and related topics, which begin in Section 2.

In Chapter 1, I discuss some of the key ideas which have been developed over the centuries, and explore their relevance to the contemporary world of mental health. I propose that there are no new ethical dilemmas, far less any new theories to explain or resolve them. Almost everything that we believe today, concerning the moral challenges of everyday life and how we might respond to them, is a revised version of some older ideas about life and how it should be lived. Such philosophies have merely been revised to suit the language or the social context of some ‘brave new world’.

In Chapter 2, I begin to examine the key ethical dilemma within the psychiatric or mental health field: that the fundamental assumptions concerning ‘mental illness’ and ‘agency’ – the person’s capacity to act freely – risks rendering the idea of ‘psychiatric/mental health ethics’ meaningless. However, this is not a nihilistic view, merely a candid appraisal of the field at the present time. It is, of course, possible to aim for the development of such a genuine ethic. However, this will require major changes in the way professionals, and the services they represent, conduct themselves with the people embraced by such services. In some senses our ideas about ethics have changed little over thousands of years. We continue to tussle with much the same problems as our ancestors and develop new theories that often differ little from those they seek to displace.

Finally, in Chapter 3 I discuss the extent to which moral dilemmas, regarding what ought to be done, vary across the different disciplines embraced by the field, and the many different situations, which professionals encounter. To what extent has our thinking about ‘mental illness’ really changed? To what extent are we merely recycling older, outmoded models of human problems: trying to avoid confronting the personal, social and political issues that we obscure with our increasingly technical concepts of ‘psychiatric disorder’?

This chapter provides an introduction to the detailed examination of the professional context of ethical inquiry, which begins in Section 2.

1
Ethics

In search of the good life

Phil Barker

Of course, indifference can be tempting – more than that, seductive. It is so much easier to look away. It is so much easier to avoid such rude interruptions to our work, our dreams, our hopes. It is, after all, awkward, troublesome, to be involved in another person’s pain and despair. Yet, for the person who is indifferent, his or her neighbors are of no consequence. And, therefore, their lives are meaningless. Their hidden or even visible anguish is of no interest. Indifference reduces the Other to an abstraction.¹

(Elie Wiesel)

Everyday ethics

Damned to anguish

Ethics or moral philosophy may involve ordinary or everyday human dilemmas, but is in no way ordinary, far less easy to discuss. Ethics has been debated for thousands of years and different schools of ethical thought are associated with many different cultures as well as with individual philosophers. This diversity may fascinate the philosophy student but may prove frustrating for anyone seeking a unifying set of human values. The more one learns the more it seems that one set of views appears to negate all others. Indeed, there may well be no single ethic that can apply across all situations, societies or cultures. More importantly, there may be no single ethic that does not make life more difficult for you or me. Ethics can be a disturbing business.

All animals act in ways that have consequences for their immediate or long-term welfare, but only humans seem to anguish over ‘dilemmas’ or ‘decisions’, developing complex, often baffling, theories to explain their decision-making. Our capacity for language and communication creates this anguish. Without the ability to label, discuss and debate the decisions we make each day, life could well be simpler. Humans appear damned to think about themselves and life in general. As a result, making decisions becomes the most challenging aspect of being alive and being human.

Ethics involves enacting our private thoughts about ourselves, others and the world around us, and is almost as old as humankind. In that sense, it existed long before philosophical terms were coined and applied to such behaviour. The sheer complexity of much ethical terminology often obscures the ethical decision-making that goes on in everyday life. As a result, ethics is invariably viewed as a rarefied activity: a subject, like theology, studied outside of life itself, usually at university. This could not be further from the everyday ethical truth.

Today, ethics focuses on dilemmas that cause unrest in society. The big ethical questions continue to revolve around abortion, euthanasia, torture, warfare or the death penalty. With the emergence of concepts like ‘assisted dying’ or ‘foetal stem cell research’, some of these age-old dilemmas have grown even more complex. However, such ‘big questions’ are merely examples of issues with which people have wrestled down the ages. By no means are these the only ethical challenges we face in our lives. Every day people deliberate over whether or not to:

• put the cat out at night;

• give money to a beggar;

• return a wallet found in the street to its owner;

• pick up litter;

• correct a shop assistant who returns an excess of change;

• help someone who is being mugged;

• give information to the police concerning a crime;

• do a favour for someone;

• put an elderly relative into a care home;

• take public transport to work rather than use the family car.

Such deliberations involve our personal or shared values concerning, among other things:

• animal welfare

• charity

• honesty

• civic mindedness

• altruism

• public duty

• generosity

• loyalty

• eco-responsibility.

All such deliberations are forms of ethical decision-making, ...