Codes of ethics in psychiatry

Codes of ethics in psychiatry, as well as medical codes more generally, have continually evolved since the Oath of Hippocrates, and remain important in contemporary psychiatry practice. However not until the 1970s were unique ethical challenges facing psychiatrists specially addressed. Codes of ethics in psychiatry take many forms but, in general, responsible care of patients and professional integrity constitute their core. Additionally, they variously cover the human rights of patients and duties to society. Codes can be international or institutionally specific, with international declarations expected to be universally relevant. Adherence is recognized as a vital component of self-regulation, with codes giving support to disciplinary procedures. Using a range of codes and covenants as illustrative, in particular the code of ethics of the Royal Australian and New Zealand College of Psychiatrists (RANZCP), the role of codes in promoting high standards of ethical practice, professionalism, and education in psychiatry is explored.

The scope of psychiatric ethics

Ethical decision-making is no easy matter, as absolutes of right and wrong, good and bad, should and ought, and other evaluative terms are elusive. Both providing the best attainable care for the patient and conducting scientific research guided by lofty ethical principles are paramount. This chapter, an introduction to the fifth edition of Psychiatric Ethics, outlines how the book aims to promote the moral agency of psychiatrists and mental health professionals when relating to patients and their families, colleagues, professional associations, and other organizations, and the society in which they work. It summarizes theoretical frameworks used in ethical decision-making and the range of topics discussed in the other 24 chapters, and offers guidelines to mental health students and graduate clinicians about how to master the field of ethics in psychiatry.

A historical perspective

Studying the history of ethics in psychiatry through the chronological development of ethical codes does not do justice to the manner in which ethical themes and issues vanish and recur in that history. This chapter considers some aspects of the history of these codes, though its primary aim is to explore major ethical themes and issues in the history of psychiatry. The humanity of the ‘mad’ and the increasing manner in which persons with mental disorders are thought to be autonomous individuals are two themes that will occupy us. Increasing recognition and acceptance of the autonomy and self-determination of persons with mental disorders is the crowning ethical achievement of the history of psychiatry recounted here. However, there are also reasons to be concerned about possible excesses that may be emerging in this regard in some sectors of psychiatric treatment and research—new historical developments that merit careful ethical scrutiny.

An introduction to clinical ethics in psychiatry

SUMMARYThe Royal College of Psychiatrists’ continuing professional development (CPD) module on clinical ethics in psychiatry by Pearce & Tan describes some common ethical dilemmas in psychiatric practice and the work of clinical ethics committees in analysing these dilemmas. In this article we build upon their work and offer additional exploration of the nature of ethical dilemmas in psychiatry. We also build upon the models of reasoning that are described in the module and suggest ways for psychiatrists to think about ethical dilemmas when a clinical ethics committee is not available.