Ethics and Psychiatry:
Toward Professional Definition

Table of Contents

Preface

Introduction: A Divided Profession

• A Divided Profession
• The Moral Problem of Our Time
• The De-Professionalization of Medicine
• The End of Hippocratic Medicine?
• Psychiatry and the Medical Model
• The Program of This Text

1. The Place of Ethics in the Definition of a Profession

• The Definition of a Profession
• The Sociology of Professions
• Profession and Monopoly
• The Antitrust Challenge to the Professions
• The Ethics of Advertising
• Conclusion
• APPENDIX 1 American Medical Association Principles of Medical Ethics

2. The Hippocratic Tradition in Medicine and Psychiatry

• The Hippocratic Oath
  • Patient Confidentiality
  • Abortion
  • Euthanasia
  • Truth-Telling
  • Sexual Contact with Patients
  • Professional Affiliations
  • Justice in the Distribution of Health Services
  • Patient Benefit
• The Case Against Hippocratic Medicine
  • The Hippocratic Oath Is Anachronistic
  • The Hippocratic Oath Doesn't Deal with the Highest Ethical Obligations of the Physician
  • The Hippocratic Oath Opposes Abortion and Euthanasia
  • Hippocratic Medicine Has Been Faulted for Defining Medical Care Mainly in Terms of Emergency Treatment
  • The Patient Benefit Principle of the Hippocratic Writings is Paternalistic
• In Defense of the Hippocratic Tradition
• Conflicting Demands Upon the Physician
  • Cooperation with Torture
  • Political Abuse of Psychiatry
  • Lethal Injections in Capital Punishment
  • Cost Containment
• Summary
• APPENDIX 1 Oath of Hippocrates
• APPENDIX 2 Hippocratic Oath for Psychiatrists

3. The Tasks and Methods of Ethics

• What Is Ethics? Medical Ethics?
  • Teleological Ethical Theories
  • Deontological Ethical Theories
  • The Consequentialist Approach

4. Confidentiality, Trust, and the Therapeutic Alliance

• The Need for Confidentiality
• Threats to Confidentiality
  • The Tarasoff Case: Protecting Public Safety
  • Preventing Fraud: Review of Medicare Records
  • Redisclosure in Information Banks
  • Cost Containment and Using the Physician as an Agent of Rationing Health Care
  • Prearraignment Examinations
  • Advancing Scientific Knowledge: Case Reports
  • Professional Gossip
  • Access to Records by Patients
  • Treating the Same Person in Both Individual and Group Therapy
  • Psychiatric Testimony in Custody Cases
  • Nonprofessionals on Health Care Teams
  • Mandatory Reporting of Suspected Child Abuse
• The Double Agent Problem
• Legal Perspectives on the Ethical Principle

5. A Critique of Szasz's Critique: The Mind-Body Problem Won't Go Away

• The Legacy of Cartesian Dualism
• The Definition of Medicine
• The "Myth" of Mental Illness
• Understanding Hysteria
• Involuntary Hospitalization
• The Ethics of Giving Placebos
• The Difference Between Placebos and the Placebo Effect

6. Informed Consent, Autonomy, and Paternalism: Respecting the Patient in Research and Practice

• The Principle of Autonomy
• The Assessment of Competence
• Toward a Definition of Informed Consent
• The Principle of Partnership
• Beyond the Impasse
• Informed Consent in Great Britain
• Informed Consent in Sweden
• Informed Consent in Japan and the Asian Pacific
• Informed Consent Behind the Iron Curtain
• Informed Consent and Torture
• Conclusion

7. The Place of Virtue and Character in Ethics: Psychiatry's Contribution to Ethics

• Moral and Therapeutic Considerations of Character
• Character as Characteristic
• Character as Resistance
• Development of the Psychoanalytic Theory of Character
• Character and Moral Development
• The Psychoanalytic Treatment of Character Disorders
• The Importance of Virtue in Professional Gatekeeping
• The Central Virtues of the Medical Profession
• The Virtues of the Patient
• Conclusion

8. Idealism in Medical Ethics: The Pursuit of Moral Perfection

• The Self as Moral Agent
• The Context of Ethical Decision Making
• Personhood
• The Crisis of the Personal
• The Moral Self
• Shame and Guilt as Regulators of Morality
• The Problem of the Moral Inversion
• Conclusions

9. The Impeachment of Altruism

10. The Meaning of Medical Responsibility

Endnotes

Bibliography

Index