Ethics in psychiatry

Question 1

First book on medical ethics

Answer 1

• Ishaq bin Ali Rahawi

- book called Adab al-Tabib (conduct of a physician) from 9th century

Question 2

Hammurabi code

Answer 2

• first attempt in history to codify medical competence and legal liabiity for negligence
• not a code of ethics

Question 3

Charaka

Answer 3

• ancient Indian physician
• earliest medical ethics relevant to modern medicine
• 4 ethical principles
  1. friendship
  2. sympathy
  3. interest
  4. no attachment to the patient after their recovery
• always strive to acquire knowledge

Question 4

Higher order principles

Answer 4

Deontology and teleology are two alternative higher-order ethical principles regarding medical practice

Question 5

Deontology

Answer 5

• Deon is greek for duty
• Rules govern medical practice
• rights and duties determine action and so it is absolutism
• -according to Ross, some duties are right because of their very nature e.g telling the truth- these are prima facie duties
• other duties are right in particular circumstances- duty proper
  e. g GMC good medical practice

Question 6

Teleology

Answer 6

• teleon is greek for ‘purpose’
• -people have interests, whether these are concerns, desires or needs
• accordingly a broad judgement of benefits and harm determine medical practice
• the right action is the one that has the best foreseeable consequences
• also known as consequentialism or utilitarianism

Question 7

Utilitarianism

Answer 7

• right action for best foreseeable consequences
• act utilitarianism: deals with a specific act only
• rule utilitarianism: deals with general practices for which rules can be established

Question 8

Prima Facie principles

Answer 8

• Beaucheamp and Childress, Gillon
  1. autonomy
  2. beneficence
  3. non-maleficence
  4. justice

Question 9

Paternalistic model

Answer 9

-doctor knows best

Question 10

Informative model

Answer 10

• doctor is seen as a dispenser of information

- choice is left to patient

Question 11

Interpretative model

Answer 11

• doctor might have treated the patient for a long time and know them well and so understands them
• shared decision making

Question 12

Deliberative model

Answer 12

• doctor may act as friend and counselor
• gives information and advises on course of action
• used in lifestyle modification

Question 13

Direct ethics

Answer 13

-to determine the ethical behaviour we should assess the act -what has to be done

Question 14

Indirect ethics

Answer 14

-about the character of the moral agent choosing these actions

Question 15

Pragmatic ethics

Answer 15

emphasis on achieving success and reaching a goal with little concern on how this is achieved

Question 16

Humanistic ethics

Answer 16

emphasis is on doing what’s best for society

-dominates ethical theory overwhelmingly

Question 17

The golden mean of Aristotle

Answer 17

in most cases ethical behaviour lies between extremes, along the range of excess and deficiency

Question 18

Nuremberg code

Answer 18

• ethical human experimentation can only take place if consent is given and study is terminated if harm is being done over good
• subject can withdraw at any point and the research must be for the common good of society

Question 19

Declaration of Geneva

Answer 19

-modification of the Hippocratic Oath, intended to highlight the dedication of medical profession for the cause of humanitarian goals

Question 20

Declaration of Helsinki

Answer 20

-addresses clinical research

Question 21

Tuskegee Syphilis study

Answer 21

• African American males were given syphilis and not told they had it or that it was treatable
• studying the natural course of syphilis
• died of syphilis

Question 22

Willowbrook School Study

Answer 22

• mentally handiapped children were given hepatitis after their parents gave consent for vaccines
• only consenting families were allowed to go to the school

Question 23

Jewish Chronic Disease hospital

Answer 23

-chronically ill patients who did not have cancer were injected with cancerous human liver cells

Question 24

Tearoom Trade Study

Answer 24

• Laud Humphries followed up many men who had anonymous sex in public places by tracing their number plates after falsely befriending them
• no explicit informed consent