Abstract
Psychiatric medicine poses specific ethical problems relating to the particularity of the illnesses and of the patients. It intends to cure and to the nature of the treatments it prescribes. Its differences with the other branches of medicine have been highlighted for a long time. The psychiatric patient worries his family circle to a greater extent and in different ways than any other patient. This chapter explores the ethics of risk in psychiatry.
TopIntroduction
If you took the maximin principle seriously then you could not ever cross a street (after all, you might be hit by a car); you could never drive over a bridge (after all, it might collapse); you could never get married (after all, it might end in a disaster); etc. If anybody really acted this way he would soon end up in a mental institution (Harsanyi, 1980).
Psychiatric medicine poses specific ethical problems relating to the particularity of the illnesses and of the patients it intends to cure and to the nature of the treatments it prescribes. Its differences with the other branches of medicine have been highlighted for a long time. The psychiatric patient worries his family circle to a greater extent and in different ways than any other patient because, as Pascal expressed it himself figuratively, “…a lame man recognizes that we are walking straight, while a lame mind says that it is we who are limping…” (Pascal, 1995, p. 25). So one may fear that the sick person should not pass the same judgment on life as ourselves, that he might be more prone to suicide than the other patients, and that, if he does not turn his aggressiveness against himself, he might turn it against others—his family, the farther circle, the nursing team, the other sick persons if he is at the hospital—this fear, whether it be justified or not, is increased by the fact that, even if one is not trained to understand what view the psychiatric patient has of his own life, that view necessarily eludes us, and that, even if we have received this training, it often remains beyond our grasp. Hence, even if any medical relation always happens in a legal context, the pressure of the law is stronger in psychiatric medicine than elsewhere, in the other departments of medicine: one may lock up people against their will, and consider likewise this confinement as a part of a treatment in constraining the patients to cure them; one may contravene the most overt desires of the patient; one may deeply and unilaterally change, for him, the balance of rights and duties which is at use for the other members of society; one may also change, just as drastically, the share and equilibrium between private life and public life: so, it is possible that the relations that the psychiatric patient may have with members of her/his family and friends be considered as items to be added to the medical file. Certainly, the matter is neither to punish the patient for some imaginary transgression he could have committed; nor is it to humiliate him; but the categories which we need and that are used in order to think about ethics, so much so that they have become more and more accepted by the law “I mean the autonomy of decision that has been described, for one or two decades, as the patient’s own responsibility, and the cluster of rubrics that derive from autonomy such as the respect of the person, of personality1 (Kant, 1996), of dignity, of consent or of informed consent- seem particularly at odds with the settlement of a great number of psychiatric problems. It is not true that the patient’s autonomy is always respected in psychiatry merely because it is impossible; the circumstances do not lend themselves to it.
Key Terms in this Chapter
Blood’s Collect: To gather blood from certain persons to give it to others.
Taboo: Very effective interdiction not only of the use of certain words, but also of the use or practice of anything. Of this prohibition, nobody knows or can explain the reason.
Donation: The action of giving something (here: blood) to another, without demanding any reimbursement in money or through any other advantage.
“Person”: The term is taken in the sense that Kant ascribes to “ rational beings because their nature already marks them out as an end in itself, that is, as something that may not be used merely as means, and hence so far limits all choice (and is an object of respect) “. “ Personality (of a being) is freedom and independence from the mechanism of the whole nature, regarded nevertheless as also a capacity of (this) being subject to special laws -namely pure practical laws given by his own reason “.
Christianity: Relating to Christian religion, as a system of doctrines and precepts.
Payment: The action of remunerate a person with money for having given something, here: its blood.
Fiction: The term is taken in the way Bentham defines a “ fictitious entity “ as “ an entity to which, though by the grammatical form of the discourse employed in seeking of it existence is ascribed, yet in truth and reality existence is not meant to be ascribed “. “ To language -and to language alone- it is that fictitious entities owe their existence -their impossible, yet indispensable existence “.
Reason: Is characterized by two criteria: universality and necessity. Its discourses may be agreed with anybody’s views. These agreements require essentially argument, discussion and demonstration rather than intuitive means, in order to influence the understanding or the conduct of the others.
Myth: A fictitious story that is told by the people of a society or of a civilization on a subject-matter and that cannot be entirely rationalized, leaving a sort of affective or imaginative remainder.