ETHICS IN PSYCHIATRY
H. Tristram Engelhardt, Jr.
Laurence B. McCullough
WHILE reflection on medical ethical issues has been intrinsic to medicine throughout its history, it is only in the past twenty-five years that the study of medical ethics has expanded to embrace the biological and behavioral sciences —an inquiry now conducted under the rubric of bioethics. This development of a more sustained inquiry in bioethics has occurred simultaneously with the various civil and human rights movements. Like these movements, the renewed and growing interest in bioethics reflects our culture's reexamination of value commitments and the proper bounds that may be placed upon institutions that wield power and authority. The consequent convergence of intellectual and social forces has culminated in formal examinations of ethical issues in medicine.
Ethics in Psychiatry
Perhaps the most prominent ethical issue in medicine has been the use of human subjects in medical research. 1,19 Multidisciplinary deliberations about the ethical dimensions of this practice achieved a public character in 1973 with the establishment of the National Commission of the Protection of Human Subjects in Biomedical and Behavioral Research in the U.S. Department of Health, Education and Welfare. In addition to general considerations of ethical issues occasioned by human research, the commission has addressed issues that bear directly on research in psychiatry; for example, research involving mentally ill subjects. 90 The commission has also considered the ethical dimensions and procedures employed for psychiatric complaints; for example, psychosurgery. 89
This concern with ethical issues in psychiatric research did not arise apart from the broader concern with the ethical dimensions of medicine and psychiatry. In fact, the interest in the ethics of human research was pursued concurrent with, and in part gave rise to, inquiry into the rights of patients, in particular hospital patients. * The ethical dimensions of rights and of rights language also have a direct bearing on psychiatry. They____________________