TY - JOUR
T1 - Ethical challenges in contemporary psychiatry
T2 - an overview and an appraisal of possible strategies and research needs
AU - Galderisi, Silvana
AU - Appelbaum, Paul S
AU - Gill, Neeraj
AU - Gooding, Piers
AU - Herrman, Helen
AU - Melillo, Antonio
AU - Myrick, Keris
AU - Pathare, Soumitra
AU - Savage, Martha
AU - Szmukler, George
AU - Torous, John
N1 - Publisher Copyright:
© 2024 World Psychiatric Association.
PY - 2024/10
Y1 - 2024/10
N2 - Psychiatry shares most ethical issues with other branches of medicine, but also faces special challenges. The Code of Ethics of the World Psychiatric Association offers guidance, but many mental health care professionals are unaware of it and the principles it supports. Furthermore, following codes of ethics is not always sufficient to address ethical dilemmas arising from possible clashes among their principles, and from continuing changes in knowledge, culture, attitudes, and socio-economic context. In this paper, we identify topics that pose difficult ethical challenges in contemporary psychiatry; that may have a significant impact on clinical practice, education and research activities; and that may require revision of the profession's codes of ethics. These include: the relationships between human rights and mental health care, research and training; human rights and mental health legislation; digital psychiatry; early intervention in psychiatry; end-of-life decisions by people with mental health conditions; conflicts of interests in clinical practice, training and research; and the role of people with lived experience and family/informal supporters in shaping the agenda of mental health care, policy, research and training. For each topic, we highlight the ethical concerns, suggest strategies to address them, call attention to the risks that these strategies entail, and highlight the gaps to be narrowed by further research. We conclude that, in order to effectively address current ethical challenges in psychiatry, we need to rethink policies, services, training, attitudes, research methods and codes of ethics, with the concurrent input of a range of stakeholders, open minded discussions, new models of care, and an adequate organizational capacity to roll-out the implementation across routine clinical care contexts, training and research.
AB - Psychiatry shares most ethical issues with other branches of medicine, but also faces special challenges. The Code of Ethics of the World Psychiatric Association offers guidance, but many mental health care professionals are unaware of it and the principles it supports. Furthermore, following codes of ethics is not always sufficient to address ethical dilemmas arising from possible clashes among their principles, and from continuing changes in knowledge, culture, attitudes, and socio-economic context. In this paper, we identify topics that pose difficult ethical challenges in contemporary psychiatry; that may have a significant impact on clinical practice, education and research activities; and that may require revision of the profession's codes of ethics. These include: the relationships between human rights and mental health care, research and training; human rights and mental health legislation; digital psychiatry; early intervention in psychiatry; end-of-life decisions by people with mental health conditions; conflicts of interests in clinical practice, training and research; and the role of people with lived experience and family/informal supporters in shaping the agenda of mental health care, policy, research and training. For each topic, we highlight the ethical concerns, suggest strategies to address them, call attention to the risks that these strategies entail, and highlight the gaps to be narrowed by further research. We conclude that, in order to effectively address current ethical challenges in psychiatry, we need to rethink policies, services, training, attitudes, research methods and codes of ethics, with the concurrent input of a range of stakeholders, open minded discussions, new models of care, and an adequate organizational capacity to roll-out the implementation across routine clinical care contexts, training and research.
KW - coercive practices
KW - conflicts of interests
KW - digital psychiatry
KW - early intervention
KW - end-of-life decisions
KW - Ethics of psychiatry
KW - experts by experience
KW - family supporters
KW - human rights
KW - mental health legislation
KW - shared decision-making
UR - http://www.scopus.com/inward/record.url?scp=85203995526&partnerID=8YFLogxK
U2 - 10.1002/wps.21230
DO - 10.1002/wps.21230
M3 - Article
C2 - 39279422
SN - 1723-8617
VL - 23
SP - 364
EP - 386
JO - World Psychiatry
JF - World Psychiatry
IS - 3
ER -