Ethical challenges in contemporary psychiatry: an overview and an appraisal of possible strategies and research needs.

Autor: Galderisi S; University of Campania 'Luigi Vanvitelli', Naples, Italy., Appelbaum PS; Columbia University and New York State Psychiatric Institute, New York, NY, USA., Gill N; School of Medicine and Dentistry, Griffith University, Gold Coast, Brisbane, QLD, Australia.; Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, NSW, Australia.; Mental Health and Specialist Services, Gold Coast Health, Southport, QLD, Australia., Gooding P; La Trobe Law School, La Trobe University, Melbourne, VIC, Australia., Herrman H; Orygen, Parkville, VIC, Australia.; University of Melbourne, Parkville, VIC, Australia., Melillo A; University of Campania 'Luigi Vanvitelli', Naples, Italy., Myrick K; Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA., Pathare S; Centre for Mental Health Law and Policy, Indian Law Society, Pune, India., Savage M; Victoria University of Wellington, School of Geography, Environment and Earth Sciences, Wellington, New Zealand., Szmukler G; Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK., Torous J; Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Jazyk: angličtina
Zdroj: World psychiatry : official journal of the World Psychiatric Association (WPA) [World Psychiatry] 2024 Oct; Vol. 23 (3), pp. 364-386.
DOI: 10.1002/wps.21230
Abstrakt: 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.
(© 2024 World Psychiatric Association.)
Databáze: MEDLINE
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