The Oxford Handbook of Psychiatric Ethics

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The Oxford Handbook of Psychiatric Ethics

edited by John Z. Sadler, Werdie (C. W.) Van Staden, and K. W. M. (Bill) Fulford. In book series: International Perspectives in Philosophy and Psychiatry. Oxford University Press, New York, NY, 2015, 1,417 pages (2 volumes), $295.00 (cloth).

So it all comes down to this. While Oxford University Press’s “International Perspectives in Philosophy and Psychiatry” series will no doubt continue, one could argue that as far as psychiatrists are concerned, the imposing 2-volume Oxford Handbook of Psychiatric Ethics is the destination toward which the preceding 46 books were headed. Defining ethics can be elusive, but many definitions include or focus on the idea of living one’s life well. A medical ethics text thus purports to help us to live our professional lives well. The 2 key questions to ask of this book are (1) With an abundance of general medical ethics literature available, does psychiatry warrant its own separate one? and (2) Regardless of the answer to the first question, does the Oxford Handbook help a psychiatrist who hopes to practice well?

As regards question 1, volume 1 aptly starts with an introduction subtitled, “Why an Oxford Handbook of Psychiatric Ethics?” In this chapter, the editors cite the expansion of neuroscience and, even more so, “changes in society and world culture” over the past 50-plus years as justifying their effort to produce “the most comprehensive psychiatric ethics reference text in the history of the field.” In delineating the structure, approach, and ambitions of this text, the editors solidly back up these points. Still, the question of whether a “psychiatric ethics reference text” is necessary is not posed.

Fortunately, this question is implicitly answered in the ensuing 93 chapters, which span standard topics such as the nature of diagnosis, autonomy, and doctor-patient boundaries, as well as others touching on arguably unique aspects of psychiatric ethics stemming from, for example, its historical legacy, specialist interventions, and intersections with a number of religions, special populations, and the law. For the most part, the answer about the need for this text is an affirmative one. As a staunch “medical model” psychiatrist, I prefer to minimize distinctions between psychiatry and other specialties. Nonetheless, while one can disagree on whether there truly are differences of form on topics such as patient responsibilities and physician virtues in psychiatry relative to the rest of medicine, it is not hard to see significant differences of content in many such areas. At their best, the thought-provoking chapters in these 2 books may lead one to wonder not whether psychiatry is exceptional in its need for this ethics handbook, but rather whether every specialty might take a cue from its existence.

So if one accepts the need for the Oxford Handbook, does it meet that need by providing help to the psychiatrist who wants to live a professional “good life?” The field of medical ethics is often mocked by clinicians for its tendency to respond to requests for guidance with the posing of questions (or, to the ethicist, “clarifying the issues”). Notwithstanding a first section, “People Come First,” that is largely written by patient-authors and is more directive and affectively challenging, subsequent chapters by psychiatrists and philosophers tend toward the question-posing variety. This approach ought not to be mocked, however. While some chapters in the Oxford Handbook revisit authors and content from the “International Perspectives” series (eg, Mona Gupta’s chapter, “Ethical Issues in Evidence-Based Psychiatry”), most strike new ground by assigning new authors to old topics, having old authors elaborate on old topics, or introducing new topics entirely. In particular, I found important, clinically relevant, and (at least to me) new insights in Brent M. Kious’ chapter, “Justice, Fairness, and Mental Health Care,” Lubomira Radoilska’s coverage of “Autonomy in Psychiatric Ethics” (which struck new ground beyond that covered in her book on the same topic), and Duff R. Waring’s refreshing take on “Patient Responsibilities in a Psychiatric Healing Project.” This text’s diverse approaches to virtue and value provoke questions in the best ways; ones that do not give an “answer” to a given ethical issue, but rather provide intellectual scaffolding to frame more flexible and wide-ranging thought on a number of psychiatric situations.

Obviously, one can only point out so many chapters in reviewing such a mammoth work. Suffice it to say that the usual suspects are here (eg, professional boundaries), but that one would be hard-pressed to find a subject that is neglected. There is ample room for variety in these volumes, and the editors took full advantage of it, with topics ranging from deep brain stimulation to Confucian perspectives (the latter in a 7-chapter section on religious contexts of psychiatric ethics). Some of these may be less immediately clinically relevant than others, but that should not cause a reader to pass over an elegant and important chapter such as Gerald Grob’s “A Moral/Ethical History of American Psychiatry.” Fortunately, a 36-page “Detailed Table of Contents” offers abstracts of each chapter for scanning.

There is much that is open to and inviting of dispute in the Oxford Handbook, but that is part of the point of such a work and of a life lived well. This is less a reference text than a topically comprehensive anthology of essays. My biggest gripe is merely that at 2 volumes and over 1,400 pages, this text is hardly a “handbook.”

Nicholas Kontos, MD

nkontos@partners.org

Author affiliation: Harvard Medical School, Boston, Massachusetts.

Potential conflicts of interest: None.

J Clin Psychiatry 2016;77(10):e1354

dx.doi.org/10.4088/JCP.16bk11145

© Copyright 2016 Physicians Postgraduate Press, Inc.