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Summary Module 5 Exam Preparation - Severe Mental Illness
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Reading Questions, Core Arguments, and Terminology for Module 5 Severe Mental Illness in Urban Context
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Module 5: Reflection on the Role of thePsychologist
Ch 5: Ethical Rationale
(Slade, 2009)
How would a recovery focused approach address the ethical dilemmas addressed in Slade
(2009), Chapter 5?
The ethical dilemmas concern the two ethical justifications for compulsion – being (1) the
interests of society and (2) the best interests of the patient
1. Best interests – would be best defined by the patient or their nominated proxy
decision-maker
- Not by mental health professionals
Care plans are typically focused on clinical goals – rather than life goals – such as:
1) Amelioration of deficits
2) Resolution of symptoms
3) Avoidance of hospitalization and relapse
4) Restoration of social functioning
Personal recovery should be the primary orientation – giving primacy to consumer-defined
goals
- The primary job of MHS is to support the person to progress towards their own
life goals – not provide treatment to meet clinical goals
Recovery-Focused Services
In a recovery-focused system – the closer the individual’s view of their own best interests
the compulsion is – the more it can be ethically justified
, In recovery-focused services – developing decision-making approaches in which the
consumer is more empowered will create new ethical dilemmas in relation to professional
accountability
- Where what the patient wants is incompatible with the clinical perspective
Values need to be balanced – which is done via valued-based practice or drawing from
biomedical ethics
The four proposed guiding principles are:
1. Respect for Autonomy – the importance of personal choice and self-determination is
emphasized
2. Non-Maleficence – there is an active focus on avoiding hopelessness and dependency
3. Beneficence – there is an equally active focus on providing effective treatments and
interventions
- Actions justified on the basis of beneficence – are balanced by the need to
promote autonomy and support citizenship
4. Justice – there is support to exercise citizenship rights
A third approach is to use different values – such as avoiding overtreatment and providing
warmth and sympathy
- Which would change basic assumptions if incorporated in MHS
Importance of maintaining therapeutic optimism
Patient-centered goals in MHS are based on what individuals themselves aspire to in life
Justifications for Compulsion
Benefit to Society (1) Societies have values reflecting the relative importance attached at a given point
in time to individual freedom and group freedom (=> i.e., the Apollonian-
Dionysian spectrum)
Societal values change over time but at any one time they are invariant
They are expressed as mandated behavioral constraints
, Most commonly in relation to mental health these constraints are that (1) no
one will be left to die or (2) allowed to harm others – these are non-negotiable
MH professionals are obligated to constrain behavior in order to uphold these
societal values
This obligation is conferred either (1) directly via mental health legislation – or
(2) indirectly via codes of conduct and mental health policy
These provide the justification for intervening to uphold societal rules – rather than
for the benefit of the patient
Best Interests (2) Concerns intervening in situations where there is a risk of damage to one’s life,
health and well-being
The right to autonomy is overridden for some people at some points in their life by
considerations of best interests
The ethical justification for compulsion is paternalism
A clinician is acting paternalistically toward a patient when:
(1) his actions benefit the patient
(2) his actions involve violating a moral rule with regard to the patient
(3) his actions do not have the patient’s past, present, or immediately forthcoming
consent
(4) the clinician believes they can make their own decision
The more acceptable ethical principle is that of beneficence – i.e., doing things to a
person on the basis of professional belief about what is in their best interests
This approach arises from a world-view that (1) treatments are effective and (2) the
privileged access of health professionals to these effective interventions – places an
ethical requirement on them to provide treatment
Results in the assumption that best interests are necessarily defined by professionals
Challenges to Assumption of Best Interests Defined by Professionals
1. The ethical imperative is increasingly out of step with wider societal values
Such societal values emphasize (1) personal responsibility, (2) informed choice, and (3) the
right to self-determination
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