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A matter of time: grappling with everyday ethical tensions at the confluence between policy and practice in a psychiatric unit
  1. Rossio Motta-Ochoa1,
  2. Melissa Park1,2,3,
  3. Raphael Lencucha1,
  4. Jiameng Xu1,4
  1. 1School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
  2. 2Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Montreal, Quebec, Canada
  3. 3Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
  4. 4Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
  1. Correspondence to Associate Professor Melissa Park, School of Physical & Occupational Therapy, McGill University, Montreal, H3A 0G4, Canada; melissa.park{at}mcgill.ca

Abstract

Objective To provide insights on emergent ethical tensions experienced by mental health practitioners during system re-organisation, which is sufficiently grounded in empirical data at the local level to inform policy on recovery at institutional and provincial levels.

Method Ethnographic methods using narrative and critical phenomenological resources over 24 months.

Findings Everyday ethical tensions emerged at the confluence of different experiences of time, for example, how a context of increasing pressure to decrease patients’ length of stay at the hospital (service-defined time) challenged efforts to listen to and advocate for what mattered to patients (personal time) and maintain the integrity of interventions (clinical time). In this context, practitioners drew on clinical language and that of personal recovery to strategically ‘push back’, ‘play with’ or ‘take back’ time.

Discussion Examining everyday practices through ethnographic methods can illuminate the everyday ethical tensions that arise when mental health professionals and psychiatrists grapple with, often competing, goods. Critical phenomenological resources can help expand the structural considerations in empirical ethics, excavate underground practices and raise questions about the conceptual categories undergirding normative ethics. Experiencing-with practitioners in clinical contexts as they encounter and creatively resolve ethical tensions also propose a normative ethics of possibility, to help bridge the gap between empirical and normative ethics.

Conclusion Focus on the relationship between policy, temporal practices and ethics suggests a reconfiguration of time and re-imagination of ethics in institutional settings in ways that can ultimately benefit patients and professionals alike.

  • clinical ethics
  • psychiatry
  • public policy
  • philosophical ethics
  • persons
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Footnotes

  • MP and RM-O are joint first authors.

  • Contributors RM-O conceived of the ideas about time, made substantial contributions to data collection, analysis and produced the initial draft. MP, RL and JX made substantive contributions to data collection, analysis and revisions. MP secured the funding and designed the study, wrote the conceptual and ethical theoretical framing and produced the final draft.

  • Funding This study was funded by the Canadian Institute of Health Research: Catalyst Grant in Ethics, A mixed qualitative study on the ethics of transforming care: Examining the development and implementation of Canada’s first mental health strategy (RN 334543).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Bureau d’Éthique de la Recherche, Centre intégré universitaire de santé et de services sociaux (CIUSSS) and a university-affiliated review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

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