Abstract
Ethical issues pervade community mental health yet, surprisingly, the field has been virtually ignored in the academic realm of medical ethics. In the past decade, the ethical questions in psychiatry which have attracted the most scrutiny are derived from the “dramatic” issues of psychiatrist-patient sexual relationships, the tradition's practice of involuntary commitment, and the therapist's duty to warn potential victims at the expense of breaching a client's confidentiality (Eth, 1990; Dyer, 1988; Bloch, Chodoff, 1991). Yet the “pragmatic,” and more pervasive, ethical tensions which arise in the daily practice of community psychiatrists have warranted little attention. Both medical ethics and community psychiatry suffer as a result. Nonetheless, ethical reasoning is intricately entwined in the decisions and relationships which make up the community mental health setting. For example, trying to determine what is the “right” thing to do for a client inevitably entails judgments about moral, social and legal matters. In other words, no decision in the clinical setting is purely psychiatric (Perlin, 1989).
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REFERENCES
Appelbaum, P.S. (1988). The right to refuse treatment with antipsychotic medications: Retrospect and prospect. American Journal of Psychiatry 145(4): 413-419.
Bloch, S., & Chodoff, P. (eds.) (1991). Psychiatric Ethics' 2nd ed., Baltimore, Oxford University Press.
Christensen, R.C. (1992). Involuntary psychiatric hospitalization: Ethical decision making in the ER. Psychiatric Times 9(11): 12-13.
Cournos, F. (1989). Involuntary medication and the case of Joyce Brown. Hospital and Community Psychiatry 40: 736-740.
Dyer, A. (1988). Ethics and Psychiatry: Toward Professional Definition. Washington, D.C., APA Press.
Eth, S. (1990). Psychiatric ethics: Entering the 1990s. Hospital and Community Psychiatry 41(4):384-386.
Geller, J. (1986). Rights, wrongs and the dilemma of coerced community treatment. American Journal of Psychiatry 143(10: 1259-1263.
Jonsen, A., Siegler, M., & Winslade, W. (1991). Clinical Ethics, 3rd ed., New York, Macmillan Publishing.
Levenson, J.L. (1986). Psychiatric commitment and involuntary hospitalization: An ethical perspective. Psychiatric Quarterly 58(2): 106-112.
Perlin, T. (1989). Ethical issues. In Manual of Clinical Emergency Psychiatry, 1st ed., Edited by Hilliard, J. Washington, APA Press.
Schuster, J.M., Kern, E.E., Kane, V., & Nettleman, L. (1994). Changing roles of mental health clinicians in multidisciplinary teams. Hospital and Community Psychiatry 45(12): 1187-1189.
Stone, A.A. (1979). Informed consent: Special problems for psychiatry. Hospital and Community Psychiatry 30(5): 321-327.
Wear, A.N., & Brahams, D. (1991). To treat or not to treat: The legal, ethical and therapeutic implications of treatment refusal. Journal of Medical Ethics 17: 131-135.
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Christensen, R.C. Ethical Issues in Community Mental Health: Cases and Conflicts. Community Ment Health J 33, 5–11 (1997). https://doi.org/10.1023/A:1022456925366
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DOI: https://doi.org/10.1023/A:1022456925366