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Sunday, 8 July 2012


Ethics must underpin all work with children especially decisions to medicate them with psychropic drugs for normal behaviour which is happening in the U.S. We must all follow restorative and co-operative principles in all our work with kids in school.

People are applying in droves to open accounts at ethical and mutual banks like the CO_OP which indeed Barclay's once was with its Quaker founders, due to the scandalous flouting of ethics with the 'financial crash' affecting the majority of us but not the rich few who have continued to gain hugely.

Perhaps its a good time to revisit these values in all professions including psychology and psychiatry.

Surely giving young children, as young as two years old, 'drug cocktails' is unethical, as is ECT for teens in the U.S. and forcing medications on children in State Care is "Barbaric!"

What are the Four Basic Principles of
Medical Ethics?

Bioethicists often refer to the four basic principles of health care ethics when evaluating the merits and difficulties of medical procedures.  Ideally, for a medical practice to be considered "ethical", it must respect all four of these principles: autonomy, justice, beneficence, and non-maleficence. 

Autonomy: means young people should be involved in the decisions that affect them and they are often not.For example they are often not told of the cumulative side effects of the drugs in their 'drug cocktails.'

Justice: means equality of response across populations in terms of social class and geographical boundaries which is not happening in the U.S. or the U.K. as seen by a twenty three fold variation for medication rates.

Beneficence: means that that the medical intervention should have the intent of 'at least no harm' and as seen with GSK this week this was not the case. Also 'drug cocktails' are often seen to do long term damage and even death as in the case of Harry Hucknall.( Put into search engine to find post)

Non-malifecence: means causing no harm and yet many children are as we know dying from anti-depressants and psychostimulants prescribed for them. 

Proposed Changes to APA Guidelines
Principles of ethics and professionalism in psychiatry



Ethical conduct by psychiatrists goes beyond mere knowledge of ethics principles. It also requires certain moral skills and habits. These assure that ethically sound judgment and the actions that follow fall within accepted ethical bounds. Examples of skills of importance to the ethical practice of psychiatry include: 
1) the ability to recognize ethical aspects of a professional situation;
 2) the ability to reflect on one’s role, motives, potential “blind spots”, and competing or conflicting interests;
 3) the ability to seek out, critically appraise, and make use of additional knowledge and valuable resources, e.g., clinical, ethical, or legal information; 
4) the ability to apply a formal decisionmaking model in evaluating the ethical aspects of a professional situation and in identifying possible courses of action;
and 5) the ability to create appropriate safeguards in an ethically complex situation. Routine behaviors or habits of the ethical practitioner include obtaining additional data, seeking appropriate consultation or supervision, maintaining clear professional boundaries, and separating roles that may pose conflicts. Together these skills and habits support ethical decision-making and minimize the likelihood of ethical breaches.

A statement of ethics principles affirmed by the profession is an important resource for aligning ethical knowledge with professional behavior. Such a document can provide guiding principles to assist practitioners in identifying and resolving ethical dilemmas. Ethics principles can also help define the boundaries of acceptable behavior, proscribing certain behaviors while supporting and encouraging others. Consequently, ethical principles are valuable in assessing the professional conduct of colleagues. Ethics principles are likewise an important tool for the educators who introduce students to the ethical foundations of the field.
To help fulfill these aims, this document has been organized into five sections.

Section 1 introduces the scope, spirit, and structure of the document.

Section 2 presents the Principles of Medical Ethics of the American Medical Association. These nine principles serve as the foundation for ethics and professionalism in the field of medicine, including the specialty of psychiatry. The American Psychiatric Association conforms to these AMA principles in its Constitution and Bylaws.

Section 3 articulates ethics principles as applied to the morally complex aspects of psychiatric work. These aspects of professional practice are organized into four domains: the ethical basis of the physician-patient relationship; ethically important practices in psychiatric care; the ethical basis of relationships with colleagues; and other ethically important topics in psychiatric practice. Each domain covers several topics, such as dual agency, honesty and trust, confidentiality, informed consent, conflict of interest, small community issues, among others. For each topic, we provide a description of important ethics concepts, and seek to demonstrate their special relevance to psychiatric practice.

Section 4 provides a discussion of the uses of the document to educational, clinical, professional compliance, and related areas.

Section 5 outlines selected additional resources that may be of value to readers.

This document differs in two respects from prior APA codes of professional ethics (the Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry). It is oriented toward educational more than regulatory purposes. It is for this reason that the document gives attention to the philosophical basis of ethical psychiatric practice, the concepts and terms of importance to ethics and professionalism, and the skills and habits of ethical professionals. Moreover, the document seeks to encompass more completely the multiplicity of roles and activities of psychiatrists, the diverse populations they serve, and the array of settings in which they work. It is our hope that this document will become a valuable resource for our profession.

Section 2. Principles of Medical Ethics of the American Medical Association

The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. 

The following Principles adopted by the American Medical Association are not laws, but standards of conduct which define the essentials of honorable behavior for the physician.
I. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.
II. A physician will uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.
III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements, which are contrary to the best interests of the patient.
IV. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.
V. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.
VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.
VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.
VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.
IX. A physician shall support access to medical care for all people. Adopted June 1957; revised June 1980; revised June 2001

Section 3. 

 Ethical principles in the professional practices of psychiatrists
In this section, we illustrate how ethical principles find expression in the professional practice of psychiatrists in their various roles and activities. We have focused on four domains:
3.1 The ethical basis of the physician-patient relationship
3.2 Ethically important practices in psychiatric care
3.3 The ethical basis of relationships with colleagues
3.4 Other ethically important topics in psychiatric practice
Each domain has several topics that correspond to everyday practice issues. In section 3.2, for example, this document addresses the topics of confidentiality, honesty and trust, non-participation in fraud, informed consent, decisionmaking capacity, involuntary psychiatric treatment, and therapeutic boundary-keeping. Within each topic, we define relevant ethics concepts and explain how they relate to the professional activities of psychiatrists. We also provide examples and, when appropriate, exceptions or special applications of these ideas within the profession of psychiatry.
This document highlights domains and topics that have apparent significance and salience in the practice of psychiatry at the present time. We could not address the full universe of ethically important issues in our field, and we could not anticipate the issues that will accompany future innovation and change in psychiatry. We have thus selected the domains and topics that will, we hope, help clarify and illuminate the fundamental ethical commitments of our profession.
We believe that ethical conduct is informed by knowledge of ethical principles and expectations but is best assured through the acquisition of ethically important skills and behaviors. These skills and behaviors – the “habits” of an ethical professional – will allow a psychiatrist to respond to complex and novel situations with an understanding of their ethical implications and the ethically-sound decisions that may be undertaken.

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