Edited by John Z. Sadler, Werdie Van Staden, and K.W.M. Fulford;
Oxford, UK: Oxford University Press; 2015 • 1417 pages • $295.00 (hardcover, 2 volumes)
The field of psychiatry is vast in scope, setting, and purpose. The Oxford Handbook of Psychiatric Ethics (OHPE) glowingly reflects the diversity and complexity of our field, in a 2-volume, 94-chapter, 1417-page “megalodon.” The timing of such an extensive text of psychiatric ethics is clearly appropriate in the setting of accelerated scientific knowledge about the brain; evolving technologies (ie, the digital/electronic revolution); and the ever-changing societal, cultural, and political interactions with psychiatric providers, patients, and the public at large.
The authors are careful to focus on psychiatry (as opposed to “mental health” ethics, or medical ethics), with a clear intent to present novel areas of debate that expand the domain of psychiatric ethics. The result is a mixture of theoretical, philosophical, and practical-clinical ethics, organized into the following major themes: people come first; specific populations; philosophy and psychiatric ethics; religious contexts of psychiatric ethics; social contexts of psychiatric ethics; ethics in psychiatric citizenship and the law; ethics of psychiatric research; and, finally, ethics and values in psychiatric treatment.
Readers familiar with other titles in psychiatric ethics will recognize several traditional areas of ethics redux, such as therapeutic boundaries, issues unique to children and adolescents, forensics, consent and research, and a substantive review of philosophical theories as they apply to psychiatric ethics. The OHPE’s chapter on “Ethics and Values in Diagnosing and Classifying Psychopathology” renders a timeless ethical issue in a new light with a thought-provoking discourse that includes the social consequences of receiving a diagnosis, and the unique self-illness ambiguity of mental disorders that sets them apart from other medical afflictions.
The chapters on consultation-liaison hospital psychiatry and “Ethical Issues in Older Patients” are concise, practical, and pertinent, while a chapter devoted to the history of ethics of sexuality and LGBT issues is highly instructive. A chapter that highlights a survey of psychiatrists’ own views on ethical dilemmas—including end-of-life, public health, professional boundaries, and conflicts of interest—will serve to bookmark this moment in time in a constantly evolving profession and society.
Where the OHPE distinguishes itself is in its exploration of new territory in psychiatric ethics, beyond “new” topics such as brain imaging, invasive and noninvasive treatments, telepsychiatry, and conflicts of interest (all of which are addressed). The OHPE takes on the Internet and social media as a radical new vector in psychiatric care.
Section II of the book, “People Come First,” is a series of 10 powerful essays written by patients about their experiences with psychiatry, which are simultaneously a calling to the humanism of our profession—and a challenge to our authority as individual providers and collectively as a system. One patient writes about “Unethical Privacy,” a provocative critique of the rigid adherence to privacy and confidentiality laws that seems to undermine his care. Another writes about her struggle to find confidence in a seemingly authoritarian and indifferent inpatient hospital environment and to preserve her dignity in a stigmatizing health system.
The section on “religious” contexts of psychiatric ethics is undeniably novel and informative, though perhaps less likely to draw as much interest as the section on citizenship and the law. This latter section includes a poignant discussion about the psychiatrist’s role in the community and the ethical duties in his or her “social contract” with society, as well as the ethical challenges imposed by the failure of society (including policy makers, insurers, and health systems) to provide adequately funded and accessible mental health services.
The OHPE functions best as an encyclopedia of topics in psychiatric ethics and will serve as a valuable reference tool for scholars and practitioners. Those who seek greater depth on any particular topic will only need to follow the wealth of references provided.
Dr. Cheung is Assistant Professor of Health Sciences at the UCLA David Geffen School of Medicine and Medical Director at the UCLA Psychiatric Emergency Services in Los Angeles.