A Different Way of Seeing: science, authority and power in the ethics of psychiatric research (original) (raw)

Ethical problems in psychiatric research

The Journal of Behavioral Health Services and …, 1997

This article raises questions about the morality and value of experiments conducted mainly on psychiatric patient-subjects whose mental capacity and judgment are often impaired, making them incapable of giving informed consent. Its focus is on experimental studies in which psychotic symptoms in patients with schizophrenia have been knowingly exacerbated by suddenly withdrawing medications that they needed, administering known psychosis-producing substances such as L-dopa and apomorphine, and ignoring the treatment needs of those serving as experimental controls in placebo studies. Concerns are raised about the draft "Statement of Principles for Ethical Conduct" by the American College of Neuropsychopharmacology. Questions are also raised about the adequacy of current safeguards, including federal regulations, peer review, and the trivialization of "informed consent" by institutional review boards that operate under veils of secrecy. Implications for mental health policy are discussed, and suggestions are made for improving safeguards and reducing risks. Unethical experiments on mental patients have been taking place in the United States for a long time. They should evoke questions about the scientists conducting them, the administrators permitting them, and the National Institute of Mental Health (NIMH) funding many of them. But because physician-researchers are regarded as holding the keys to medical advance and ultimate cures, the biomedical research community has been exempted from being held accountable lest such questions interfere with important research. Dubious experiments, violating fundamental ethical and possibly legal standards and causing human subjects pain and harm-often without their informed consent-are not, however, what the public should expect from science. Jay Katz* recently reminded the medical bioethics community that "the oft-invoked moral right to engage in human experimentation is itself in need of a thoroughgoing examination, for that right, which finds its justification in the need to advance the frontiers of knowledge, can all too readily obliterate 'the deepest matters of our morality' by the ways in which we use human beings for our own purposes. ''1

article ethics in psychiatry research dysphrenia 2013 4 2

There have been concerns about ethics of advancing scientific knowledge at the expense of individual safety and interests of people with mental illness. Measures to protect vulnerable participants are needed to ensure that the methods of research do not infringe on the rights of mentally ill. In developing countries, cultural issues have compounded the challenges of traditional ethical principles. The ethical principles that guide research in human participants stem from guidance from various organisations through the years.

Ethics in medical research: General principles with special reference to psychiatry research

Indian Journal of Psychiatry, 2013

Ethics is an understanding of the nature of conflicts arising from moral imperatives and how best we may deal with them. Ethics in medical research deals with the conflicts of interest across various levels. Guidelines have been proposed for standardized ethical practice throughout the globe. The four fundamental principles of ethics which are being underscored are autonomy, non-maleficence, beneficence, and justice. Some special ethical issues have particular relevance to psychiatric research arising primarily from the specific vulnerabilities of those with mental illness and the risks posed by some research methodologies. Accordingly, sensitivity is required in the design of psychiatric research. It is suggested that though the value of published guidelines and the help that may be available from research ethics committees is quite great, the primary responsibility for maintaining high standards of practice in research rests with research workers themselves.

Introduction: The Diversification of Psychiatric Ethics

Harvard Review of Psychiatry, 2008

Psychiatric ethics has emerged as a distinct academic medical discipline. The publication of the third edition of the Oxford University Press textbook Psychiatric Ethics in 1999 and Oxford's publication of An Anthology of Psychiatric Ethics in 2006 have helped to establish psychiatric ethics as a discipline in its own right and to identify core issues facing the field. 1,2 These issues include those relating to confidentiality, professional boundaries, informed consent, involuntary treatment, managed care, and health resource allocation. While these areas remain essential for deliberation, research, and education in contemporary psychiatry, the scope of psychiatric ethics has been continually widening to include other important domains of our field. This special issue of the Harvard Review of Psychiatry aims to showcase some, but by no means all, of both the long-standing and the novel subjects facing psychiatric ethics in the twenty-first century. The articles in this issue make clear that contemporary psychiatric ethics must draw upon traditional principles of biomedical ethics but supplement these principles with diverse new considerations, approaches, and forms of reasoning. Nowhere is the need for fresh ethical reasoning more essential than in biological psychiatry. The genomics revolution in biomedical research, in general, has had a profound impact on the focus and tasks of psychiatric research, in particular. With an explosion of research on genetic contributions to psychiatric illness and early success in identifying important candidate genes, the urgency of ethical reflection on this form of investigation has intensified. Recent articles in the medical and public health literature have addressed the multifaceted ethical challenges associated with

Ethics and evidence in psychiatry

Perspectives in Biology and Medicine, 2009

Many psychiatrists have endorsed the idea of evidence-based psychiatry, the application of the principles of evidence-based medicine (EBM) to psychiatric practice. Proponents of an evidence-based approach to psychiatry hope that if practice is driven by "hard" scientific data, there will be greater potential to help patients. In other words, advocates of evidence-based psychiatry aim to bolster psychiatry's ethical standing through scientific evidence. Can EBM provide this ethical substantiation to psychiatry? This article provides an overview of some of the main ethical issues within psychiatry and examines three interrelated questions: (1) to which ethical values is EBM committed? (2) which ethical theory is reflected in these values? and can these values and theories resolve existing ethical issues in psychiatry? EBM strives for the "greatest good for the greatest number," where good is defined as improved health.This utilitarian orientation cannot, however, address critical areas of moral importance for psychiatry, such as how its practitioners differentiate normal from abnormal, how they determine which forms of suffering should be alleviated through psychiatric means, and when involuntary intervention is ethically justified.The ethical principles implicit in EBM are too limited to serve as an ethical basis for psychiatry.

Ethical Practices and Legal Challenges in Mental Health Research

Asian Bioethics Review, 2020

Considerations of justice and concern for well-being support conducting mental health research and addressing ethical concerns specific to mental health research are critical. We discuss these concerns, provide recommendations to enable the ethical conduct of mental health research, and argue that participants' interests should be given primary weight in resolving apparent dilemmas. We also comment on provisions of two legislative actions in India relevant to mental health research: Rights of Persons with Disability Act 2016 and the Mental Health Care Act 2017. Both conform to the 2006 United Nations Convention on Rights of Persons with Disabilities of which India is a signatory. Both provide protections and enumerate rights relevant to people with mental health conditions but with differing focus. The commonalities and differences between the three are discussed in the background of international literature on research in mental health conditions. Studies involving deception and future directions for ethical requirements regarding genetic research are discussed.