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Protecting altruism: A call for a code of ethics in British psychiatry

  • Sameer P. Sarkar (a1) and Gwen Adshead (a2)
Extract

Codes of ethics have existed for medicine since the time of Hippocrates. However, a written code of ethics (like a written constitution) has so far eluded British psychiatry. In this editorial we discuss the arguments for and against a code of ethics as an essential aspect of our identity as medical professionals. Our professional identity as psychiatrists is coming under scrutiny from the General Medical Council, the emergence of the user movement and the proposals in the draft Mental Health Bill. At a time when psychiatry is seen increasingly as a guardian of public safety, there has never been a more pressing need for a code of ethics.

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Copyright
Corresponding author
Sameer P. Sarkar, Broadmoor Hospital, Crowthorne, Berkshire RG45 7EG, UK
References
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Protecting altruism: A call for a code of ethics in British psychiatry

  • Sameer P. Sarkar (a1) and Gwen Adshead (a2)
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eLetters

Altruism and Codes of Ethics

susanne McCabe, retired
22 August 2003

The editorial is more a statement of 'good intent' than one which makes any concrete suggestion, as the authors suggest. There is a problem to begin with though, in positioning psychiatrists as 'altruistic'. Surelyit should be expected that health workers do behave with good intentions -but it does not amount to 'altruism' when psychiatrists are simply carryingout their obligations in a professional manner, with the accompanying rewards, and that they can impose unwanted actions on another. With the introduction of the Human Rights Act for example more cases are being won over unlawful detention and discrimination. The values of society do change as they say but it cannot be be wrong to abuse a person's Human Rights overnight, it has always been wrong and has always been contested. Psychiatry has always been a site for power and control. The use of labelsis one way of attempting to disempower others. People in the 'user movement' are far less likely to use the authors' prefered choice of 'patient', if they have been exposed to awareness raising groups or literature.They choose 'user' or even 'person'. The service user is positioned in this editorial as mainly weak, dependant and vulnerable. This is rarely the case all of the time shown by the strength of characterand commitment to improving services and relationships by ex/user/survivors; not only are they struggling with unacceptable quality of services and relationships with mental health workers but levels of poverty and stigma which make their achievements even more to be admired. The movement has largely emerged and strengthened because of the way psychiatrists have treated their fellow human beings. The word 'consumer' is inappropriate. What is on offer is rarely worth paying for, it suggests a choice of service where there is rarely any. Because the payment is invisible though it is not acknowledged often that people are paying through their taxes. Psychiatrists are not benignly providing a service. The debate concerning 'professional' versus 'trade' has gone in the other direction in the UK; more people are descibed as 'professional' these days where they show high levels of committment to providing a service to others. It carries overtones of concern with status and again terminology has been historically used by the medical profession to keep 'others' out,to claim priveledged access to others, their private information, their families, their bodies and to claim superior status by excluding other groups who becaome positioned as 'inferior', just as NHS'patients' have been positoned as 'lower class' in general by some psychiatrists and so able to be treated differently from 'their own'. Codes of Ethics have been used to strengthen these concepts. They control and regulate members partly through fear of exclusion and loss of work or status. Psychiatrists have gained great clinical freedom to practice according to individual values (as long as they group together to form sub-sections) which people who consult them may or may not share; they are rarely informed of the eg spiritual beliefs of the Psychaitry and Spirituality group, the psychotherapeutic beliefs of various factions in psychotherapy, the concept of 'evil' held by some.Codes of Ethics can only ever provide a framework. Those who draw them up have historically done so in their own self interets rather than to protect those in uninformed or vulnerable positions. It would be vital therefore that all stakeholders are involved in consultations about any proposal which could impact on them, especially one which proposes a drawing up another Code of Ethics, in addition to laws and guidelines theyare already obliged to keep, in order to strengthen the separate identity of psychiatrists.It is not only in wicked 'other' places that abuse of power has developed but at the heart of institutions in the UK which had accrued too much power and freedom from outside scrutiny. Some 'interference' is healthy inany democracy. ... More

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