Ethics

The concept of “ethics” was introduced by Socrates, and defined as a philosophical discipline by Aristotle. Today this discipline tries to set up criteria for “good” and “bad” behavior/actions, and to evaluate the motives for these actions, and the consequences.

In all health care work, and particularly in work with persons exposed to injustice and human rights violations, a clear awareness of ethical codes, standards and principles is quite necessary. The knowledge and clarity about ethical and human rights principles will strengthen the involvement of health professionals in human rights violations, and fortify their actions to prevent such violations. It is in order to strengthen knowledge about these principles, that we include a thematic page on ethics.

Ethics – what are we talking about?
Various “Codes of Ethics”
Guidelines
Ethics and Mental Health
Ethics and Human Rights
Ethics regarding mental health in war
Ethics and Disaster
Ethics and Cultural Aspects
Ethics and Therapy
Challenges in Ethics
Education on Ethics
Ethics in practice
Ethics - organizations and sites

Ethics – what are we talking about?

Here we have collected some articles and reviews, highlighting some basic definition for ethics, in connection with different other topics.

  • Health Ethics, Equity and Human Dignity
    This article (12 p.) discusses the necessity to review ethical principles in health, to ensure that human rights and dignity are fully respected. – Mamdouh Gabr, Cairo University.
  • Medical ethics: four principles plus attention to scope
    The “four principles plus scope” approach provide a simple, accessible, and culturally neutral approach about ethical issues in health care. The principles: respect for autonomy, beneficence, non-maleficence, justice. The article discusses these topics, and the conclusion in personal decision making. - BMJ 1994, 309:184, R. Gillon.
  • Applying the Four Principles
    The author reports to the article by Gillon from 1994, discussing the four principles on examples. – Journal of Medical Ethics, 2003;29, R. Macklin.
  • Public Health Ethics articles
    This site provides lots of links to articles about the topic “ethics and public health”, published in the Journal of Public Health. Links to abstracts free of charge.
  • Ethics of conducting research in conflict settings
    The article discusses the necessity of research in conflict areas to improve the quality of assistance, considering the ethic principles in doing research in a vulnerable population, and the harm-benefit ratio. – Conflict and Health 2009, 3:7.
  • Ethics
    The online encyclopedia Wikipedia provides with this definition of “ethics” in general, from the historical origins to the present (partly philosophical) sub-categories.
  • Professional Ethics
    One the important branch of ethics which deals with the professional aspects of ethics. It is a brief introduction on professional ethics. Center for the studies of ethics in the professions.
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Various “Codes of Ethics”

Lots of organizations working with mental health and therapy, psychiatrists, psychologists and others, have framed some principles concerning ethics, ethical behavior etc while encountering people in need, crisis and illness. For sure there are many more codes to find, the general and underlying principles are very similar.

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Guidelines

It seems quite difficult to find (may be set up?) “guidelines” to follow, when it comes to “ethics” – ethical guided assistance, behavior, etc. Most of the (hopefully leaded by ethically based considerations) attempts to cope with disaster and catastrophes, mention in general guidelines some aspects of this topic. We found nevertheless some more specific.

  • ”Do No Harm” – Training Materials
    The CDA has developed some training materials, aiming to sensitize helpers in “Do No Harm“. This training was the result of projects to learn more about assistance given in conflict settings (often used and misused to pursue political or military advantage).You can download hand- and workbooks, trainers package etc.
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Ethics and Mental Health

A variety of articles and links, chosen somewhat subjective. The field is quite broad, so there is a range from ethics in social work/field working up to ethics in more specific mental health and treatment within general medicine and psychiatry/psychology. These topics here include not in specific ethics in mental health in conflict times/zones.

  • Journal of Ethics in Mental Health
    This is an “international, peer-reviewed, web-based journal, available free on-line, worldwide. It aims at providing a useful forum for sharing ideas and experiences among all who are committed to improving ethical standards, behaviours, and choices in mental health care giving”.
  • Ethics in Mental Health Research
    This website aims to provide with resources for teaching, studying, investigating ethical issues in mental health research. Collaboration at Saint Louis Univ., Missouri Inst. of Mental Health, Nat. Inst. of Health, and the Nat. Inst. of Mental Health.
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Ethics and Human Rights

  • ‘Stop Stealing Our Stories’: The Ethics of Research with Vulnerable Groups
    Health professionals` ethic and human rights violations, revealed in may 2004, CIA inspector generals report. “Physicians for Human Rights” is discussing in this article (8 p.) the CIA report (released in 2009) about the role health professionals played in the CIA`s torture program, and the level of ethical misconduct. – Physicians for Human Rights, 2009.
  • Aiding torture
    Health professionals` ethic and human rights violations, revealed in may 2004, CIA inspector generals report. “Physicians for Human Rights” is discussing in this article (8 p.) the CIA report (released in 2009) about the role health professionals played in the CIA`s torture program, and the level of ethical misconduct. – Physicians for Human Rights, 2009.
  • Ethics, Human Rights and Globalization
    Second global ethic lecture, held by Mary Robinson, UN High Comm. For Human Rights at that time. – Univ. of Tübingen/Germany, jan 2002.
  • Compendium of United Nations standards and norms in crime prevention and criminal justice
    The United Nations released in this Compendium some basic principles, see here in particular article 16 – “Principles of Medical Ethics relevant to the role of health personnel....” – UN 2006
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Ethics regarding mental health in war

  • American physicians and dual loyalty obligations in the "war on terror"
    If U.S. physicians are faced with a conflict of interest between following national policies or international principles of humanitarian law and medical ethics, they should opt to adhere to the latter when treating war detainees. It is important for the U.S. medical community to speak out against possible detainee abuse by the U.S. government. Jerome Amir Singh 2003
  • Doubtful prisoner-of-war status
    The Geneva Convention relative to the Treatment of Prisoners of War regards to principles a prisoner of war cannot be prosecuted and punished for the mere fact of having taken part in hostilities, and that prisoners of war must be given humane treatment from the time they fall into the power of the enemy until their final release and repatriation. If a person is not given combatant status, he may be tried for having committed a belligerent act. Where this criminal offence may be punished by capital punishment under the domestic jurisdiction, the lack of prisoner-of-war status may be a matter of life or death.Yasmin Naqvi, 2002.
  • Ethics Abandoned: Medical Professionalism and Detainee Abuse in the War on Terror
    The report is based on two years of review of records in the public domain by a 19-member task force. The report details how DoD and CIA policies institutionalized a variety of interventions by military and intelligence agency doctors and psychologists that breach ethical standards to promote well-being and avoid harm. Institute on Medicine as a Profession 2013

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Ethics and Therapy

  • Ethics of child and youth care professionals
    The development of a North American Code of Ethics for Child and Youth Care is a benchmark for the profession, The Code of Ethics unites the range of professional roles and functions and relates them to common commitments and shared responsibilities. The Code of Ethics establishes a framework to guide thinking and practice for all Child and Youth Care Professionals.
  • Code of ethics of body psychotherapists
    The United States Association for Body Psychotherapy (USABP) is an association of body-oriented psychotherapists, allied somatic practitioners, and interns trained in related modalities. The purpose of the USABP is to support the practice and further evolution of the field of body psychotherapy.
  • Code of Ethics of the National Association of Social Workers
    The 2008 NASW Delegate Assembly approved the following revisions to the NASW Code of Ethics
  • "What Should I Do?" - Ethical Risks, Making Decisions, and Taking Action
    The materials in this course are based on current published ethical standards and the most accurate information available to the authors at the time of writing. Many ethical challenges arise on the basis of highly variable and unpredictable contextual factors. This course material will equip mental health professionals to gain a basic understanding of core ethical principles and standards related to the topics discussed and to ethical decision making generally, but cannot cover every possible circumstance. When in doubt, we advise consultation with knowledgeable colleagues and/or professional association ethics committees. Gerald P. Koocher and Patricia Keith-Spiegel.
  • American Association of Marriage and Family Therapy (AAMFT) Code of Ethics
    The Board of Directors of the American Association for Marriage and Family Therapy (AAMFT) hereby promulgates, pursuant to Article 2, Section 2.01.3 of the Association's Bylaws, the Revised AAMFT Code of Ethics, effective July 1, 2012
  • American Counseling Association (ACA) Code of Ethics
    The mission of the American Counseling Association is to enhance the quality of life in society by promoting the development of professional counselors, advancing the counseling profession, and using the profession and practice of counseling to promote respect for human dignity and diversity.
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Ethics and Disaster

In case of disaster – catastrophes, war, conflict etc – is has always been somewhat difficult to define ethic principles in providing aid, and to ensure that these principles are followed. Just basic questions (as: whom should you help first in case of disaster? And who makes the “ethical” decisions?) can be very difficult to decide.

  • Disaster Management Ethics
    The Disaster Management Ethics module (65 p.) “addresses some of the ethical issues and dilemmas faced by the humanitarian assistance community as it seeks to respond to human need in the context of natural and human-caused disasters. The format simulates a discussion which aims to foster conversation and interaction. It brings together the voices of fifteen practitioners and scholars to discuss five ethical issues in humanitarian assistance”. It works as a guideline, with case-studies, and questions to answer. – Disaster Management Training Programme DMTP, Dep. Humanitarian Affairs/UN.
  • Disaster Psychiatry Handbook
    The American Psychiatric Association has released this handbook (56 p.), concerning psychiatric dimensions of disaster. Especially chapter 5 – mediolegal and ethical issues in disaster psychiatry – discusses the ethic challenges in disaster situations. APA, nov 2004.
  • World Medical Association Statement on Medical Ethics in the Event of Disasters
    The WMA states here the medical ethics to be concerned in handling disasters and victims. – WMA, oct 2006.
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Challenges in Ethics

  • Delinquency or Mental Health Problem
    Reflections by Thomas Plante: Although many mental health and juvenile justice professionals strive to provide state-of-the–art, culturally competent services—and are even mandated to do so by professional codes of ethics (e.g., American Psychological Association, 2002)—the reality is that they all too often fall short….very short. This article is about the challenges in practicing ethics.
  • Ethics in mental health practice
    This site is a unique opportunity to use distance learning to explore a wide range of challenging ethical issues in the mental health professions. There is no question that interest in ethical issues in psychology, counseling, social work, psychiatry, marriage and family therapy, psychiatric nursing, and pastoral counseling – and, more generally, professional ethics – has burgeoned in recent years.
  • “The Whole Truth” Versus “The Admissible Truth”: An Ethics Dilemma for Expert Witnesses
    Thomas G. Gutheil, et al. The expert witness testifies under oath to tell “the whole truth,” yet certain aspects of the legal system itself make this ideal difficult or impossible. The authors present both a philosophical and a practical discussion of the challenges for the expert in attaining this goal. Recommendations are provided for experts, to preserve the truth in the adversary system. This article concerns about ethics in psychiatry and law. 2003
  • Ethics in a short white coat: the ethical dilemmas that medical students confront
    Dimitri Christakis and Chris Feudtner. The authors report on the kinds of dilemmas students face as clinical clerks, using cases that students submitted in 1991-92 during an innovative and well-received ethics class given at a tertiary care hospital as part of the internal medicine clerkship. The article can be download in PDF format. 1993
  • Ethical dilemmas in community mental health care
    A Lie´geois, C Van Audenhove. In the present article the authors will provide an ethical reflection on the results of a European qualitative research project. We will begin, therefore, with a presentation of the research findings and then will develop a value based ethical model. The remainder of the article will discuss the ethical dilemmas confronting the various stakeholders. 2005
  • Ethical Dilemmas in Managed Mental Health Care
    The current paper describes the evolution of managed care, common practices in managed care, and ethical issues inherent to working in a managed mental health care system.
  • Ethical aspects of de-institutionalisation in mental health care
    This report has focused on the ethical dilemmas posed by de-institutionalisation in mental health care in the participating countries. In Concerted Action, we defined de-institutionalisation as the reform process of mental health care which involves moving patients from larger scale psychiatric institutions towards the community, where alternative psychiatric services strive for treatment, care and support in the client’s natural environment.
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Education on Ethics

  • Using Ethics to Guide Casework Decision Making
    The Pennsylvania Child Welfare Training Program. This site is a good educational source for training and other educational purposes by public child welfare agencies and other not-for-profit child welfare agencies. The main purpose is working on ethical issues related to children.
  • Teaching ethics in the clinic. The theory and practice of moral case deliberation
    A C Molewijk et al. This article presents the underlying theory on (teaching) ethics and illustrates this approach with an example of a moral case deliberation project in a Dutch psychiatric hospital. The project was evaluated using the method of responsive evaluation. This method provided us with rich information about the implementation process and effects the research process itself also lent support to the process of implementation. 2008
  • Practice Dilemmas and How to Resolve Them
    In response to a significant problem, this website approaches professional choices from a unified perspective that views decision making as an orderly process sharing essential characteristics in all of the mental health disciplines. More than that, it invites the user to interpret professional issues from a communitarian, rather than individualistic, perspective. With these issues in mind, the system for addressing professional dilemmas is useful for practitioners and students in mental health settings. Examples of the use of this system are offered in a variety of practice dilemmas presented in links to this page.
  • 5 Ways to teach ethics
    Here are five techniques which author has in his ethics courses to help students explore the ethics of psychology—and their own ethics. They give you one example of each technique; you can take it from there and apply these to ethics in your personal life and your own profession. They make no claim that these are original, and this is certainly not a definitive list.
  • Teaching Ethics Across the Psychology Curriculum
    The writer explains that every content area in psychology stimulates numerous teachable moments with respect to ethical issues - the raw material is there, and it is simply a matter of casting course content in terms of its ethical dimension. When ethics content is seamlessly integrated across the curriculum, students come to understand that adhering to ethical principles is the responsibility of all members of the profession and they come to expect to be confronted with ethical dilemmas in many professional contexts.
  • Essential Ethical Skills of Mental Health Professionals
    An overview for mental health clinicians, researchers, and learners. in Professionalism and Ethics. The writer illustrates that all mental health professionals whose work embodies the highest ethical standards tend to rely on a set of six core ethics skills that are learned during or before professional training and are continually practiced and refined during one's career.
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Ethics in practice

  • Children Dealing with the parent whose judgment is impaired by alcohol or drugs: legal and ethical considerations.
    This clinical report identifies and discusses the legal and ethical concepts when a patient is brought to a pediatric office by a parent or guardian exhibiting symptoms of judgment impairment. The report offers implementation suggestions when establishing anticipatory office procedures and training programs for staff on what to do (and not do) in such situations to maximize the patient's well-being and safety and minimize the liability of the pediatrician. John J. Fraser Jr. et al. 2004.
  • Children Ethical issues in undertaking research with children and young people
    International Literature Review: This paper reviews recent literature regarding ethical issues in research with children and young people. This is a topic that has seen a significant growth in interest over recent years, in response to developments in both child research and ethics. Whilst acknowledging the clear importance of the issues related to medical and psychological research studies on children, they are beyond the scope of this review which is focused on ethical issues related to research with children, who are actively participating and expressing their views and opinions. Powell, M.A. 2011.
  • Children Ethics: a part of everyday practice in child care
    This is a discussion about the significance of the early years and therefore the importance of quality in children’s services, but at the same time there is recognition that the child care profession is undervalued. It takes about the time and resource constraints which can make it difficult to reflect critically, individually and collectively, on practices and policies.
    Lennie Barblett, Catharine Hydon, Anne Kennedy 2008
  • Women Ethical issues in treating pregnant women with severe mental illness
    Severe mental illness tends to occur and recur among women in the reproductive period. Both the disorders and the treatments may have effects on the mother and the foetus. The clinician hence is often in a dilemma when treating pregnant women with severe mental illness and is challenged with ethical issues related to decision making in this regard. This paper highlights some of these ethical and clinical dilemmas through case vignettes based on data from a specialized prenatal psychiatry service.
    Geetha Desai, Prabha S Chandra, 2007
  • Women Ethical Considerations in Treating Women with Mental Illness during Pregnancy
    The writer argues treating women with mental illness in relation to reproduction can create numerous ethical tensions for the patient and the psychiatrist, often related to con?icting interests between the patient, child, and/or family members such as spouses. The author explains how psychiatrist plays a pivotal role in guiding patients through such complicated decisions.
    Mytilee Vemuri, 2012.
  • Women Ethical and safety recommendations for interviewing trafficked women
    In response to the rapid global rise in trafficking and growing demand for information on trafficking by policymakers, donors, service providers, and the media, women who have been trafficked are increasingly being interviewed to discuss their experiences. This article is introduces recommendations that are intended primarily for use by researchers, members of the media, and service providers unfamiliar with the situation of trafficked women. They do not explicitly discuss the different risks and obligations of interviewing females who are minors, although many of the same principles will apply. Health Policy Unit, London School of Hygiene & Tropical Medicine, the Daphne Programme, WHO 2003.
  • Ethnic minority groups Research Ethics for Mental Health Science Involving Ethnic Minority Children and Youths
    The American Psychological Association, the National Institute of Mental Health, and the Fordham University Center for Ethics Education convened a group of national leaders in bioethics, multicultural research, and ethnic minority mental health to produce a living document to guide ethical decision making for mental health research involving ethnic minority children and youths. This report summarizes the key recommendations distilled from these discussions. Celia B. Fisher et.al. 2002
  • Rural Communities Frontier Ethics: Mental Health Care Needs and Ethical Dilemmas in Rural Communities
    Roughly 15 million of the 62 million rural U.S. residents struggle with mental illness and substance abuse. Important but little-recognized ethical dilemmas also affect rural mental health care delivery. The authors describe the features of rural mental health care and provide vignettes illustrating ethical issues encountered in the predominantly rural and frontier states of Alaska and New Mexico. Laura Weiss Roberts et al. 1999
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Ethics and Cultural Aspects

  • Ethics, Competence, and Professional Issues in Cross-Cultural Counseling
    This paper discusses the relevance of multiculturalism to professional excellence in counseling. Focus also on multicultural awareness, multicultural counselors. – Paul B. Pedersen, 2007.
  • Ethics and Culture in Mental Health Care
    This article examines the complex relationship between culture, values, and ethics in mental health care. Cultural competence is a practical, concrete demonstration of the ethical principles of respect for persons, beneficence (doing good), nonmaleficence (not doing harm), and justice (treating people fairly)—the cornerstones of modern ethical codes for the health professions. Five clinical cases are presented to illustrate the range of ethical issues faced by mental health clinicians working in a multicultural environment, including issues of therapeutic boundaries, diagnosis, treatment choice, confidentiality and informed consent, and the just distribution of limited health care resources. Jinger G. Hoop et al. 2088.

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Ethics - organizations and sites

  • Ethics and Health at WHO
    The World Health Organization has in 2002 launched its Ethics and Health Initiative, now carried on by the Department of Ethics, Trade and Human Rights. On this website you will find also some links to this topic, as well as information on the work the WHO is involved here.
  • International Global Ethics Association
    It represents a “non-partisan, non-profit, global academic network, working within the new and emerging field of Global Ethics”.
  • The Scattergood Program for the Applied Ethics of Behavioral Healthcare
    Scattergood Ethics is dedicated to education, research, and resource development for the field of psychiatric, mental, and behavioral healthcare ethics. The program engages in scholarly research, trains and educates clinicians and scholars in mental and behavioral healthcare ethics, sponsors programs and public events, and promotes and advocates for greater attention to the ethical dimensions of diagnosis and treatment.

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