People undergoing treatment for mental disorders

Select one and ONLY one of the areas of investigation described below, and set out the ethical landscape for it, i.e. indicate what features of the subject should be relevant to morally sensitive decision. If you discover that there are legal complications to such a decision, note them as well. How would an ethical care-giver manage the difficulties you may notice in the area? Since this is a preliminary investigation, the emphasis will be on understanding the issues at hand rather than resolving them. However, since there has been some discussion about these matters in print, your discussion should reflect consideration of at least some of it. Your comments about resolution should take the form of suggestions for which you can give reasons. One important academic journal for the field is Philosophy, Psychiatry and Psychology. There is also an on-line Journal of Ethics in Mental Health, edited at McMaster University. Since you could become a greater expert in the area you choose than either the instructor or the marker, you should engage in careful exposition of your subject. Do not however, assume that the reader of your paper is completely uninformed about the area of discussion

5-7 pages, more or less, is the desired length. Should you find your subject interesting, you will be encouraged to continue your work in the area in your final submission. If you do, you will have to submit a copy of your graded second piece along with the third. TAs will indicate the papers that they have graded, and the revision/expansion will be reviewed by the grader who read the original version.

A. Consider the work of one or the other “client movement” in the field of mental health. These include consumer’s groups, psychiatric survivor’s movements and modern-day versions of anti-psychiatry. The groups can be very specialized (for example directed against electro-convulsive therapy, or what is considered to be excessive use of psychoactive drugs, or directed against compulsory treatment). What kind of arguments does the selected group raise? For example are claims about rights brought up, or about benefits and harms? What merit do you think your group’s arguments have? How should an ethically sensitive “mental health professional” respond? One much-read local author is Pat Capponi. Another, Bonnie Burstow, is a Prof. at OISE. You will be able to find some guidance for this in Rudnick.

B. Some psychoactive drugs are to be used as treatment for people judged to have mental disorders, and some of these disorders are said to affect decision-making capacity. How may one test the effectiveness drugs thought to help those who have such disabilities in an ethically acceptable manner, given that many of these disorders are thought to affect the ability to make informed decisions, and the possibility of improved condition counts as a strong inducement to say yes?

C. Do people undergoing treatment for mental disorders have a right to “effective treatment”? If so, what would that right entail? Some have claimed that this supposed right should allow actions on behalf of mental health clients against caregivers who avoid pharmaceutical and other therapies that have shown some effect in controlled studies when those therapists have chosen modes of treatment not readily subjectible to such investigation. What do you think of this? Suppose, for example that a pharmaceutical treatment offers a near certainty of a limited remission of symptoms, but at the cost of serious side effects, while a less invasive (and less-resisted) treatment delivers some insight, and a limited chance of a fully adaptive way to manage symptoms.

D. What rights to be informed should parents have when their children are undergoing treatment? How will it be possible to reconcile their potential as assistants in their children’s care with the child’s right to confidentiality, and the need to build a therapeutic alliance between caregiver and care receiver? Should parents of children older than the those in early childhood have the ultimate power to consent or refuse treatment?

E. How can one build an extended caring relationship with a client while maintaining professional detachment and ensuring that no disruptive boundary crossing takes place? What would count as a disruptive crossing of a line?

F. Could someone presenting Dissociative Identity Disorder, really be said to have multiple personalities? In deciding this you must discuss what it is to be one person, and/or to have one personality. Use your answer to consider how to attribute responsibility (and consequences) to actions done by one alter when others find them unacceptable or to consider what would be a justifiable aim in treating the condition.

G. Many anorexic patients will not eat, and will not do so even though they know that their action could kill them. Since there is insight on some level, and usually full competence to assess information, little indication of acute suicidal tendencies but a strong resistance to treatment, how can a caregiver respond responsibly?

H. A person indicates to her/his holders of the power of attorney for care, that if she/he becomes incompetent due to a geriatric dementia or other irreversible neurological or mental condition, no treatment beyond the palliative should be allowed for any potentially fatal disease. The reason given at the time cites loss of ability to carry on at anything like the level of self-awareness and planning that she/he considers essential to a worthwhile life. However, at some point after a dementia sets in, the person in question experiences a condition that will be fatal if not treated (pneumonia, for example). She/he expresses no discontent with life as it has developed (and perhaps takes great pleasure in much of her experience), She/he can understand that she/he is sick and requests treatment. How should the ethical caregiver respond? How should the good psychiatrist advise such a caregiver?

I. Psychopaths and those with anti-social personality disorder are often characterized as rational, but morally incompetent in some way or another. They can understand that nature of their disorder, and that they have it. A history of criminal convictions can play a role in the diagnosis of both of these conditions. Consider whether treatment (and even diagnosis) would amount to some form of sophisticated social control technique applied without regard to patient consent (considering that assessment, at least, could be the result of the decision of a medical or law-enforcement official). It would also not involve an adversarial “fact-finding” process, such as a trial. Would this be objectionable? Alternatively, consider whether there is a way that a good caregiver can intervene to produce a change in behaviour without manipulation.

J. What sorts of issues of conflict of interest does the increasing importance of pharmacological treatments in the mental health professions, and of the research used to get a license to employ such treatments medically, pose for psychiatrists or other health care givers?

K. During the processing of the revision of DSM (Diagnostic and Statistical Manual of Mental Disorders), the classification of conditions became a matter of considerable debate. One area of vigorous discussion in the preparation of DSM 5 is in the area of disorders having to do with sex and gender. Review recent controversy over this matter (or some other of interest to you), and compare it with the categorizations settled on by DSM. Are there any serious ethical implications of the exclusions, inclusions or categorizations actually decided upon?

 
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