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The Moral Elephant in the Room – Patient Morality in Psychiatry

Cross-post from the Journal of Medical Ethics Blog.


By Doug McConnell, Matthew Broome, and Julian Savulescu.

In our paper, “Making psychiatry moral again”, we aim to develop and justify a practical ethical guide for psychiatric involvement in patient moral growth. Ultimately we land on the view that psychiatrists should help patients express their own moral values by default but move to address the content of those moral values in the small subset of cases where the patient’s moral views are sufficiently inaccurate or underdeveloped.

Those who are interested in how we got that position can see our argument in the paper but here we’ll say something about what motivated us to write this paper.

We had been using the late Steve Pearce and Hanna Pickard’s 2010 paper, “The Moral Content of Psychiatric Treatment”, in teaching the MSt in Practical Ethics at Oxford. In that paper, they argue that moral norm breaking is casually and constitutively linked to some instances of mental illness and that psychiatry routinely works by improving patient morality. We had been interested to see the strong reactions some of the students had against the idea that psychiatrists should have any involvement in patient morality. This view, incidentally, was shared by at least one psychiatrist when our paper was presented at the 16th World Congress of Bioethics in Basel.

Given the reaction that the Pearce and Pickard paper tended to generate, we were surprised to see that it hadn’t attracted any fierce rebuttals. In fact, we found that the literature dealing explicitly with psychiatry and patient moral values was sparse. Moral language tended to be absent or replaced with (ostensibly) morally neutral language, such as discussion of risk management. It seems as if psychiatrists have been reluctant to publish their views one way or the other on the intersection of psychiatry and patient morality.

So we were encouraged to write our paper, both to articulate the objections that people might have to psychiatric involvement in patient morality, and to advance Pearce and Pickard’s core observation that, in many cases, psychiatry does and should work by addressing patient morality. It’s our view that psychiatry would be more effective if it was explicit in its interactions with patient morality and, given that current psychiatric practice does (implicitly) engage with patient morality, it would be better if psychiatry was transparent about this moral aspect of practice.

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1 Comment on this post

  1. I can’t say I am surprised that your findings on sparse data surfaced. I suppose it is reasonable that there be some connexion between morality and Psychiatry, insofar as Psychiatry addresses matters of mind. I see no cause for flaring tempers or violent arguments there. I think I understand though why students may have questioned; been uncomfortable with the premise. Students, possessed of nominal faith, would likely question and/or be bothered with this sort of cross-disciplinary mingling, seems to me. They might feel compelled to ask questions of trusted clergy concerning what was going on at school. Were I in such a position under same or similar circumstances, that is what I would do. This goes to notions of overlapping magisteria and cross-disciplinary confusion. In that sense, I am not entirely certain it is a good idea. There are, or ought to be, lines of demarcation in such matters. This takes no one’s side on the topic, asking innocently if we should consider deeper ramifications. There are relationships we should not mess with, unless there is compelling reason for doing so.

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