A history of psychiatric ethics.
In the not-far-distant past, ethics for all doctors was, at best, an ill-attended lecture or two on how to keep out of trouble; it was assumed the rest was absorbed by a form of social and professional osmosis. Although ethics has entered the undergraduate curriculum, continuing medical education programs, journals, and books, it still is in a state of flux. Although immense progress has been made in the last 30 to 40 years, much remains to be done. Trainees are often naïve, and the older generation is on a steep learning curve. An encouraging feature is the current lively debate on matters ethical and how they can best be incorporated into everyday clinical practice. The long-held notion of ethics resting complacently in the paternal arms of Hippocrates has, with almost brutal haste, been projected into a rapidly evolving modern world of technologic, moral, and societal change. Yet, at its core, ethics has to retain its humanism and guard against influences from every quarter that tries to make it a set of rules, thereby negating the diversity and uniqueness of our patients. Even as you read, there will be new influences and pressures on clinical practice that have an ethical dimension. For instance, we are adjusting to new privacy laws in Australia that allow patients, whether public or private, access to their psychiatric records. Globalization is not restricted to world trade; it also operates in the framework of societal change and the wider dissemination and implementation of libertarian views. If such "freedoms" are not currently available to patients, they soon will be. This brief historical foray in identifying some of these forces can assist in their early recognition so that as a profession, we are forewarned and forearmed and, in that respect, be ahead of both Henry Ford ("History is more or less bunk...") [42] and the Bourbons ("They learn nothing and they forget nothing") [43].
Bloch
Sidney
S
University of Melbourne, St. Vincent's Hospital, 46 Nicholson Street, Fitzroy, Vic 3065, Australia. s.bloch@medicine.unimelb.edu.au
Pargiter
Russell
R
D004992:Ethics, Medical / Q000266:history*; D049668:History, 15th Century; D049669:History, 16th Century; D049670:History, 17th Century; D049671:History, 18th Century; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D049690:History, Ancient; D049691:History, Medieval; D006801:Humans; D001523:Mental Disorders / Q000628:therapy; D008605:Mental Health Services / Q000941:ethics / Q000266:history; D011570:Psychiatry / Q000941:ethics* / Q000266:history*