Ethics in Psychiatric Care The Psychiatric Association of

Ethics in Psychiatric Care The Psychiatric Association of Thailand (PAT) March 31, 2549 ��������� ��. �. , �. �. (����� 31 ), B. A. , M. A. (Oxford), Th. M. (Harvard), Ph. D. (Hamburg) www. mettanando. com mettanando@hotmail. com

Fundamental Spiritual Questions Ø Who am I? Ø What is this world? Ø Is there the afterlife? Ø What is the meaning of my life? Ø Why this has to happen to me?

Modern Society vs. Traditional Society Tomorrow> Today> Yesterday Ø Progressive Ø Science = Ground for social Change Ø Everyone is equal to everybody else Ø Challenge old ideas Ø In favor to simplicity Ø Outcome > Process Ø Truth = Energy & Matter Ø Ø Ø Ø Ø Yesterday> Tomorrow Conservative Sacred text = ground for social change In favor of social hierarchy, status quo, male>female Respect of authority Respect of external appearance Process > Outcome Truth = Unseen Sacredness

Scientific View vs. Religious view Big Bang Theory Ø Origin of life= lower species Ø Mind = brain process Ø Ethics = social values Ø No afterlife Ø Goal of life = propagation of species Ø Suffering & happiness = coincidence Ø Genesis Ø Superiority of man over all animals and plants Ø Brain = house of mind Ø Ethics = Natural Law Ø Death is not the end Ø Goal of life = Eternity Ø Suffering & happiness= meaningful, nothing is a coincidence Ø

When “shit happens!” in World Religions Ø Confucius: Confucius says “Shit happens”! Ø Hindu: This shit happened before! Ø Buddhist: This shit is your karma! Ø Catholic: You deserve it! Ø Muslim: This shit comes from Allah! Ø Protestant: Why it did not happen to other people? Ø Jewish: Why shit always happens to US?

������ �� ������ (Traditional/Religious Ethics) ������ (Deontology) ������ (Utilitarianism)

ประโยชนนยม (Utilitarianism) ØJeremy Bentham, Introduction to the Principles of Morals and Legislation, published 1789. John Stuart Mill, (1806 -1873), ดหรอชวอยท ผลของการกระทำ ความดสงสดคอ ความสขของคนหมมากทสด

Marxism and Medicine K. Marx & F. Engel, interpretation of history, leading to socialist/communist evolution Ø Human beings = economic animals Ø Society is in perpetual struggle between two classes: the bourgeoisie vs. the proletariat Ø Marxism rejects all the normative ethics; but emphasizes social revolution of the proletariat. Ø Religion = Opiate Ø The Fall of the Berlin Wall in 1989 = end of the Cold War and Marxism was defeated. Ø But Capitalism has not yet won! Ø

Sigmund Freud Ø Founder/Father of Psycho Analysis Ø Religion is man made. There is no God. Ø Religion supports metal defense mechanism and allows human beings to work and over come inferiority complex and mental conflicts in life.

Principles of Medical Ethics Ø Autonomy: (Right of individuals) truth telling, respect to patient’s privacy, etc. Ø Risk/Benefit: (Estimation of risks vs. benefit), prognosis, cure or palliative , Ø Justice (Impartiality, Accountability, Social Concern, Environmental Concern (

Moral reasoning Ø วเคราะหปญหาดวยหลกการทางจรยธรรม : autonomy, risk/benefit, justice Ø เปาหมายในการวเคราะห คอ What is the Right thing to do in this situation? Ø Not: What is good?

4 Areas of Application Ø Personal Management Ø Interpersonal Management Ø Professional Management Ø Community Application

Personal Management Ø Life philosophy Ø Detection of Inner Conflict Ø Acknowledgement of Conflict Ø Management of Conflict Key: self realization related world view, proper attitude

Rules of Life Ø Rule #1: Life is beauty. Ø Rule #2: Whenever you think that life is otherwise than beauty, …… Ø Read Rule #1 again.

Interpersonal Management Ø Acknowledgement of Interpersonal Conflict Ø Management of Conflict Key: Skill in relationship

Rule of Human Relationship ØThe Golden Rule: ØDo unto others like what you want others to do unto you. Ø������� Ø�������

Principles of Professional Ethics ØDeontological Approach ØUtilitarian Approach ØTraditional Approach

Community Application ØCommunity Awareness ØFuture Concern ØCreative Participation ØProper strategic Approach

Community Care Ø Community protects families Ø Integration of medical care, education, spiritual care, communication programs Ø Shared leadership: doctors, nurses, social workers, educationists, lawyers, spiritual leaders Ø Inclusive management: life-long care for all Ø Semi-charity: co-op or foundation

Benefit Economical Ø Clear-cut division between primary & tertiary care (public health vs. medicine) Ø Stronger Community: volunteer recruitment and volunteer development programs Ø Better personnel recruitment: doctors, nurses, teachers, religious persons, etc. Ø Holistic approach to health - education – human resource development Ø

Psychiatric Patients Ø Psychiatric patient = Vulnerable patient Ø Principle of “respect to autonomy” cannot be directly applied Ø They are not isolated individuals, but more dependent on families and communities. Ø Protection of the welfare of the families and societies has to be constantly aware by the psychiatrist.

Respect to personal dignity Ø Psychiatric patients are often victimized by the society. Ø Rights (especially rights to legality) are taken away by society. Ø Their rights are dependent on the responsibility of their caregivers. Ø They are all humans and deserve respect and dignity of human beings.

Justice Ø Main principle of “ethics” for setting the balance between the rights of the patients and the members of the family and the society. Ø What “right (s)” is (are) taken away from the patient? Why? Ø What “burden (s)” is (are) imposed on the family/ society? Why ?

Buddhist Attitude of Care Ø Community = Caregiver Ø Psychiatrist & Nurse = Beautiful Friend (����� ) of the patient and the community Ø Middle Way of Care: not paternalism, not driven by commercial services

Q&A