2. INTRODUCTION
• Ethics is an endeavor. It refers to ways of understanding what is good
and right in human experience. It is about discernment, knowledge and
self-reflection, and it is sustained through seeking, clarifying and
translating. It is the concrete expression of moral ideals in everyday life.
Ethics is about meaning, and it is about action.
3. ETHICS IN PSYCHIATRY
• In psychiatry, ethics is about the use of specialized expertise to prevent and
alleviate the suffering of mentally ill individuals. Ethics in this context is
unusually complex. This is partly due to the specific form of suffering that
defines mental illness: the distortion of cognition, feeling, perception and
behaviors and the erosion of relationships, societal role and sense of self.
Mental illness affects these most basic of human qualities and, accordingly,
psychiatrists enter their patients' lives in ways that are distinctly personal and
distinctly powerful. The goal of treatment in this context is to relieve suffering
through the transformation of the thoughts, experiences, behaviors and
relationships of ill individuals. Psychiatrists' therapeutic repertoire thus
encompasses skills that range from attentive listening to compassionate,
insistent intervention. For these reasons, the care of people with mental
illness raises extraordinarily difficult ethical questions about our
understanding of personhood and about the principled use of power in clinical
care.
4. CASE STUDY
• A 29 year old Turkish worker, who had come to Germany four years
before, stabbed his wife and wounded her severely. Her life was saved
only because he rushed her to the hospital for emergency surgery.
• In court both claimed that they had a quarrel before the stabbing in
their car. She accused him of adultery and told him that she was going
to make love to his best friend and that his friend would do a better job
than the husband. Her concluding words were: “I will be fucked by a
better lover and I hope those who fucked you did a good job too”.
• The defendant remembered that he stabbed once, although the victim
was wounded twice, and he had a blurred memory which could be a
sign of profound disturbances of consciousness, a reason to mitigate
punishment according to German law. The couple had meanwhile been
reconciled and wanted to continue their marriage.
5. CONTINUE…
• After the psychiatric examination, which did not reveal any
disturbances, the defendant wanted to talk to the psychiatrist under the
privilege of confidentiality, which was denied. At that moment the
defendant started to tremble, cry, and sweat and almost collapsed.
• He then claimed that he had been the victim of sexual abuse in Turkey
and had seen a doctor at that time but had not told him about his
victimization. The only persons who knew about it were his brother who
had prevented the defendant from shooting his molester, and now the
psychiatrist. If anyone in the Turkish community were to learn about it,
he would lose all self respect; and his wife would leave him because he
could not be master of his own house.
• This opinion was supported by an expert on oriental culture. The
defendant preferred a harsher sentence over the disclosure of his
secret to the court.
• Question: Was the psychiaytrist experienced to advise the court
about the story of the patient in this case ?
