Ethics and evidence in psychiatric practice.

Many psychiatrists have endorsed the idea of evidence-based psychiatry, the application of the principles of evidence-based medicine (EBM) to psychiatric practice. Proponents of an evidence-based approach to psychiatry hope that if practice is driven by "hard" scientific data, there will be greater potential to help patients. In other words, advocates of evidence-based psychiatry aim to bolster psychiatry's ethical standing through scientific evidence. Can EBM provide this ethical substantiation to psychiatry? This article provides an overview of some of the main ethical issues within psychiatry and examines three interrelated questions: (1) to which ethical values is EBM committed? (2) which ethical theory is reflected in these values? and (3) can these values and theories resolve existing ethical issues in psychiatry? EBM strives for the "greatest good for the greatest number," where good is defined as improved health. This utilitarian orientation cannot, however, address critical areas of moral importance for psychiatry, such as how its practitioners differentiate normal from abnormal, how they determine which forms of suffering should be alleviated through psychiatric means, and when involuntary intervention is ethically justified. The ethical principles implicit in EBM are too limited to serve as an ethical basis for psychiatry.