Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
School of Psychology, University of Birmingham, Birmingham, UK.
J Med Ethics. 2023 Jun;49(6):423-427. doi: 10.1136/jme-2022-108442. Epub 2022 Aug 19.
Psychiatric involvement in patient morality is controversial. If psychiatrists are tasked with shaping patient morality, the coercive potential of psychiatry is increased, treatment may be unfairly administered on the basis of patients' moral beliefs rather than medical need, moral disputes could damage the therapeutic relationship and, in any case, we are often uncertain or conflicted about what is morally right. Yet, there is also a strong case for the view that psychiatry often works through improving patient morality and, therefore, should aim to do so. Our goal is to offer a practical and ethical path through this conflict. We argue that the default psychiatric approach to patient morality should be procedural, whereby patients are helped to express their own moral beliefs. Such a procedural approach avoids the brunt of objections to psychiatric involvement in patient morality. However, in a small subset of cases where patients' moral beliefs are sufficiently distorted or underdeveloped, we claim that psychiatrists should move to a substantive approach and shape the of those beliefs when they are relevant to psychiatric outcomes. The substantive approach is prone to the above objections but we argue it is nevertheless justified in this subset of cases.
精神科参与患者的道德观念存在争议。如果精神科医生的任务是塑造患者的道德观念，那么精神科的强制潜力将会增加，治疗可能会基于患者的道德信仰而不是医疗需求进行不公平的管理，道德争议可能会破坏治疗关系，而且，在任何情况下，我们对什么是道德上正确的往往不确定或存在冲突。然而，也有强有力的理由认为，精神病学通常通过改善患者的道德观念来发挥作用，因此，应该以此为目标。我们的目标是为解决这种冲突提供一条实用和合乎伦理的途径。我们认为，精神科医生对待患者道德观念的默认方法应该是程序性的，即帮助患者表达自己的道德信仰。这种程序性方法避免了精神科医生介入患者道德观念所引发的大部分反对意见。然而，在一小部分情况下，当患者的道德信仰严重扭曲或不发达时，我们主张精神科医生应该采取实质性的方法，在这些信仰与精神科治疗结果相关时，对其进行塑造。实质性方法容易引发上述反对意见，但我们认为，在这种情况下，这种方法仍然是合理的。
