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Ethics and Morality

Ethical Principles in Mental Health Care

Primum non nocere: above all, do no harm!

Key points

  • Autonomy, non-maleficence, beneficence, and justice are ethical principles that guide mental health care.
  • Having an intentional process of ethical deliberation is essential.
  • Clinicians need to act in the best interests of the people, families, and communities they serve.

Ethical principles are especially pertinent to the conduct of professionals in psychology and psychiatry. The hard work comes when principles are in conflict, and clinicians must consider what values, biases, and obligations matter most.

In the field of biomedical ethics, Tom Beauchamp and James Childress have had a seminal role in articulating fundamental ethical principles that guide professional conduct in a vast range of related specializations such as medicine, psychology, social work, and other health or social care services. Their book, Principles of Biomedical Ethics, has served as a practical guide for the development of many codes of ethics prepared by professional associations and regulatory bodies that oversee psychotherapy in various parts of the world.

These four principles stand out:

  • Autonomy: A person’s right to act as a free agent and the need to respect the rights of others to make free choices (respect for the client’s autonomy, dignity, and right to self-determination).
  • Non-maleficence: “Above all, do no harm” (Latin: primum non nocere), i.e., not engaging in intentional physical or emotional harm or in actions with a high risk of harm.
  • Beneficence: Engage in actions that benefit others and promote the welfare of the person who is suffering (including the prevention and the mitigation of harm). This means directing treatment in a way that promotes the best interests of the person you are working with; be careful not to project your perception of what is ‘best’ onto others.
  • Justice: Treat people in similar circumstances similarly, and acknowledge when a person's circumstances differ and may require additional support. Justice means upholding the dignity and honoring the rights of all people. Practicing equity, inclusion, and attempting to address systematic inequalities are central components of justice.

Other Ethical Principles to Consider:

  • Trust: All relationships are built upon the foundation of trust. Being truthful, loyal, honest, and honouring one's commitments can create better outcomes for the individuals and communities we hope to support.
  • Care: Always consider the unique interpersonal factors at play in a situation and act from a place of care, kindness, and responsibility—mental health providers should be attuned to others' needs.
  • Transparency: sharing information and creating accessibility to knowledge in an honest, clear, and straightforward way at a level the person or family can understand is important.
  • Societal interest: Upholding personal responsibility to always act in the best interests of society.

This list of principles is not exhaustive, and many other ethical principles may be applicable to the context of different situations. However, the application of principles can sometimes come into conflict when making decisions, which is where the process of ethical deliberation truly begins.

Photo by Tingey Injury Law Firm on Unsplash
Photo by Tingey Injury Law Firm on Unsplash

Ethical Deliberation

If, after an evaluation of existing laws and guidelines, there is still no clear decision, further deliberation is required to explore values, personal biases, goals, and intentions to inform how we should make decisions.

A deliberative ethical process requires us to understand the perspectives of the appropriate stakeholders and consider relevant values. Some values may feel right, but may not apply to the context of the situation. Once this information has been gathered, there are likely a couple of reasonable options on the table.

To decide what option is the “best,” clinicians can deeply reflect on each available pathway forward. Practically, this may look like analyzing which action aligns best with the relevant values and principles previously identified. Some clinicians attempt to develop rational arguments for each ethical position in a given situation and attempt to choose the most logically defensible position.

It is imperative for mental health care providers to also listen to their intuition and "gut feelings"—these will often elicit emotions that help us identify when an ethical conflict is being experienced. In learning to listen to your gut feelings or identifying an "ick factor," clinicians can create an intentional space to reflect on the context of the situation and unpack why such feelings are arising. This intuitive response can allow clinicians to practice critical reflectivity, identify how values may be at play or in conflict in client scenarios, and how different decisions within treatment may have risks or benefits that warrant substantial considerations.

A suffering person’s well-being demands that mental health care providers act not on their own emotions, but rather deliberately focus on the best interests of the individuals, families, or communities they serve. This also means that professionals need to consider the interpersonal and cultural contexts in which people find themselves. After all, none of us exist in a social, cultural, or political vacuum.

There are many processes of reflection and ethical frameworks that can help mental health professionals act with integrity, intentionality, and logic. Such reflection takes time and energy, but it is a choice clinicians get to make to ensure that our professions are held to the highest standard and that persons who are suffering receive the best care possible.

Daniel Wyzynski / Used with permission
Source: Daniel Wyzynski / Used with permission

This article was co-authored with Daniel Wyzynski, a clinical and organizational ethicist in the Office of Health Ethics at London Health Sciences Centre. He is also an adjunct research professor at Western University. Daniel specializes in bioethics, ethical deliberation, adolescent mental health, patient-centered and family-centered care within clinical healthcare contexts.

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