Term Paper on "Ethics of Mental Health Care: Anorexia"

Quoted Instructions for "Ethics of Mental Health Care: Anorexia" Assignment:

Select one of the areas of investigation described below, and set out the ethical landscape for it, i.e. indicate what features of the subject should be relevant to morally sensitive decision. If you discover that there are legal complications to such a decision, note them as well. How would an ethical care-giver manage the difficulties you may notice in the area? Since this is a preliminary investigation, the emphasis will be on understanding the issues at hand rather than resolving them. However, since there has been some discussion about these matters in print, your discussion should reflect consideration of at least some of it. Your comments about resolution should take the form of suggestions for which you can give reasons. One important academic journal for the field is Philosophy, Psychiatry and Psychology. There is also an on-line Journal of Ethics in Mental Health, edited at McMaster University. Since you could become a greater expert in the area you choose than either the instructor or the marker, you should engage in careful exposition of your subject. Do not however, assume that the reader of your paper is completely uninformed about the area of discussion

A) Some psychoactive drugs are to be used as treatment for people judged to have mental disorders, and some of these disorders are said to affect decision-making capacity. How may one ethically test for effectiveness drugs thought to help those who have such disabilities, since many of these disorders are thought to affect the ability to make informed decisions, and the possibility of improved condition counts as a strong inducement to say yes?

B) Do people undergoing treatment for mental disorders have a right to *****effective treatment*****? If so, what would that right entail? Some have claimed that this supposed right should allow actions on behalf of mental health clients against caregivers who avoid pharmaceutical and other therapies that have shown some effect in controlled studies when those therapists have chosen modes of treatment not readily subjectible to such investigation. What do you think of this? Suppose, for example that a pharmaceutical treatment offers a near certainty of a limited remission of symptoms, but at the cost of serious side effects, while a less invasive (and less-resisted) treatment delivers some insight, and a limited chance of a fully adaptive way to manage symptoms.

C) One common therapeutic response to Dissociative Identity Disorder is to encourage the patient to resolve the multiple *****alters***** into a single dominant personality. Since the caregiver must attempt to steer this process, she or he must select one. On what basis should a good caregiver focus attention on one rather than others in cases where there are several possible candidates? One possible example to consider: a strong candidate with one gender-identification in a body that ordinarily takes on a different one.

D) Many anorexic patients will not eat, and will not do so even though they know that their action could kill them. Since there is insight on some level, and usually full competence to assess information, little indication of acute suicidal tendencies but a strong resistance to treatment, how can a caregiver respond responsibly?

E) A person indicates to her/his holders of the power of attorney for care, that if she/he becomes incompetent due to a geriatric dementia, no treatment beyond the palliative should be allowed for any potentially fatal disease. The reason given at the time cites loss of ability to carry on at anything like the level of self-awareness and planning that she/he considers essential to a worthwhile life. However, at some point after a dementia sets in, the person in question experiences a condition that will be fatal if not treated. She/he expresses no discontent with life as it has developed ( and perhaps takes great pleasure in much of her experience), She/he can understand that she/he is sick and requests treatment. How should the ethical caregiver respond? How should the good psychiatrist advise such a caregiver?

F) Psychopaths and those with anti-social personality disorder are often characterized as rational, but morally incompetent in some way or another. They can understand that nature of their disorder, and that they have it. A history of criminal convictions can play a role in the diagnosis of both of these conditions. Consider whether treatment (and even diagnosis) would amount to some form of sophisticated social control technique applied without regard to patient consent (considering that assessment, at least, could be the result of the decision of a medical or law-enforcement official). It would also not involve an adversarial *****fact-finding***** process, such as a trial. Would this be objectionable? Alternatively, consider whether there is a way that a good caregiver can intervene to produce a change in behaviour without manipulation.

G) Because of his condition, J. has trouble managing his own life: his rented room is a wreck, he has trouble communicating, and walks the street shouting instead. He sometimes forgets to eat, and cannot recall doctor*****s appointments, but resists all attempts to offer treatment, help or even provide a good meal. J. suspects, and rejects, any offer of help by screaming in fear at the offer or threatening the one who offers with violence. Past treatments have led to bad responses. The current possibilities for treatment are risky. How should a caregiver respond to J.?