The Issue

Today ethical values in medicine and pharmacy can mean two different things: firstly, how they influence and ought to influence the individual patient-professional interaction and secondly, how they influence and ought to influence organizations in health care. Often authors concentrate upon the first of these meanings. However, we shall give consideration to both meanings in this chapter.

Further, we shall discuss not only explicit values but also those values that are implicit or hidden in what we shall call "perspectives" and "dimensions in evaluations". By this we mean frames of reference which include sets of concepts used in the analysis of the phenomenon under discussion. It seems to be characteristic both of medicine and of pharmacy to keep many of their values implicit and hidden.

Traditionally, in the language of health professionals, the assessments and decisions taken in clinical practice were regarded in neutral terms, as reflecting professional values which were not possible to transfer to explicit public values. However, some problems, e.g. how to prescribe and use psychotropics, have become public issues. When this has happened the values are often formulated in more explicit terms. This clarification of ethical values is normally not done in scientific articles. Rather, it is in popular books that the opposing views of this problem are published, and it is there that a number of professionals present their standpoints. The books by Kramer and Breggin which constitute part of the antidepressant debate (1-3) are recent examples which have made ethical values in this area of medicine much more clear (see the discussion which follows).

Thomas Kuhn suggested that only one perspective has a dominant position at any specific time in a profession (4). Every so often the efforts of a new generation of researchers result in that dominant perspective being forced aside to make way for its successor. However, what is now happening in the field of psychotropics is that Kuhn's proposition no longer holds sway. It seems that a number of perspectives can exist side by side at the same time in the field of psychotropics. No more is it the case that health professionals have one perspective and the general public another. Instead we find a spectrum of different perspectives within medicine as well as among the general public. Also, as will be described in this chapter, similar perspectives can be observed among health professionals and among lay people. Differences in the perspectives held can be found within each group as well as between the groups.

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