Bioethics is widely thought of as having a quasi-legal role in medicine, standing outside clinical practice, checking and curtailing the powers of doctors. An alternative model, developed for example in the medical school in Oxford, is that of ethical reasoning as a key practice skill. Practice skills are the skills required for the successful application of medical knowledge in day-to-day practice. The practice skills model combines ethics, law, and communication, as three disciplines essential to good practice skills, in a problem-solving approach to clinical training. (2Z>
In this section we outline three aspects of the contribution of ethical theory to clinical practice skills in psychiatry:
1. the importance of casuistic or case-based reasoning as an aspect of the 'know-how' of medical expertise;
2. the role of principles, standing midway in specificity between codes of practice and high-level ethical theories;
3. the significance particularly for psychiatric ethics of balancing different value perspectives not only in treatment but also in diagnosis.
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