Conclusions

We have outlined three aspects of psychiatric ethics which have been relatively neglected by mainstream bioethics: the importance of codes especially in the international context, the ethical significance of diagnostic concepts, and the value of an integrated practice skills model of ethical reasoning.

We began by suggesting that these aspects of psychiatric ethics have been neglected because, in bioethics as in biomedicine, psychiatry has been treated as an addendum to mainstream medicine. But their importance has turned out to be a consequence of the greater depth and complexity of ethical problems in psychiatry. Moreover, these three aspects of psychiatric ethics, once recognized, are seen to be important not only in psychiatry but in medicine overall. The promotion of internationally recognized standards through accepted codes, the significance of patients' values in how their problems are understood as well as managed, and the full integration of ethical reasoning into clinical problem solving, are the desiderata of good practice in medicine generally. Far from being an addendum to bioethics, psychiatry thus offers a window on good practice in medicine as a whole.

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