Ethical Considerations at the Intersection of Psychiatry and Religion
John Peteet, M.D., Associate Professor of Psychiatry, Harvard Medical School
Mary Lynn Dell, MD, Nationwide Children's Hospital
Alan Fung, MD, The University of Toronto
Psychiatry and religion/spirituality share a concern for human flourishing, individual beliefs and values, and social context. Yet tensions between science and religion, and especially between psychiatry and the behavioral sciences and religion, have historically hindered constructive dialogue, creating uncertainty about how to approach ethical questions emerging at the interface between them. Many questions arise: What is the clinician’s role in treating patients with unhealthy forms of religion? How should a therapist approach a patient’s existential, moral, or spiritual distress? What are the ethical implications of taking into account a patient’s religious beliefs as they bear on decisions about treatment, parenting, or end of life care?
Psychiatric ethics have traditionally focused on the implications of generally accepted principles and professional virtues, including respect for the patient’s culture and values. Both the Resource Document on Psychiatrists’ Religious and Spiritual Commitments published by the American Psychiatric Association (APA) and the Position Statement on Religion and Spirituality published by the World Psychiatric Association (WPA) emphasize the need to understand the place of religion/spirituality as a source of these values. Conversely, religious ethics often emphasize caring for the ill and impaired. However, few resources have been available for understanding the ways in which religion/spirituality informs the relevant values of patients and their clinicians, how clinicians should address conflicting values, or what principles should guide the interaction between clinicians’ own professional and personal commitments. Discussions within the APA’s Caucus on Spirituality, Religion, and Psychiatry of this conceptual and practical lack led to the recent publication by Oxford University Press of Ethical Considerations at the Intersection of Psychiatry and Religion, co-edited by the presenters in this panel.
Our aim is to help clinicians and religious professionals working in mental health settings think more clearly about these issues and offer pragmatic guidance for approaching challenging cases. The presentations in this panel highlight the approach of the book to three particular areas of concern. Others available for consideration in the discussion include ethical issues arising in inpatient, outpatient, consultation/liaison, community, forensic, child and adolescent psychiatry and in the work or religious professionals and hospital ethics committees.
The first speaker begins by considering the role of professional ethics in psychiatry from an international perspective, and the stances of various professional psychiatric associations. These are illustrated by the case example of terrorism, including suicide and religious terrorism. His presentation also discusses ethical considerations regarding the intersection between religion/spirituality and traditional beliefs & cultures, which are illustrated by the example of ethics and healing in ancient China and India. The importance of a global ethic and various international attempts at its development are reviewed, and clinical vignettes used to illustrate ethical challenges in an international context. The presentation concludes with a discussion of the challenges in developing a global ethic in relation to psychiatry and spirituality/religion.
The second speaker addresses ethical issues surrounding the spirituality of intellectually disabled people, with particular focus on dilemmas that arise in their mental health care. Both principlism and ethics of care can inform decision-making regarding those with disabilities, which inevitably involve family members and other caretakers in important ways. Suggestions for both mental health providers and religious communities follow.
The third speaker considers ethical issues as they arise for consultation-liaison (C/L) psychiatrists, who work at the interface between psychiatry and other medical specialties. C/L psychiatrists frequently receive consultation requests reflecting tensions among the values of the clinical team, the patient, and the patient’s family, but little attention has been devoted to the religious and spiritual dimensions of these challenges. This presentation will use brief clinical case examples to review the relevance of religion/spirituality for ethical conflicts in several domains of consultation-liaison psychiatry: (1) the appropriate scope of the consulting psychiatrist’s role in diagnosis and treatment; (2) religious/spiritual aspects of capacity and candidacy evaluations; (3) patient and family values that conflict with those of the medical care team; and (4) a psychiatrist’s own values that conflict with the patient’s or society’s values. The presentation concludes by discussing in more depth a case involving several of these themes, analyzing it according to the Jonsen Four Quadrants Model.
Mary Lynn Dell, MD, Nationwide Children's Hospital
Alan Fung, MD, The University of Toronto
Psychiatry and religion/spirituality share a concern for human flourishing, individual beliefs and values, and social context. Yet tensions between science and religion, and especially between psychiatry and the behavioral sciences and religion, have historically hindered constructive dialogue, creating uncertainty about how to approach ethical questions emerging at the interface between them. Many questions arise: What is the clinician’s role in treating patients with unhealthy forms of religion? How should a therapist approach a patient’s existential, moral, or spiritual distress? What are the ethical implications of taking into account a patient’s religious beliefs as they bear on decisions about treatment, parenting, or end of life care?
Psychiatric ethics have traditionally focused on the implications of generally accepted principles and professional virtues, including respect for the patient’s culture and values. Both the Resource Document on Psychiatrists’ Religious and Spiritual Commitments published by the American Psychiatric Association (APA) and the Position Statement on Religion and Spirituality published by the World Psychiatric Association (WPA) emphasize the need to understand the place of religion/spirituality as a source of these values. Conversely, religious ethics often emphasize caring for the ill and impaired. However, few resources have been available for understanding the ways in which religion/spirituality informs the relevant values of patients and their clinicians, how clinicians should address conflicting values, or what principles should guide the interaction between clinicians’ own professional and personal commitments. Discussions within the APA’s Caucus on Spirituality, Religion, and Psychiatry of this conceptual and practical lack led to the recent publication by Oxford University Press of Ethical Considerations at the Intersection of Psychiatry and Religion, co-edited by the presenters in this panel.
Our aim is to help clinicians and religious professionals working in mental health settings think more clearly about these issues and offer pragmatic guidance for approaching challenging cases. The presentations in this panel highlight the approach of the book to three particular areas of concern. Others available for consideration in the discussion include ethical issues arising in inpatient, outpatient, consultation/liaison, community, forensic, child and adolescent psychiatry and in the work or religious professionals and hospital ethics committees.
The first speaker begins by considering the role of professional ethics in psychiatry from an international perspective, and the stances of various professional psychiatric associations. These are illustrated by the case example of terrorism, including suicide and religious terrorism. His presentation also discusses ethical considerations regarding the intersection between religion/spirituality and traditional beliefs & cultures, which are illustrated by the example of ethics and healing in ancient China and India. The importance of a global ethic and various international attempts at its development are reviewed, and clinical vignettes used to illustrate ethical challenges in an international context. The presentation concludes with a discussion of the challenges in developing a global ethic in relation to psychiatry and spirituality/religion.
The second speaker addresses ethical issues surrounding the spirituality of intellectually disabled people, with particular focus on dilemmas that arise in their mental health care. Both principlism and ethics of care can inform decision-making regarding those with disabilities, which inevitably involve family members and other caretakers in important ways. Suggestions for both mental health providers and religious communities follow.
The third speaker considers ethical issues as they arise for consultation-liaison (C/L) psychiatrists, who work at the interface between psychiatry and other medical specialties. C/L psychiatrists frequently receive consultation requests reflecting tensions among the values of the clinical team, the patient, and the patient’s family, but little attention has been devoted to the religious and spiritual dimensions of these challenges. This presentation will use brief clinical case examples to review the relevance of religion/spirituality for ethical conflicts in several domains of consultation-liaison psychiatry: (1) the appropriate scope of the consulting psychiatrist’s role in diagnosis and treatment; (2) religious/spiritual aspects of capacity and candidacy evaluations; (3) patient and family values that conflict with those of the medical care team; and (4) a psychiatrist’s own values that conflict with the patient’s or society’s values. The presentation concludes by discussing in more depth a case involving several of these themes, analyzing it according to the Jonsen Four Quadrants Model.