Overview

"The relevant literature suggests that ethical codes regulating mental health care are 'more honoured in the breach than in the observation' (Pritchard, 2001) and that current codes of good practice may, paradoxically, be bad for this. Patient-centred medicine with its emphasis on user autonomy and participation in care plans has provoked harsher questioning of traditional deontological codes and renewed interest in those based on neo-Aristotelian virtue ethics and the ethic of care. However, much recent work has claimed the latter as ""essentially feminine"", whilst mental health practice itself is considered by feminists to be paternalistic in ideology and attitude. This work asks, therefore, which type of ethic is best suited to flourishing mental health practice and what are the gender considerations relevant to answering this question? Ethical practice can be understood only in the context of its interpretation by the relevant players. This, in turn, requires an investigative approach true to the precepts of the relatively new discipline of empirical ethics, which combines sociological grounded theory and fieldwork, informed by philosophical ethics. This is, therefore, the theoretical and methodological framework of this study. Analysis of the data collected suggests that claims of gender differences in approaches to caring cannot be substantiated. Mental health professionals of both sexes practice either caring or emotional labour, or both, or neither. Ethical codes are widely disregarded by both male and female carers, who claim to act upon intuition and 'common sense' in addressing ethical dilemmas. Most users believe codes of good practice to be generally respected by healthcare professionals, but describe poor communication, disempowerment, a lack of ""genuine"" caring and, above all, adverse discrimination. Whereas practitioners echo their views, they blame poor care on a lack of resources. Both consider adverse discrimination in both clinical and social settings to reduce all chance of flourishing in mental health care today. Values are inherent to the recurring theme of stigmatisation, and to ethics and codes of good practice. Their influence is all-pervading, yet until recently they have not been considered central to ethics education curricula. Although all codes of ethics, regardless of their orientation, are regularly reviewed, revised and extended, until practitioners and policy-makers become fully aware of the essential role of values in practice and make education in these an a priori condition to training in ethics, such codes, lacking a solid base of understanding, will continue to be bad for good practice and the flourishing which should result from this."

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9781070935225

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