Psychiatry, Law and Ethics

EDUCATIONAL PROGRAMS IN ETHICS IN PSYCHIATRY

A. Carmi

International Center for Health, Law and Ethics, Haifa, Israel

The student specializing in psychiatry during the course of his studies and the graduate psychiatrist during his clinical activities are both beset with more recurrent ethical problems than face any other health carer. Surveys of the educational syllabuses of the world’s medical schools indicate a woeful lack of instructors and teaching aids in ethics. The dearth of instructors is evidenced by the fact that courses in ethics, if they exist at all, are given to students by staff members who have no qualifications in ethics. As for the lack of teaching aids, it derives from the fact that current syllabuses are not updated to accord with modern scientific progress and are not structured methodically. A contribution to the teaching of ethics by the WPA and by its Standing Committee on Ethics and the Section on Psychiatry, Law and Ethics in particular, will undoubtedly be of tremendous importance to the world’s populations requiring treatment. The United Nations Educational, Scientific and Cultural Organization (UNESCO) became aware of the failure of ethical education at medical schools in most countries as a result of two surveys made at 150 medical schools of all the world’s continents in 1995 and 2001. The Organization rightly attributed this defect to the phenomenon of the deterioration of relationships between health carers and their patients. UNESCO, entrusted by the United Nations with responsibility for worldwide progress in education as well as science, decided that it must play its part in redressing the situation by providing for the efficient training of the teachers and for ethical teaching aids. These can be achieved by the compilation of a professional curriculum of studies in ethics, followed by national and international seminars at which personnel can be trained to teach ethics as methodized in the new curriculum.

ETHICS AND MENTAL HEALTH LEGISLATION

J. Arboleda-Florez

Department of Psychiatry, Queen’s University, Ontario, Canada

For the past several decades a wave of reform has been felt in many countries in regard to general health services and, most specifically mental health services. Many of these reform proposals or legislative changes have impacted or have the potential to impact negatively on the entitlements to access to health services. The negative impacts have many facets and range from lack of parity issues or constraints on access to diagnostic or therapeutic modalities to outright discrimination based on inability to pay for health services. Unfortunately, this last challenge to access affects mostly disenfranchised minorities. In mental health, the challenges go past the familiar stigmatizing and discriminating policies of long-term hospitalizations in institutions deprived of basic quality benchmarks and abuses to the dignity and civil rights of patients and onto issues brought about by deinstitutionalization including lack of jobs and discriminatory housing policies. This paper will review issues on mental health policies that perpetuate unethical and discriminatory practices against mental patients and their families.

MENTAL DISEASES IN THE JEWISH DIVORCE LAW

S. Wolfman

Faculty of Jewish Studies and Humanities, University of Tel Aviv, Israel

There are quite numerous references, already written about 2000 years ago in the Mishna and Talmud, to the mentally ill person, as one who is disconnected from reality and, therefore, is unable to take care of his own matters. Such a person, who is termed, in the Halacha literature, as Shote’, is defined in Chagiga as having bizarre manners, such as sleeping in cemeteries and tearing his clothes. Obviously, such person’s discretion is defected and accordingly, his legal competence, in matters where such discretion is a precondition to the validity of legal acts. The act of divorce in Jewish law, in particular the handover or servicing the Get, the divorce certificate, is preconditioned with absolutely free will of the Get server, the husband. After Rabenu Gershom’s ordinance, the wife’s consent as well is a precondition to the divorce. Consequently, it is difficult for the Rabbinical courts to validate divorce when one of the parties is dissociated from reality and cannot use the discretion needed for the free will of the husband, or the needed consent of the wife, to receive her Get. The question of the competence of the mentally ill patient to divorce has attracted a lot of debates during all centuries. The debates are rather in the area of divorce enforcement on the mentally ill husband while he is in remission from his psychotic state and is able both to understand the surrounding reality as well as to use discretion. The presentation will deal with the mental diseases in divorce law, as reflected in the responsa literature and in rabbinical courts ruling in Israel.