In contemporary medical ethics health is rarely acknowledged to be an ethical obligation. This oversight is due to the preoccupation of most bioethicists with a rationalist, contract model for ethics in which moral obligation is limited to truth-telling and promise-keeping. Such an ethics is poorly suited to medicine because it fails to appreciate that medicine's basis as a moral enterprise is oriented towards health values. A naturalistic model for medical ethics is proposed which builds upon biological and medical values. This perspective clarifies ethical obligations to ourselves and to others for life and health. It provides a normative framework for the doctor-patient relationship within which to formulate medical advice and by which to evaluate patient choice.The authors believe that too little attention has been paid to the proposition that individuals have an ethical obligation for their health, and to how best to characterize the nature and moral force of this obligation. While Samuel Gorovitz and others argue against a primary obligation to oneself for health, Sider and Clements defend the view that such an obligation is a fundamental constituent of human morality. They claim that health is a responsibility owed to oneself and to others, particularly family members, and one that determines the nature of the physician patient relationship. Acknowledging that their position runs counter to most of contemporary medical ethics and its preoccupation with patients' rights, truth telling, and contracts, the authors argue that health is a basic human good, and that maintaining health is a moral duty.
Psychiatrists usually select therapeutic modalities for their patients on the basis of empirical and theoretical considerations. Only in special circumstances (e.g., psychosurgery) are ethical concerns primary. Yet every therapeutic decision involves questions of value and requires ethical justification. The author outlines four resources for ethical direction in therapy: a general systems or biopsychosocial formulation of the clinical problem, the historic ethical commitments of the medical profession, the patient's informed perspective, and the psychiatrist's own values. Finally, a method is proposed for the resolution of conflicts among these four perspectives in individual cases.
In late middle age, many patients consult physicians with nonspecific complaints involving a decline in mental functioning. Distinguishing between psychologic and organic causes of mental impairment, particularly between depression and dementia, is essential.
