Offenders and Alleged Offenders with Mental Disorder in Non-Medical Settings

CodEs and prinCiplEs Ethics is a branch of philosophy. It is the study of how moral ideas develop, how they interact, how they relate to other aspects of human learning and how they may be applied in practice. Medical ethics should be a systematic study of how moral principles can be applied to the practice of medicine. This chapter reflects the bias of this book and focuses on medical ethics, but many of the issues considered have relevance for other professions as well. Medicine is a highly value laden subject. The very definitions of disease and the attending on sick people are based on moral assumptions. These moral assumptions have changed with time, and will change further in the future, keeping within the broader ethical framework of the society in which they are placed, and they have to be tested within the peer group of other doctors. Morality so pervades psychiatry that every chapter in a psychiatric textbook will embrace moral issues either implicitly or explicitly. Questions about the suitability of retaining and treating people with mental disorder in prison are, for example, in large part moral ones. Scientific information about the efficacy of treatment in prison will influence the argument, but such scientific knowledge is unlikely ever to override completely the moral debate. This chapter on ethics is a chapter more for raising questions than for providing answers. Discourse on ethics frequently starts with the Greeks and the Hippocratic Oath (see appendix 4), or with Hammurabi and the Babylonians. Musto (1991) takes the reader from Greece and Rome to the religions of the middle ages, up to the French Revolution, and into nineteenthcentury Britain. This is appropriate as the modern medical profession did not really begin until the nineteenth century in spite of its apparently long history. In 1803, Thomas Percival published his famous Medical Ethics. It is even now of interest and resonant with some modern values, but it also illustrates our point that ethics are related to time and culture and some elements are subject to change. Percival says, for example: