Modern psychiatric ethics

Psychiatry did little better in the 20th century, in which the profession in Nazi Germany embraced mass sterilisation programmes and euthanasia with such eugenic fervour that the institutional populace was almost annihilated by the early war years. 3 It is easy (and perhaps convenient) to forget that eugenic policies, including selective sterilisation, were widespread in many countries, most notably in Scandinavia and the USA. 4 Collective guilt and disgust in the wake of the Nazi holocaust created a determination to codify guidance on ethical practices in the medical profession, culminating in the 1964 Declaration of Helsinki. 5 Despite this atmosphere of liberal individualism in the west, the Soviet Union exempted itself from such considerations, and the psychiatric profession famously abused its position for political reasons. 6 Such was the outrage of the medical community that the World Psychiatric Association expelled the Soviet psychiatrists and created the first uniquely psychiatric code of ethics in its 1977 Declaration of Hawaii. 2 Subsequent codes and resolutions have flourished in an atmosphere of openness in medicine, with adherence to professional ethics as the foundation of the modern day doctor–patient relationship. Back to the future The 21st century confronts psychiatry with a timehonoured challenge; the pursuit of the historic ethical principles of autonomy, beneficence, non-maleficence, and justice in the face of limited resources, stigma, ignorance, prejudice, and discrimination. Psychiatrists have a duty to remain vigilant and to review continuously routine practices and treatments to ensure compatibility with these ethical principles. Moreover, in the UK in particular, we face the additional challenge of an imminent revision of the 1983 Mental Health Act 7