Ethical framework in clinical psychiatry

Bloch & Green (2006) provide an excellent overview of the ethical issues that are encountered in clinical psychiatry and the different available frameworks for understanding and resolving them. What is striking, however, is that this discourse is almost entirely without reference to God or religion.

Such pragmatic atheism is, of course, not at all unusual these days. It is a reflection of the impact of the Enlightenment upon our understanding of the way in which public discourse on such matters should be conducted. Indeed, there are even avowedly religious writers (such as Bishop Richard Holloway) who consider that it is unhelpful to bring God into such debates (Holloway, 2000). However, it is still remarkable that an entire article of this kind fails even to mention the matter.

It is remarkable, for example, that the important historical influence of Judaeo-Christian ethical thinking upon the culture in which we live is apparently entirely ignored. It is equally remarkable that the religious pluralism of contemporary Western culture is not addressed.

The omission is remarkable also because religious belief and belonging to a faith community have such important influences upon the ethical thinking of both those who suffer from mental disorders and those who care for them. To imagine that ethical conversation can be had while entirely ignoring such influences makes it feel as though atheism is being imposed upon the debate. The omission is also remarkable because of the validity of at least some of the arguments of Richard Holloway and others with respect to the dangers of bringing God into the conversation. When we feel that we have God ‘on our side’, human beings can become very intransigent, ungenerous or even unreasoning. The need to understand how and why this is the case is therefore very important.

The omission is also remarkable, however, because it avoids discussion of the possibility of a point of reference for both rule-based and character-based ethics which might actually transcend that of the human parties involved. Again, I recognise that there are those who will deny that such a point of reference exists - but surely the discussion about whether or not it exists, its potential impact and the plurality of views about its existence is rather important.