Friday, 14 December 2007

Psychiatric virtue ethics

I’ve spent the day reviewing a manuscript for a book on psychiatric ethics written by Jennifer Radden (editor of The Philosophy of Psychiatry: A Companion) and John Sadler (co-editor of PPP and author of Values and Psychiatric Diagnosis).

The manuscript is for a book with OUP and is, as I would expect, very well written. The basic thesis is that ethical obligations on psychiatrists stem both from their status as professionals with client relations and also from their specifically medical role. Doctors have obligations to their patients. But, and this is what gives the book half of its purpose, psychiatry – over and above medicine in general – imposes yet further obligations on its practitioners. These, the book argues, are best articulated as a set of virtues that are called for by the roles psychiatrists adopt, and it is this that provides the second purpose of the book. Articulating ethics through virtues contrasts with the dominance within medical ethics of utilitarianism, Kantian deontology and the popular hotch potch: the Four Principles approach.

There is, however, a fairly standard objection to virtue ethics. Whilst utilitarianism (at least in those forms in which utility is not itself characterised in ethical terms; so when it is taken to be, eg, expected happiness) and Kantian deontology (with its uber categorical imperative and derived principles) promise specific guidance for ethical judgement, virtue ethics seem not to. The problem is that to determine what to do, one needs to determine what a virtuous agent would do. But there is no independent account of what the demands of virtue are from outside a perspective that has already earned the right to characterise itself in virtuous terms. (I should say that I don't think that this is a real worry. The idea that we can and should in general step outside our practices to justify them as from cosmic exile is a mistake, though a tempting one.)

Radden and Sadler footnote this worry but I think that they take their book to be engaged in a different project to that of defending the approach from first principles. Instead they spend 15,000 words of a central chapter setting out what they think the virtues are, in response to the challenges of psychiatry. That seems fine. What seems odder is, relatedly, that they do not attempt very firmly to demonstrate the advantages of virtue ethics over other approaches. They suggest, eg, that it complements rules-based approaches. (They do suggest that because good psychiatric practice requires affective responses from psychiatrists which cannot be governed by rules but can indirectly be inculcated, virtue ethics may be a better fit. But this point does not seem to carry much weight and I think it could not.)

The real weakness of an ecumenical approach, however, is that lacks an explanation of moral seriousness. It sounds instead as though one can add together a variety of different methods for framing ethical judgements just as one pleases and without a clear sense of what would make any such judgement right or wrong. What is it that disciplines a moral judgement?

That said, I'm very impressed with the book because its aims and purposes seem clear from the start and are carried out thoroughly.