Common sense ethics and psychiatry

Prey Alling ethical principles forbid enforced medical treatment in recognition of the individual’s right to choose whether to accept treatment or to remain untreated. Prevailing medical practice, especially in psychiatry, at times includes the imposition of medical treatment. Can prevailing medical practice be reconciled with prevailing ethical principles? The case is similar to that of medical prevarication: Can the physician’s telling of lies from benevolent motives ever be reconciled with the prevailing ethical principle of unconditional truthfulness? Can enforced treatment be justified at least as a substitute for legal punishment, since some people view it as a lesser evil? These are burning ethical questions on today’s agenda. They have been vociferously pressed, and rightly so, especially since the view of mental illness as a deliberately chosen way of life is gaining legitimization. In the last 25 years many writers have registered forceful complaints against psychiatric practices, and particularly against enforced treatment. There are various versions of this complaint, but most of them attack psychiatry on the basis of what I call classical individualistic ethics. Not without justice, Thomas S. Szasz is viewed as the leader of this trend. A classical individualistic ethic views the individual as autonomous, hence as the agent exclusively responsible for his own actions. Such an ethic must regard the recommendation to treat the mentally ill forcibly as utterly unacceptable since forcible treatment violates the assumption that they are fully and unconditionally autonomous. The aim of this essay is to show the futility of debates about the morality of enforced treatment in psychiatry because all participants accept the framework of the classical individualistic ethic. This framework has the all-too-convenient property of endorsing, in the name of common sense, contradictory solutions for ethicoclinical psychiatric problems. A fruitful debate will emerge only when the framework is challenged and transcended without falling into the traps of collectivist ethics or moral pragmatism which preclude the very problem at hand. Solomon Maimon, the 18th-century critic of the Kantian version of classical individualistic ethics, had already challenged and transcended that framework. Maimon’s modified form of individualistic ethics deserves to be reintroduced, especially when, in the name of the classical framework, Szasz has for the past 20 years been calling for a total revolution in our world view.