Burns, Tom

BMC Psychiatry

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Burns Tom

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Paternalism in mental health: time for rehabilitation?

Tom Burns

Springer - Publisher Connector

BioMed Central
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BMC Psychiatry
Open AccessOral presentation
Paternalism in mental health: time for rehabilitation?
Tom Burns
Address: University of Oxford, Warneford Hospital, Oxford, OX3 7JZ, UK
Mental health legislation has received enormous atten-
tion internationally in the era of deinstitutionalization,
particularly as societies become more risk averse. The
response has been framed within a libertarian tradition
and the language is almost exclusively about autonomy
and partnership. Apart from risk, patient autonomy has
gone from being one of the principles in the discourse sur-
rounding mental health legislation to being the principle
one. Paternalism and beneficence are discarded as dis-
credited. Practice, however, is still recognisably paternalis-
tic in most developed countries. This disjunction between
the public language and common practice leads to some-
times tortured and unconvincing definitions (to permit
current practice) and unhelpful confusion in the public
mind about what psychiatry is. Contrary to the wide-
spread belief within mental health that everyone else has
abandoned paternalism there are cogent and respectable
critiques of autonomy as a dominant ethical principle.
These critiques encourage a less damning view of pater-
nalism seeking to place it alongside other ethical goals in
society. These challenges come from within economics,
the law, political philosophy and, perhaps most surpris-
ingly, from some feminist authors. These critiques will be
briefly outlined with the modest ambition of encouraging
debate in this area. While patient autonomy is important
it does not preclude the legitimate consideration of
restriction of liberty in a patient's best interests. A debate
which reflects more accurately what we do (rather than
think we ought to do) may be more helpful in informing
policy and legislation.
from WPA Thematic Conference. Coercive Treatment in Psychiatry: A Comprehensive Review
Dresden, Germany. 6–8 June 2007
Published: 19 December 2007
BMC Psychiatry 2007, 7(Suppl 1):S23 doi:10.1186/1471-244X-7-S1-S23
<supplement> <title> <p>World Psychiatric Association (WPA) Thematic Conference. Coercive Treatment in Psychiatry: A Comprehensive Review</p> </title> <editor>Thomas W Kallert, John Monahan, Juan E Mezzich</editor> <note>Meeting abstracts – A single PDF containing all abstracts in this Supplement is available <a href="http://www.biomedcentral.com/content/pdf/1471-244X-7-S1-full.pdf">here</a>.</note> <url>http://www.biomedcentral.com/content/pdf/1471-224X-7-S1-info.pdf</url> </supplement>
This abstract is available from: http://www.biomedcentral.com/1471-244X/7/S1/S23
© 2007 Burns; licensee BioMed Central Ltd. 


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