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| | The Psychiatric Profession and its Human Rights Aspects | | 2005-2-25 23:54:02 2005 Beijing WPA-CSP Workshop Marianne Kastrup,M.D |  I would like to thank WPA ,its President professor Ahmed Okasha and the Chinese Psychiatric Association for inviting me to lecture in this very significant symposium.
A brief overview of what I intend to touch upon:
First of all to set the topic in a global setting
A presentation of selected ethical codes with particular reference to human rights
The WPA Ethical and Review Committee
The role of human rights in psychiatry
Preventive measures if future involvement of health professionals in the violation of human rights should be avoided, and
Future recommendations.
We have in recent years witnessed an upsurge in the attention paid to the ethical aspects of the psychiatric profession. Today, the psychiatric profession is guided by a number of rules and declarations. Some are common to all medical professionals, others reflect the specific role of the psychiatric profession.
Why is it so important to focus on ethical codes in psychiatry?
First of all we deal with a discipline where confinement and acting against patients will may take place, then we experience attacks by "anti-psychiatric" movements, we may have difficulty in obtaining informed consent from our patients and then we are faced with the danger of political abuse.
The potential risk of the psychiatric profession to be part of political abuse has been an area of great concern for the profession, including the World Psychiatric Association.
To avoid psychiatric abuse, it is decisive that psychiatric diagnoses should be determined according to internationally accepted standards, and difficulty in adapting to moral, social or political values in it self should not be considered a mental illness. Any opportunistic application of a psychiatric diagnosis should be clearly avoided, and it should be recognized that the presence of mental illness may be used to de-humanize or exclude certain group of persons.
Abuse may comprise among other things falsely certifying that somebody requires psychiatric hospitalization, administering psychiatric drugs to persons in the absence of medical indication or placing political prisoners directly in psychiatric institutions.
The World Psychiatric Association has set up a Committee on Ethics that has the responsibility to identify and explore areas of ethical concern to psychiatry.
Further the World Psychiatric Association has set up a Committee to Review the Abuse of Psychiatry. This committee shall review individual complaints regarding possible abuse of psychiatry and give recommendations to the Executive Committee of the World Psychiatric Association as to possible actions to be taken. From primarily reviewing individual complaints and allegations regarding abuse of psychiatry, the Committee now takes a more proactive form as it may express a concern regarding countries/regions where the intentions of the Madrid Declaration are not respected, e.g. lacking access to mental health care, or disrespect for psychiatric patients.
If we turn to the psychiatric profession, we have - as I see it - a moral obligation as professionals to work for a more equal access to mental health services for all in need hereof. As professionals we further have to ensure that all have a possibility to have their basic needs satisfied. In psychiatry this is rather a rarity in particular when we consider it on a global level.
I find that withholding mental health care to those in need hereof should be considered as a serious breach of ethical rules.
We have an obligation as psychiatrists to participate in the public debate and recognize that there are certain diagnostic groups that have no lobby to support them.
Another important aspect is the recognition that certain groups of doctors run a particular risk of being involved in human rights violations. Such doctors that are generally referred to as "doctors at risk" will usually be employed by other than medical authorities.
From a preventive point of view we have to adhere to internationally accepted classification systems, we have to develop internationally agreed upon complaints procedures, collaborate interdisciplinary, develop international and national boards of control and finally to establish consumer influence in psychiatry.
Having outlined certain areas of concern, further steps to be taken include how to prevent human right violations involving health professionals to continue to take place.
A preventive strategy may be developed at an international level, at state/governmental level, at civic society level or developed within an organizational framework, e.g. WPA.
Psychiatrists should be aware of their obligation to participate in the public debate, and any doctor being aware of conditions affecting health that are indefensible should express concern via public means. We have to disseminate scientific based knowledge on medical involvement in violations and the consequences hereof. Further the dissemination of this knowledge and educational material is essential and an area where WPA plays a decisive role.
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Ministry of Health, (2003) No.013
ICP:No.040657