The Principles Of Bioethics and Their Application to the Treatment of Mentally-Ill Patients

Eli Watson 13th January 2025

Ever since the Greek physician Hippocrates codified an oath for doctors in the 4th century BC, the topic of Bioethics has been part of the medical field. Although the concerns have always existed in one form or another, in recent years they have become more mainstream and resulted in the modern field of Bioethics. This resulted in a code being created for medical providers and policymakers alike, The Principles Of Bioethics. These principles can be applied to all manners of medical practice, but are they still applicable to patients with mental illness? Mentally ill patients present a unique challenge because mental health has not been a large part of any discussion until of late and some feel that the principles are not applicable to the treatment of said patients. Although on rare occasions they will not be pertinent, the four principles of bioethics are sufficient for the vast majority of cases because they are broad enough to be applied to various situations.

The principle of autonomy is sufficient for the treatment of the mentally ill, as it allows for varying degrees of autonomy, depending on their mental capabilities. Autonomy is encompassed by the idea of informed consent, which states that the patient has the right to make informed choices about their own care. But how does this apply to patients with mental illness? This is when the principles of autonomy and beneficence work together. Well, if it is for the patient’s benefit for them to not make decisions about their care, whether it be because of a limited mental capacity or other factors, including their mental illness, then their autonomy should be reduced. If they can make logical decisions, then they should keep their autonomy. As it turns out, more people with mental illness fall in the second category than the first. A study conducted by the Center for Mental Health Services Research University of Massachusetts Medical School found that “most people with mental illness perform about the same as the rest of the population” (Lidz 2). In this case the question of the study was to see if patients with mental illness can make informed, rational decisions about their treatment. The study’s findings said that yes, most can. In this instance the principals were sufficient as they gave the opportunity for most patients to keep their autonomy, as it was better for them to do so. While for the minority, they allowed for the autonomy to be reduced as that was of the best interest for them. On the other hand, if the patient is not in a state to make decisions about their care, then their autonomy is limited, such as in the case of some Jehovah’s Witnesses that refused a blood transfusion for their dying child. “The physician had a .. duty to respect the autonomy of the patient, [and a] duty to avoid harm and provide.. benefit” (McCormic 3) In this particular case the principles of autonomy and beneficence came into play to help the patient. Though some autonomy was sacrificed, the principles allow for this flexibility. Granted, in some cases these principles don’t work as smoothly as they should, or so it would seem. This is such as in the case of Debbie and Hayley Spruell, wherein the mother cannot “force Hayley to take his medication… or make any decisions about his care… he is a legal adult” (Hassan 3). However, this instance is a problem with the laws of Texas and not the principals themselves, and there are options under Texas law that Mrs. Spruell can take, such as legal guardianship, although these are not easy or convenient.. A lawyer was quoted saying “[she] has a problem … typical to Texas law”(Hasan 3). This case is not the fault of the principals, rather the fulfillment of them into written law, and therefore this does not detract from the principles of bioethics.

The principle of justice is sufficient for the treatment of mentally ill patients as it ensures everyone is dealt with fairly and considers the mental illness as a factor in the case of crimes and treatment. Justice in itself is not a simple thing, as it can often be misinterpreted to be based on equality rather than fairness. Equality in the case of medical treatment is inherently unjust as different people need different levels and types of treatment and care, and total equality would not provide this. So one part of the principle of justice is fair treatment and care, “Justice is … usually defined as… fairness or as Aristotle said, ‘giving to each that which is his due‘" (McCormic 5). This is an example of the first part of Justice, and it is sufficient as it allows for enough flexibility to provide treatment that is fair and beneficial specific to each mentally ill person and their needs. But the other part is justice in the context of the law, and prosecutions. Say for instance a person with mental illness commits a crime. Are they prosecuted like the average person, or is their illness taken into account? What if it can be proved that their illness was the cause of the crime? What if they only committed the crime because they had not been taking their medicine? Such is the second part of the principle of justice. Historically we have had issues with the execution of the latter funcion, with many different proposed solutions such as the ultimately ineffective Community Mental Health Centers Act signed by President John F. Kennedy in 1963. In the end, “The ultimate solution is keeping psychotic people whose criminal infractions are a product of their sickness out of jails in the first place” (Satel 2). In this case justice ensures that in dealing with mentally ill criminals their mental illness is considered in the course of law, and if their illness caused them to be in a wrong state of mind then justly sentence them and provide treatment. The principle of justice is sufficient in respect to the second part of justice, as it is broad enough to allow for the flexibility to consider factors like mental illness in sentencing, and allows judges to provide instruction for treatment or rehab during incarceration, for example. Admittedly, the principle is probably the one least implemented into actual law. This is not the fault of the principle, just the implementation. As explained by Thomas McCormic, “The demands.. Justice must apply at the bedside of patients but also systematically in the laws and policy… [of] healthcare. Much work remains to be done.”(McCormic 6). The basis and guidelines of this principle are solid, but time will tell how well it is incorporated into law.

In conclusion, the principles of bioethics are sufficient in the treatment of mentally ill patients as it allows for enough flexibility to be applied to the vast majority of cases, and ends up being effective in its role through the relationship between autonomy and beneficence as well as both parts of justice, fair treatment and just incarceration of mentally ill convicts. While the principles behind it all are solid, the field of Bioethics as we know it is still young and many things have not yet been made law. This decreases the reach of the principles but not their effectiveness. One shortcoming of this examination is that I did not address the final principle, the principle of nonmaleficence. This is because this principle is incorporated with the foundation of the medical world, causing as little harm to patients as possible. After all, that is the purpose of it all.

Works Cited

Thomas, McCormick. “Principles of Bioethics”. University of Washington Department of Bioethics and Humans, 2018, https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/articles/principles-bioethics Accessed 15 January 2025.

Charles, Lidz, Ph.D. “Can People with Mental Illness Consent to Research?” Center for Mental Health Services Research University of Massachusetts Medical School, January 2006, https://www.umassmed.edu/globalassets/center-for-mental-health-services-research/documents/products-publications/issue-briefs/human-rights/can-people-with-mental-illness-consent-to-research_.pdf Accessed 15 January 2025.

Syeda, Hasan. “A Mother Struggles to Care for Her Adult Son with Schizophrenia” Kera News, December 19, 2019, https://www.keranews.org/health-science-tech/2019-12-19/a-mother-struggles-to-care-for-her-adult-son-with-schizophrenia Accessed 15 January 2025.

Sally, Satel. “Out of the Asylum, Into the Cell” The New York Times, Nov. 1, 2003, https://www.nytimes.com/2003/11/01/opinion/out-of-the-asylum-into-the-cell.html Accessed 15 January 2025.