In this paper it is argued that bioethics has tended to emphasise: ‘high tech’ areas of medicine at the expense of ‘low tech’ areas such as psychiatry; problems arising in treatment at the expense of those associated with diagnosis; questions of fact at the expense of questions of value; and applied ethics at the expense of philosophical theory. The common factor linking these four ‘bioethical blind spots’ is a failute to recognise the full extent to which medicine is an ethical as well as scientific discipline. Once this is acknowledged it leads to a full-field bioethics in which the different areas are mutually complementary. In particular, it paves the way for a fruitful two-way exchange between the more abstract aspects of philosophical theory and the contingencies of day-to-day clinical work. The arguments of the paper are illustrated with recent work on the abuse of psychiatry.
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Hope, T. and Fulford, K. W. M. (1993). Medical education: patients, principles and practice skills. In,Principles of Health Care Ethics, ed. by R. Gillon. John Wiley and Sons, Chichester.
Merskey, H. (1991). ‘Ethical aspects of physical manipulation of the brain’.Psychiatric Ethics, 2nd edn, ed. by S. Bloch and P. Chodoff, pp. 185–214. Oxford University Press, Oxford.
Beauchamp, T. L. and Childress, J. F. (1989).Principles of Biomedical Ethics. Oxford University Press, Oxford.
Bloch, S. and Chodoff, P. (1991).Psychiatric Ethics, 2nd edn. Oxford University Press Oxford.
Kopelman, L. M. (1989). Moral problem in psychiatry. In,Medical Ethics, ed. by R. Veatch. Jones and Bartlett Publishing, Massachusetts.
Hope, R. A. (1990). Ethical philosophy as applied to psychiatry.Current Opinion in Psychiatry,3, 673–676.
Anzia, D. J. and La Puma, J. (1991). An annotated bibliography of psychiatric medical ethics.Academic Psychiatry 15, 1–7.
Campbell, A. V. and Higgs, R. (1982). InThat Case: Medical Ethics in Everyday Practice London, Darton, Longman and Todd.
Boorse, C. (1975). On the distinction between disease and illness.Philosophy and Public Affairs 5, 49–68.
Boorse, C. (1976). What a theory of mental health should be.Journal of Theory Social Behaviour 6, 61–84.
Fulford, K. W. M. (1989).Moral Theory and Medical Practice. Cambridge University Press, Cambridge.
Agich, G. J. (1983). Disease and value: a rejection of the value-neutrality thesis.Theoretical Medicine 4, 27–41.
Engelhardt, H. T. Jr. (1975). The concepts of health and disease. In,Evaluation and Explanation in the Biological Sciences, ed. by H. T. Engelhardt Jr and S. F. Spicker, D. Reidel, Dordrecht.
Gillon, R. (1986).Philosophical Medical Ethics. John Wiley and Sons, Chichester.
Hesse, M. (1980).Revolutions and Reconstructions in the Philosophy of Science. The Harvester Press, Brighton.
American Psychiatric Association (1980).Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. American Psychiatric Association, Washington, DC.
Frances, A., First, M. B., Widiger, T. A., Miele, G. M., Tilly, S. H., Davis, W. W. and Pincus, H. A. (1991). An A-Z guide to DSM-IV conundrums.Journal of Abnormal Psychology 100 (3), 407–412.
Clare, A. (1979). The disease concept in psychiatry. In,Essentials of Postgraduate Psychiatry, ed. by P. Hill, R. Murray and A. Thorley. Academic Press, Grune & Stratton, New York.
Kendell, R. E. (1975). The concept of disease and its implications for psychiatry.British Journal of Psychiatry 127, 305–315.
Roth, M. and Kroll, J. (1986).The Reality of Mental Illness. Cambridge University Press, Cambridge.
Szasz, T. S. (1960). The myth of mental illness.American Psychologist 15, 113–118.
Duff, A. (1983). Mental disorder and criminal responsibility: In,Philosophy and the Criminal Law ed. by A. Duff and N. Simmonds. F. S. Verlag, Stuttgart.
Moore, M. S. (1984).Law and Psychiatry: Rethinking the Relationship. Cambridge University Press, Cambridge.
Fulford, K. W. M. (1993). Value, action, mental illness and the law. In:Criminal Law: Action, Value and Structure, ed. by K. Gardner, J. Horden and S. Shute. Oxford University Press, Oxford.
Williams, B. (1985).Ethics and the Limits of Philosophy. Fontana, London.
Seedhouse, D. (1991).Liberating Medicine. John Wiley and Sons, Chichester.
Hare, R. M. (1963). Descriptivism.Proceedings of the British Academy 49, 115–134. Reprinted in Hare R. M. (1972).Essays on the Moral Concepts. Macmillan, London.
Urmson, J. O. (1950). On grading.Mind 59, 145–169.
Fulford, K. W. M. (1993). Closet logics: hidden conceptual elements in the DSM and ICD classifications of mental disorders. In,Philosophical Perspectives on Psychiatric Classification, ed. by J. S. Sadler, M. Schwartz and O. Wiggins. Johns Hopkins University, Baltimore.
Warnock, G. J. (1967).Contemporary Moral Philosophy, Macmillan, London.
Toulmin, S. (1980). Agent and patient in psychiatry.International Journal of Law and Psychiatry 3, 267–278.
Nordenfelt, L. (1987).On the Nature of Health: An Action-theoretical Approach. D Reidel, Dordrecht.
Fulford, K. W. M. (1993). Thought insertion and insight: disease and illness paradigms of psychotic disorder. In,Phenomenology, Language and Schizophrenia, ed. by M. Spitzer. Springer-Verlag, Berlin.
Seedhouse, D. (1986).Health: The Foundations for Achievement. John Wiley and Sons, Chichester.
Gluzman, S. (1989).On Soviet Totalitarian Psychiatry. International Association on the Political Use of Psychiatry, Amsterdam.
Bloch, S. (1981). The political misuse of psychiatry in the Soviet Union.Psychiatric Ethics, 2nd edn, ed. by S. Bloch and P. Chodoff. Oxford University Press, Oxford.
Wing, J. K. (1978).Reasoning about Madness. Oxford University Press, Oxford.
Merskey, H. and Shafron, B. (1986). Political hazards in the diagnosis of sluggish schizophrenia.British Journal of Psychiatry 148, 247–256.
Fulford, K. W. M., Smirnoff, A. Y. U. and Snow, E. (1993). Concepts of disease and the abuse of psychiatry in the USSR.British Journal of Psychiatry 162, 801–810.
Fulford, K. W. M. (1990). Philosophy and medicine: the Oxford connection.British Journal of Psychiatry 157, 111–115.
Austin, J. L. (1956–7). A plea for excuses.Proceedings of the Aristotelian Society 57, 1–30. Reprinted in White A. R. (ed) (1968).The Philosophy of Action. Oxford University Press, Oxford.
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Fulford, K.W.M. Bioethical blind spots: Four flaws in the field of view of traditional bioethics. Health Care Anal 1, 155–162 (1993). https://doi.org/10.1007/BF02197110
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