Abstract
The Declarations of Hawaii and Madrid are the first international declarations on the ethical obligations of psychiatrists, specifically elaborated by and for psychiatrists. Thereby, they responded to ethical challenges provoked by profound societal changes in which the patient–physician-relationship and their acting is embedded. Their development over the last 30 years as well as their content will be described.
The medical profession has not only a formal, professional contract with society and the individual patient, but also a psychological, moral contract where the expectations of the doctor as representing the healing art, dedicated to the need of our suffering fellow human beings, is our overall goal and existential basis for our role. Our continuous striving to secure quality of care development, on the basis of human rights and medical ethics, is an implicit reflection of our dedication to this moral contract.
(Steenfeldt-Foss 2005)
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Notes
- 1.
In 1995 perhaps 15 national psychiatric associations had special codes for psychiatrists; e.g. American Psychiatric Association (1973).
- 2.
A major step was the publication of the Nuremberg Codex in 1947. It was developed for the Nuremberg trial against some of those national socialist physicians who participated in cruel medical experiments with prisoners of concentration camps and who were involved in killing patients with mental disorders. This codex was a major step since it made the principle of informed and voluntary consent for all participants of medical research mandatory, and because it brought this principle to public awareness by the worldwide publicity of the Nuremberg trial. It was a major step also insofar as prior instructions did not prevent these inhumane experiments not the least because they were almost unknown to the physicians in Germany: already in 1900 the Prussian Ministry of Culture instructed the directors of university hospitals that all research patients must consent voluntarily, and in 1931 the German Ministry of the Interior strengthened and differentiated this rule by a very clear decree.
The broad and intense progress of medical science after World War II brought hope also for severely ill people and provoked the demand for research to improve their treatment. With the development of consequentialistic ethics in therapy research it also became acceptable with patients who were incompetent to give informed consent under the condition that the research intervention is expected to benefit the participating patient and his/her consent was substituted by that of a legal guardian. This was codified for the first time by the World Medical Association in 1964 with the Helsinki Declaration, and later on also in national laws.
- 3.
See footnote 1.
Abbreviations
- DNA:
-
Desoxiribonucleid Acid
- DRG:
-
Diagnose-Related Groups
- ENMESH:
-
European Network for Mental Health Service Evaluation
- NGO:
-
Non-Governmental Organisation
- WHO:
-
World Health Organisation
- WMA:
-
World Medical Association
- WPA:
-
World Psychiatric Association
References
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Steenfeldt-Foss, O.W. (2010). Ethical Principles in Psychiatry: The Declarations of Hawaii and Madrid. In: Helmchen, H., Sartorius, N. (eds) Ethics in Psychiatry. International Library of Ethics, Law, and the New Medicine, vol 45. Springer, Dordrecht. https://doi.org/10.1007/978-90-481-8721-8_8
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