23 Ethics Related to Mental Illnesses and Addictions
23 Ethics Related to Mental Illnesses and Addictions
Introduction
Overview
The general public learns about mental illnesses and addictions primarily from mainstream media, including news reports, television programs, and movies. The stories presented usually center on sensationalism or danger, such as those about young women at life-threatening stages of anorexia nervosa or people labeled as “psychopaths.” Or the stories appeal to our feelings of sympathy or empathy, such as those about people with untreated mental illnesses sleeping on subway vents during winter or a person with moderate dementia who finds greater companionship with someone other than their spouse. These reports and programs often oversimplify the ethical nature of these situations by dramatically pitting one value against another: self-determination versus life, public safety versus rehabilitation, quality of life versus non-abandonment, and happiness versus loyalty. Distilling situations down to one or two values can be motivated more by the ongoing competition for the public’s attention and/or economics than by the demands of concise reporting.
However, mental illnesses and addictions are complex, as those who live with a mental health or addiction problem and their families can attest. The high incidence of mental health and addiction problems and their disruptive and lasting impact on people’s lives, families’ sustainability, communities’ well-being, and employers’ productivity are publicly acknowledged more often now. In recent years, more and more governments (civic, provincial/state, national) and employers have become interested in listening to those with first-hand experience of these conditions and to those who have developed holistic, integrative ways to diagnose and offer treatments and supports earlier and longer.
Ethical complexity is not limited to crises and strong emotions. It exists in everyday, seemingly routine questions, experiences, and situations. The cases in section 1.2, below, help illustrate the wide diversity of ethically complex, “real world” situations that those living with a mental health or addiction problem, their families and friends, professional healthcare workers, and their managers commonly face. Accordingly, the selected cases involve a variety of participants, interests, contexts, histories, health problems, options, and values. The healthcare ethics literature—which is quite extensive now—and educational workshops and courses encourage their readers and participants to increase their understanding of a particular situation or question and they offer various theories, concepts, and approaches to help make ethically defensible decisions. This chapter has similar objectives: first, to broaden and deepen readers’ understanding of ethically relevant aspects in living with a mental health or addiction concern; second, to increase the understanding of ethically relevant aspects in offering, managing, and accessing healthcare services; and thir