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3.5 Benzodiazepine tranquillisers, Prozac and the SSRIs

One of the most significant ranges of drugs ever produced is the benzodiazepine tranquillisers (usually classed as ‘minor tranquillisers’ or ‘hypnotics’), often prescribed as a remedy for ‘minor’ disorders such as depression, sleeplessness and anxiety. In effect, they extended the range of conditions that could be treated by medication. The best-known example is probably Valium.

3.3.1 A conflict of interest

One of the difficulties of the involvement of drug companies in the mental health field is that it produces a conflict of interest. To put it crudely, drug companies rely on a continuing supply of patients to keep them in business. This is not always congruent with people's best interests, as you will see below. Although mental health services are intended to help people experiencing mental distress, they also have other driving forces. The market economy model of provision has encouraged the
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2.1 Introduction

Western society is increasingly preoccupied with concerns about risk, so much so that some sociologists now define it as ‘risk society’ (Beck, 1992). It is argued that people in general are experiencing heightened levels of anxiety in response to rapid technological and social change. News stories in the media are filled with warnings and dire predictions for the future. This is particularly true when the potential consequences appear to be both catastrophic and difficult to predict, such
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1.2.1 Boundaries and terminology

In another context Shakespeare asked, ‘What's in a name?’, and suggested by way of an answer that a rose may smell as sweet whatever it is called. In the context of social boundaries, however, the language used is actually very important in determining ‘who's in’ and ‘who's out’.

Activity 1: L
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Acknowledgements

This unit is taken from Perspectives on Complementary and Alternative Medicine (Course Reader) which forms part of the core text for the Open University course K221 Perspectives on Complementary and Alternative Medicine, (eds Tom Heller, Geraldine Lee-Treweek, Jeanne Katz, Julie Stone and Sue Spurr) (The Open University) published by Routledge, Taylor and Francis in association with The Open University. Copyright © The Open University 2005.

Except for third party materia
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3.22 Extract 3 References

Beauchamp, T. and Childress, J. (1994) Principles of Biomedical Ethics (4th edition), Oxford, Oxford University Press.

Cant, S. and Sharma, U. (eds) (1996) Complementary and Alternative Medicines: Knowledge in Practice, London, Free Association Books Ltd.

Department of Health (2001) The Expert Patient: A New Approach to Chronic Disease Management for the 21 st Century, London, DoH.

Ernst, E. (1996) ‘The ethics of complementary medicine’, Journal o
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3.21 Conclusion

This extract has shown that CAM practice raises a variety of ethical issues. Although ethical considerations have different dimensions when applied to CAM, this extract demonstrated that ethical issues – such as consent, competence, boundaries and effective communication – remain central to good practice. CAM practitioners, like all other responsible health care workers, must be taught and encouraged to recognise the ethical dimensions of their work. All practitioners must be accountable
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3.20 Key ethical issues for CAM practitioners: an effective complaints mechanism

Effective relationships require strong communication skills. A good therapeutic relationship allows users the space and security to air their dissatisfaction without recourse to an external body. However, not all users enjoy such open relationships with their practitioners and may prefer to end the relationship than voice a complaint. This is why it is crucial for professional bodies to have accessible and user-centred complaints mechanisms in place. Complaints panels must include a significa
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3.19 Key ethical issues for CAM practitioners: professional etiquette and whistleblowing

In the past, professional bodies cautioned their members against disparaging other members of the same profession in front of a user. In the UK many codes of ethics still discuss professional etiquette from the perspective of safeguarding the interests of the practitioner rather than the user. Sensitivity is required when treating a user who is dissatisfied with a previous practitioner, but this should not prevent a practitioner being critical of someone else's obviously unacceptable treatmen
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3.18 Key ethical issues for CAM practitioners: maintain professional boundaries

All practitioners have a duty to create and maintain safe boundaries, irrespective of their therapeutic orientation, training or individual way of practising. The therapeutic relationship is based on trust and practitioners must never exploit users for their own ends. Practitioners should be aware that they may be working with users who have difficulty respecting boundaries, whether emotional, sexual or financial. Practitioners also need to be very clear about making their own boundaries expl
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3.17 Key ethical issues for CAM practitioners: respect confidentiality

During their professional practice, practitioners will be told a lot of personal information about their clients. This information is imparted in the context of a trusting relationship in which users trust that the information they have conveyed will be used only in their best interests and divulged only with their consent. The duty to respect users' confidentiality flows from the duty to respect their autonomy. People cannot make their own choices and control their lives if they cannot contr
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3.16 Key ethical issues for CAM practitioners: consent for children receiving CAM

Growing numbers of parents seek CAM for their children, as witnessed by the development of paediatric specialities in some CAM therapies, such as neonatal and paediatric osteopathy. A key ethical issue is that, in the UK, as in other jurisdictions, parents are entrusted to act as proxy decision makers for their children's health decisions until they can make their own choices. Parents are bound by law to make decisions in their children's best interests. Although most CAM therapies are relati
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3.15 Key ethical issues for CAM practitioners: respect for autonomy and consent

Many practitioners claim that the patient-centred nature of their therapy means they automatically respect the user's autonomy. On closer inspection, CAM practitioners’ commitment to respecting the users' wishes and values may be less patient-centred than they would like users to believe. Some CAM practitioners may fail to acknowledge users' rights, particularly in the area of risk disclosure and gaining consent to treat, or even touch, the user. Some CAM practitioners mistakenly believe th
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3.14 Key ethical issues for CAM practitioners: negotiation of contracts with users

To benefit users, the user and the practitioner must work towards common goals that have been explicitly discussed. It is especially important for the user to understand the limits of what the therapy can deliver and not be under any delusions about the likely extent of recovery. What should CAM practitioners tell users about the therapy and about themselves? Practitioners cannot assume that users know what their therapy entails. A useful starting point might be to give users an introduction
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3.10 Difficulties in applying conventional bioethics to the CAM relationship

Much of the literature in bioethics views the doctor/patient relationship as the paradigmatic example of a health care encounter. Various assumptions are made about the roles of ‘good’ doctors and ‘good’ patients, gender, dominant cultural values, patient expectations and a shared (western) understanding of health and disease. These assumptions may not be shared by many CAM practitioners or, indeed, CAM patients. Can
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3.9 Acting ethically: tools for analysis

Do the usual principles underpinning conventional health care ethics provide an adequate or acceptable framework for the discussion of ethics in the CAM relationship? Most bioethics teaching in medical schools in the UK and USA draws on the principles-based approach to considering ethical dilemmas. To recap, the four principles are:

  • respect for autonomy

  • the duty to benefit (beneficence)

  • the duty not to harm (non-malef
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3.4.5 What can be agreed about ethics?

Even though every person has an idea about what acting ethically means, when faced with an ethically contentious problem, or when it is not clear what will bring about the best outcome, ‘good’ people will act in diverse, and often opposing, ways, while maintaining they are ‘doing the right thing’. While ordinary individuals also have ethical responsibilities to one another (for example, to tell the truth), the duties owed by professionals to their users go beyond everyday ethical resp
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3.4.3 Respecting autonomy is the foremost ethical principle in health care

Some commentators believe the pendulum has swung so far in favour of respecting autonomy that it leaves little scope for users to be passive recipients of healing. The desire to make each user an active participant in their own healing process can make it hard, or even impossible, for a user to refuse to engage in active decision making, and leave the decision to the benevolent practitioner. In this case, the user may waive his or her rights, by choosing not to be kept informed about changes
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2.14 Extract 2 References

Armstrong, D. (1987) ‘Silence and truth in death and dying’, Social Science and Medicine, Vol. 24, No. 8, pp. 651–7.

Armstrong, D. (1993) ‘Public health spaces and the fabrication of identity’, Sociology, Vol. 27, No. 3, pp. 393–410.

Budd, S. and Sharma, U. (1994) The Healing Bond: The Patient-Practitioner Relationship and Therapeutic Responsibility, London, Routledge.

Busby, H. (1996) Alternative medicines/alternative knowledges: putting fle
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1.5.5 Social bookmarks

If you find you have a long unmanageable list of favourites/bookmarks you might like to try social bookmarks as an alternative.

Activity – what you need to know about social bookmarks

Read 7 things you should know about socia
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