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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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3.1 Introduction

In this extract you consider mental health as a business. This is not the way mental health services are usually regarded, as it is more common, at least in the UK, to regard them as public services. However, ideas about being more businesslike in health and social care have gained prominence in recent years. What does being a business, or more businesslike, mean? For one thing, it implies a profit motive: goods or services delivered to make money for private companies and their shareholders.
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1.2.3 Boundaries of ‘normality’

The origin of the ‘other’ in society is the widespread human tendency to create categories where people who don't fit in can be placed away from the mainstream. Social categories may lead to prejudice and discrimination, but may also lead to the physical separation of people to the margins of that society. Sibley (1995) traces the physical marginalisation of people in what he calls the ‘geographies of exclusion’. Part of the process of exclusion is where the ‘bad’, the ‘mad’ a
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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’.

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1.1 Introduction

This extract looks at what we are calling ‘boundaries of explanation’. It tackles key issues such as:

  • What are mental health and distress – and who decides?

  • What are the views of people who have acquired a label of ‘mental illness’?

  • What are the views of those who determine – and patrol – the boundary between mental distress and ‘normality’?

The extract looks at language and terminology an
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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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3.13 Key ethical issues for CAM practitioners: research

Every therapy needs to have a sound theory underpinning it. Without it, a therapy cannot grow and mature. Research may extend and improve the knowledge base for a given therapy but not all practitioners are willing or able to participate in useful, well designed research. The issues are related to the ethical principles of benefiting (beneficence) and not harming (non-maleficence). Without evidence to support the claims that are being made, how can practitioners be sure that they are doing go
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3.12 Key ethical issues for CAM practitioners: competence

Practitioners must have a sufficient level of competence to benefit users. The proliferation of training bodies, and the diversity of qualifications available, make it harder to know what represents an appropriate standard of pre-registration training or continuing professional development (CPD). Bringing a therapy under a single regulatory body makes it easier to set national educational standards in which diversity can be maintained, but a basic level of competence to practise is ensured. A
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3.11 Key ethical issues for CAM practitioners

Although CAM practitioners’ duties may vary in nature from other health professionals’ duties, the types of ethical concern remain broadly similar. The rest of this extract considers the key ethical areas underpinning standards of best practice in CAM. Although CAM practice varies dramatically in scope, all the issues listed in Author(s): The Open University

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-maleficenc
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3.6 Ethical practice and accountability: the role and function of professional bodies

The UK's medical profession is regulated by the General Medical Council (GMC). One of the main ways in which the GMC, and other regulatory bodies, influences its members is through its code of ethics. This sets out broad principles, rather than detailed guidance, for how practitioners should behave in specific circumstances. This is necessary because a practitioner retains individual accountability and ultimate responsibility for decisions taken during professional practice. Not all br
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2.12.2 Litigation

The level of litigation against CAM therapists is currently very low, particularly compared with corresponding actions being brought against doctors and other health care professionals. This, in turn, is reflected by the low annual indemnity insurance paid by most CAM practitioners. CAM therapists tend to attribute this to CAM's safety profile compared with orthodox medicine, together with CAM practitioners’ ability to forge better therapeutic relationships with users. However, other commen
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2.11 The failure of CAM therapeutic relationships: complaints

The issue of complaints is uncomfortable for any health practitioner. CAM practitioners may be particularly reluctant to accept that their actions may give rise to complaints. Since many therapists do not perceive their therapy to be intrinsically harmful, they are unlikely to make provision for when it goes wrong. Moreover, the comparative absence of litigation against CAM practitioners may give a false sense of security, whereby therapists do not consider themselves above the law but see th
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2.10 The failure of CAM therapeutic relationships: sexual abuse and exploitation

Another issue that can cause a therapeutic relationship to break down is the failure to maintain appropriate personal or professional boundaries, to the extent that it constitutes serious abuse. A broad spectrum of activities can be called abuse. The term ‘abuse’ originates from the Latin meaning ‘a departure from the purpose (use)’ (Rutter, 1990, p. 41). Given this meaning, clearly some of the boundary issues mentioned above are on the fringes of the category of abuse within CAM. Muc
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2.3 Changing notions of the therapeutic relationship and responsibility

The shift in practitioner-patient relationships in the last 30 years was described earlier in this book. In addition, Budd and Sharma note that in industrialised societies the nature of the majority of illnesses presented to doctors has changed from acute to chronic and, along with this, the nature of the healing relationship has also changed (1994, p. 11). For many long-term conditions, orthodox treatment can provide only short-term gains. Instead, the key issue is the management of symptoms
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1.1 Introduction

Since the Second World War, health has come to signify much more than an absence of physical disease for many people in western societies. Interest in health now includes concerns about food, the strength of social networks and the quality of the environment. The stresses of modern living are recognised as a serious health issue. Personal choices are positively or negatively charged, depending on whether they are ‘good for you’ or ‘bad for you’. Most newspapers and magazines publish n
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Acknowledgements

The content acknowledged below is Proprietary (see terms and conditions). This content is made available under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 Licence.

Couse image: B
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References

Baker, C. (ed.) (1998) Human Rights Act 1998: A Practitioner's Guide, London, Sweet and Maxwell.
Bashir, A. (1999) ‘Working in racist Britain’, Community Care, 21–27 October, p. 26.
Biehal, N., Clayden, J., Stein, M. and Wade, J. (1992) Prepared for Living? A Survey of Young People Leaving the Care of Three Local Authorities, London, National Childre
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