Psychiatry shares most ethical issues with other branches of medicine, but also faces special challenges. The Code of Ethics of the World Psychiatric Association offers guidance, but many mental health care professionals are unaware of it and the principles it supports. Furthermore, following codes of ethics is not always sufficient to address ethical dilemmas arising from possible clashes among their principles, and from continuing changes in knowledge, culture, attitudes, and socio-economic context. In this paper, we identify topics that pose difficult ethical challenges in contemporary psychiatry; that may have a significant impact on clinical practice, education and research activities; and that may require revision of the profession's codes of ethics. These include: the relationships between human rights and mental health care, research and training; human rights and mental health legislation; digital psychiatry; early intervention in psychiatry; end-of-life decisions by people with mental health conditions; conflicts of interests in clinical practice, training and research; and the role of people with lived experience and family/informal supporters in shaping the agenda of mental health care, policy, research and training. For each topic, we highlight the ethical concerns, suggest strategies to address them, call attention to the risks that these strategies entail, and highlight the gaps to be narrowed by further research. We conclude that, in order to effectively address current ethical challenges in psychiatry, we need to rethink policies, services, training, attitudes, research methods and codes of ethics, with the concurrent input of a range of stakeholders, open minded discussions, new models of care, and an adequate organizational capacity to roll-out the implementation across routine clinical care contexts, training and research.

中文翻译：

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当代精神病学的伦理挑战：对可能的策略和研究需求的概述和评估


精神病学与其他医学分支有很多共同的伦理问题，但也面临着特殊的挑战。世界精神病学协会的道德准则提供了指导，但许多精神卫生保健专业人员并不了解它及其支持的原则。此外，遵循道德准则并不总是足以解决由于其原则之间可能发生的冲突以及知识、文化、态度和社会经济背景的持续变化而产生的道德困境。在本文中，我们确定了当代精神病学中构成困难的伦理挑战的主题；可能对临床实践、教育和研究活动产生重大影响；这可能需要修订职业道德准则。其中包括： 人权与精神卫生保健、研究和培训之间的关系；人权和精神健康立法；数字精神病学；精神病学的早期干预；有精神健康问题的人做出的临终决定；临床实践、培训和研究中的利益冲突；以及具有生活经验的人和家庭/非正式支持者在制定精神卫生保健、政策、研究和培训议程方面的作用。对于每个主题，我们都会强调道德问题，提出解决这些问题的策略，提请人们注意这些策略带来的风险，并强调需要通过进一步研究缩小的差距。 我们的结论是，为了有效应对当前精神病学的伦理挑战，我们需要重新思考政策、服务、培训、态度、研究方法和道德准则，同时听取一系列利益相关者的意见、开放的讨论、新的模式的护理，以及足够的组织能力来在常规临床护理环境、培训和研究中推广实施。