Is evidence-based psychiatry ethical?

by Mona Gupta

Overview

Rated as one of the top 15 breakthroughs in medicine over the last 150 years, evidence-based medicine (EBM) has become highly influential in medicine. Put simply, EBM promotes a seemingly irrefutable, principle: that decision-making in medical practice should be based, as much as possible, on the most up-to-date research findings. EBM has been particularly popular within psychiatry, a field that is haunted by a legacy of controversial interventions. For advocates, anchoring psychiatric practice in research data makes psychiatry more scientific valid and ethically legitimate. Few, however, have questioned whether EBM, a concept pioneered by those working in other areas of medicine, can be applied to psychiatric disorders.

In this groundbreaking book, the Canadian psychiatrist and ethicist Mona Gupta analyzes the basic assumptions of EBM, and critically examines their applicability to psychiatry. By highlighting the basic ethical tensions between psychiatry and EBM, the author addresses the fundamental and controversial question - should psychiatrists practice evidence-based medicine at all?

Product Details

ISBN-13:	9780199641116
Publisher:	Oxford University Press
Publication date:	08/12/2014
Series:	International Perspectives in Philosophy and Psychiatry
Pages:	214
Product dimensions:	5.90(w) x 9.10(h) x 0.60(d)

About the Author

Mona Gupta, Psychiatrist and researcher in bioethics, University of Montreal, Canada

Mona Gupta is a psychiatrist and researcher in bioethics at the Universite de Montreal in Montreal, Canada. She received her medical degree from McGill University and then completed her postgraduate training at the University of Toronto where she also received her PhD in bioethics. Dr Gupta has published and presented widely on the subject of ethics and evidence-based medicine in psychiatry.

Table of Contents

1. What does evidence have to do with ethics? 2. What is Evidence-based medicine? 3. Ethical values and evidence-based medicine: the debate4. Psychiatry and evidence-based psychiatry5. The critique of evidence-based psychiatry6. The Ethics of EBM7. EBM Experts talk about ethics, evidence-based medicine, and psychiatry8. Is evidence-based psychiatric practice, ethical practice? 9. ConclusionsAppendix

Editorial Reviews

Reviewer: Michael Schrift, DO (University of Washington School of Medicine)
Description: This is an illuminating and interesting book on the applicability of evidence-based medicine (EBM) to psychiatry, a discipline with imprecise and unstable diagnostic criteria that are not based on any known pathophysiology and with outcomes that are not defined by remission of illness but by fractional reductions in the number and severity of itemized symptoms measured by rating scale scores. If there is a question of the scientific applicability EBM to psychiatry, then is the use of EBM in psychiatry ethical? Written and edited by a scholar in the field, this excellent book is a welcome addition to the psychiatric literature.
Purpose: The book aims to answer the question, "Is evidenced-based psychiatric practice ethical?" The author attempts to demonstrate that EBM ignores aspects of the doctor-patient relationship since this is difficult to quantify and thereby distorts aspects of treatment. The author's goal is to "examine evidence-based psychiatry using the perspective and methods of bioethics, in the hope that this will deepen the understanding of the issues psychiatrists face in trying to practice EBM."
Audience: The intended audience is psychiatrists and psychologists as well as medical ethicists and philosophers.
Features: The first chapter is an introduction to the contentious issues that will be addressed in the following chapters. Chapter 2 defines the terms used in EBM and chapter 3 summarizes the debate regarding EBM's basic concepts and practice. The applicability of EBM to psychiatry is addressed in chapter 4, while chapter 5 is a review of the assumptions underpinning EBM. The ethical values embedded in EBM are explored in chapter 6. Important themes about ethics and EBM are addressed in chapter 7. Chapter 8 returns to the main theme of the book: Is evidence-based psychiatric practice ethical? The final chapter focuses on future directions and the author's conclusions and opinions about the problems of EBM in psychiatry. Each chapter ends with relevant and timely citations of the pertinent literature.
Assessment: This is an excellent and scholarly book that addresses an important issue for the future of psychiatry. I highly recommend it to any practicing psychiatrist.

Doody's Review Service

"This is an excellent and scholarly book that addresses an important issue for the future of psychiatry. I highly recommend it to any practicing psychiatrist." — Doody's Health Sciences Review

"[It] does an excellent job of exploring these issues, clarifying the arguments pro and con, and encouraging further discussion, debate, and scholarship in this area." — PsycCRITIQUES

"Throughout this text, Gupta methodically works through complicated and detailed information about ethics, psychiatry, medicine, and evidence-based practice. The book is a goldmine of information about these issues as they pertain to psychiatry and ethics. For people working in psychiatry who have not been exposed to these arguments, the book is a comprehensive introduction to the assumptions, biases, ideological influences, and moral divides within the discipline." —Perspectives on Science and Christian Faith

From the Publisher