by James M. DuBois; New York, Oxford University Press, 2007, 256 pages, $39.95
Dr. Lidz is a research professor of psychiatry at the University of Massachusetts Medical School, Worcester.
Although psychiatry is a subdiscipline of medicine and mental health issues are widely regarded as medical ones, many ethical issues in research and clinical care are best treated as specific to mental health. For example, it is relatively rare for medical patients to be brought for treatment by the police. Familial pressures for treatment are less prominent in general medicine than in psychiatry. Moreover, the ability to make rational decisions is relatively rarely an issue for general medical patients. Thus the need for a serious look at research ethical issues in psychiatry is long overdue. Although much of the literature that the book refers to is drawn from general medical ethics, many examples and case discussions are drawn from psychiatric settings.
James DuBois, professor and chair of medical ethics at Saint Louis University, is a widely respected commentator on research ethics with extensive experience in training professionals to deal with the complex issues involved. His substantial understanding of the issues in mental health has contributed to an important introduction for those who are new to issues in medical ethics and who are focused on research issues in mental health.
This clear and well-written volume is a comprehensive look at these issues. Beginning with a review of the basic principles in medical ethics as applied to research, it also covers informed consent, capacity to consent, surrogate decision making, risk and benefit assessment, confidentiality, research design, justice issues in recruitment, and conflicts of interest. Another virtue of this book, especially to the novice reader, is that the author does not preach. He recognizes that there are many legitimate points of view within the wide boundaries of ethically acceptable behavior.
If there is a general criticism of Ethics in Mental Health Research, it is that the intended audience is not quite clear. Although the author says that it is intended either to be a supplement to a training course or to be read by itself, it seems too detailed to serve as a supplement. A reader who is familiar with the broad literature in medical ethics may find that a great deal of the volume is not new. On the other hand, a reader who has no familiarity with these issues will fail to appreciate some of DuBois's important innovations, such as the addition of the principle of relationality to the more familiar principles of autonomy, beneficence, and justice. The author seems to want the book to be both an elementary teaching tool and an addition to the academic literature. If one is genuinely interested in the ethics of mental health research, however, there is nothing to compete with this volume as an introduction to the issues.