In recent years so-called Complementary and Alternative Medicine practices have made significant political and professional advances particularly in the United Kingdom : osteopathy and chiropractic were granted statutory self-regulation in the 1990s effectively giving them more professional autonomy and independence than health care professions supplementary to medicine ; the practice of acupuncture is widespread within the National Health Service for pain control; and homoeopathy is offered to patients by a few General Practitioners alongside conventional treatments. These developments have had a (...) number of consequences: one is that both CAM and Conventional and Orthodox Medical professions have had to reappraise their professional identity. In manual therapy for example, questions have been asked about the differences between physiotherapy, osteopathy and chiropractic, and what the justification is for having separate professions. A wider question concerns the relationship between CAM and COM; are CAM distinct professions or should they, as has happened to a limited extent in the UK, be absorbed into the broader field of ‘ Medicine ’ or ‘Health Care’ as adjunctive therapies. CAM professions have also had to develop, implement and enforce codes of practice for practitioners and clarify the scope of practice within a profession. At the heart of these issues lies the need to identify and clarify professional values. A key claim of CAM professions is that their practice is distinct and the outcome of treatment at least as effective and in many cases more effective than with conventional therapies. In addition, what counts as effective outcome is often different from conventional medical understanding, involving more subtle humanitarian considerations, for example. Three values are identified as being commonly held across CAM professions. These are: offering ‘natural’ treatment; being patient rather than disease focussed; and being holistic. However, these may not be as distinctive of CAM as is claimed either because the meaning is unclear or because COM professions claim similar values. The paper argues that the values that inform ‘good practice’ and ‘effective outcome’ should be seen as distinct components of professional competence. This has implications for establishing professional identity and codes of practice. (shrink)

BackgroundAlthough values have increasingly received attention in psychiatric literature over the last three decades, their role has been only partially acknowledged in psychiatric classification endeavors. The review process of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders received harsh criticism, and was even considered secretive by some authors. Also, it lacked an official discussion of values at play. In this perspective paper we briefly discuss the interplay of some values in the scientific and non-scientific debate around (...) one of the most debated DSM-5 category proposals, the Attenuated Psychosis Syndrome. Then, we point out some ethical consequences of a facts-plus-values perspective in psychiatric classification.DiscussionDifferent stakeholders participated in the APS-debate and for analytical purposes we divided them into four groups: researchers in the field of high-risk mental states; the DSM-5 Psychotic Disorders Work Group; patient, carers and advocacy groups; and external stakeholders, not related to the previous groups, but which also publicly expressed their opinions about APS inclusion in DSM-5. We found that each group differently stressed the role of values we examined in the APS-debate. These values were ethical, but also epistemic, political, economic and ontological. The prominence given to some values, and the lack of discussion about others, generated divergent positions among stakeholders in the debate.SummaryAs exemplified by the APS discussion, although medicine is primarily an ethical endeavor, values of different kinds that take part in it also shape to a large extent the profession. Thus, it may be strategic to openly discuss values at play in the elaboration of diagnostic tools and classificatory systems. This task, more than scientifically or politically significant, is ethically important. (shrink)

Purpose: Moral distress occurs when one identifies an ethically appropriate course of action but cannot carry it out. In this conceptualization, medical students may be particularly vulnerable to m...