The medical profession should be guided by ethical principles. This need existed since the time of Hippocrates and perhaps even earlier than that. However, in recent years, this need has become a sine qua non necessity. Ethical codes and guidelines are appearing everywhere and in every medical discipline and there is increasing demand and pressure for their implementation, stemming from the profession but also from society.

The codes of ethics in medicine and psychiatry are based on principles that are part of the existing moral theories. These theories should be considered as complementary rather than antithetical because they fill in the gaps of each other. They are the following: Virtue Ethics, Casuistry, Deontological Theory, Utilitarianism, Principlism, Ethics of Care, Linguistic Philosophy.

Among these theories, Virtue Ethics which emerged from the Aristotelian tradition, received the greatest attention and is more widely accepted. This theory professes the development of character traits that promote virtuous behavior. Among these traits, phronesis (practical wisdom) has been highlighted as a trait of great importance. Virtue Ethics is considered as the only approach that has retained relevance and legitimacy over the course of history.

Another theory that has received great attention is Principlism, developed by Beauchamp and Childress in 1994. This theory is based on a quartet of principles, namely nonmaleficence, beneficence, autonomy and justice. The first two principles are in fact Hippocratic, the other two are more modern, although the principle of justice may also be considered ancient as it was Aristotle who dealt extensively with the principle of equity, which is similar to that of justice.

All moral theories are filtered through the person of the physician and are addressed to the person of each individual patient. Therefore, their application is individualized and personified. The ethical message can be enhanced, highlighted, differentiated, distorted, or even neutralized.

To paraphrase the well-know WHO pronouncement “there is no Health without Mental Health” we can say that “there is no Medicine without Ethical Medicine”.

Green S, Bloch S. An Anthology of Psychiatric Ethics, Oxford 2006
Lolas F. Ethics in Psychiatry: a framework, World Psychiatry, 2006:185–187

Prof. George Christodoulou
Honorary President, Hellenic Psychiatric Association
Chair, Standing Committee on Ethics, World Psychiatric Association
Chair, European Division, Royal College of Psychiatrists

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