BioMed Central Page 1 of 5 (page number not for citation purposes) Philosophy, Ethics, and Humanities in Medicine Open Access Review Ethical psychiatry in an uncertain world: conversations and parallel truths Alexander M Carson 1 and Peter Lepping* 2 Address: 1 School of Health, Social Care, Sport and Exercise Sciences, Glyndwr University, Plas Coch, Wrexham, UK and 2 North Wales NHS Trust & Cardiff University, Wrexham Academic Unit, Technology Park, Croesnewydd Road, Wrexham LL13 7YP, UK Email: Alexander M Carson - a.carson@glyndwr.ac.uk; Peter Lepping* - LeppingP@cardiff.ac.uk * Corresponding author Abstract Psychiatric practice is often faced with complex situations that seem to pose serious moral dilemmas for practitioners. Methods for solving these dilemmas have included the development of more objective rules to guide the practitioner such as utilitarianism and deontology. A more modern variant on this objective model has been 'Principlism' where 4 mid level rules are used to help solve these complex problems. In opposition to this, there has recently been a focus on more subjective criteria for resolving complex moral dilemmas. In particular, virtue ethics has been posited as a more sensitive method for helping doctors to reason their way through difficult ethical issues. Here the focus is on the character traits of the practitioner. Bloch and Green advocated another way whereby more objective methods such as Principlism and virtue ethics are combined to produce what they considered sound moral reasoning in psychiatrists. This paper points out some difficulties with this approach and instead suggests that a better model of ethical judgment could be developed through the use of narratives or stories. This idea puts equal prima facie value on the patient's and the psychiatrist's version of the dilemma they are faced with. It has the potential to lead to a more genuine empathy and reflective decision-making. Introduction In professions that have direct contact with people, the role of humanities in professional education assumes a particularly important value. Since the vast majority of the work of health care professionals is with colleagues and clients, it seems obvious that humanities in general and ethics in particular should play a large part in both their education and their clinical practice. Doctors have tradi- tionally viewed the Hippocratic Oath as an ethical frame- work in which to practice medicine but as medicine has become more complex, so has its ethical dilemmas. There has been a great deal of discussion about whether medi- cine in general and psychiatry in particular are faced with such unique circumstances in clinical practice that they need a unique ethical framework [1]. In a recent, thought- ful article, Sidney Bloch and Stephen Green not only agree that psychiatry needs an ethical framework that can cap- ture the complex moral dilemmas inherent in practice but they also provide a framework that provides a comple- mentary model of ethical practice [2]. Their model is designed to link Principle based ethics with virtue ethics. This mix or complement of objective rules or Principles and subjective character traits is, they contend, a method of practitioners exercising what could be called, 'judgment within limits'. Principles, according to Bloch and Green, provide the boundaries or limits in which practitioners can exercise their judgments. To give justice to the actual situation or relationship they advocate the use of charac- Published: 25 June 2009 Philosophy, Ethics, and Humanities in Medicine 2009, 4:7 doi:10.1186/1747-5341-4-7 Received: 3 September 2008 Accepted: 25 June 2009 This article is available from: http://www.peh-med.com/content/4/1/7 © 2009 Carson and Lepping; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.