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In the first of four parts the chapter describes the contemporary breakdown of public civil discourse in the realms of political discourse, social media use, and education for civic engagement. Second, it introduces the concept of “values literacy” as a set of epistemic skills and attitudes for recognizing, analyzing, and interpreting values. Third, the chapter then fleshes out a method of values recognition and analysis and defines values operationally as attitudes or dispositions that are action-guiding and subject to praise or blame. Finally, in the fourth part, the chapter makes the case for how educating the polity in values analysis can deepen and expand civil discourse. The sincere seeker of human flourishing can use values analysis to explode simplistic accounts into complex sets of value trade-offs and compromises, exposing the insincere while revealing potentials for common ground and shared flourishing.

Substance abuse in the context of the opioid crisis presents a major public health concern. Despite some evidence that medical students’ attitudes towards substance use disorders worsen during medical school, very few studies have examined how students’ early clinical experiences with substance use disorders shape their views of this clinical population. This study uses student reflective essays to explore these formative educational experiences. Using content analysis, the authors analyzed a collection of 802 medical student reflective essays written during core clerkships (excluding Psychiatry), coding for ethical and professional themes as well as descriptions of substance use disorders. In addition to the qualitative identification of themes, the authors used chi-square analysis to determine which themes had statistically significant associations with substance use disorders. Fifty-three essays described patients with substance use disorders. The most common substances described were opioids (n = 25), alcohol (n = 18), and cocaine (n = 11). There were five themes statistically associated with substance use disorders (p

Influences of chronic homelessness on patients' conceptions of bodily integrity can conflict with clinicians' recommendations about clinically indicated interventions, such as dialysis or amputations. This article considers such conflict by drawing on a capabilities-based model to reframe health care as shared between a patient and clinical team.

Phenomenon: Metonymy refers to the substitution of the name of an attribute or adjunct for the name of the object or person being described. In medical contexts, this may involve referring to a per...

The clinical practice of psychotherapy is saturated with ethics and moralities. Having an Oxford Handbook of Psychotherapy Ethics seems a necessity in a contemporary world where visions of the good seem up for grabs; subject to whomever shouts the loudest and the most often. The quiet exchanges behind (typically) closed doors, which consider what the good is for the patient, what it means, and how to secure it, seem more crucial than ever. The Oxford Handbook of Psychotherapy Ethics aims to provide the most comprehensive reference textbook of psychotherapy ethics; to offer benchmark chapters as go-to guides for a wide variety of practitioners, scholars, policymakers, and patients; to address conceptual, philosophical, cultural, and religious perspectives while also addressing everyday practice concerns; and to identify areas of ethical consensus and convention, while identifying unresolved issues as well as identifying new, problematic areas needing further analysis and research.

This paper describes and demonstrates an autonomous robotic team that can rapidly learn the characteristics of environments that it has never seen before. The flexible paradigm is easily scalable to multi-robot, multi-sensor autonomous teams, and it is relevant to satellite calibration/validation and the creation of new remote sensing data products. A case study is described for the rapid characterisation of the aquatic environment, over a period of just a few minutes we acquired thousands of training data points. This training data allowed for our machine learning algorithms to rapidly learn by example and provide wide area maps of the composition of the environment. Along side these larger autonomous robots two smaller robots that can be deployed by a single individual were also deployed (a walking robot and a robotic hover-board), observing significant small scale spatial variability.

There is as little doubt as much as there is empirical proof that psychotherapy is an effective intervention for psychological problems and disorders. However, there is ongoing controversy about the mechanisms underlying these often impressive, but also often overestimated effects, reaching back to the very origins of psychotherapy research. While this “great psychotherapy debate” vivifies both psychotherapy research and practice, it finally poses an ethical challenge for both psychotherapists and psychotherapy scholars. Basically, the lack of agreed and validated mechanisms impedes the attempt to inform patients about how changes of psychotherapy are brought about. Thus, even though patients can readily be furnished with possible and expectable benefits, costs and strains, the situation becomes more complex and less certain with regard to the specific mechanisms and determinants of change. In this chapter, psychotherapy scholars’ strivings and troubles for specificity will be briefly covered, touching the uncomfortable relationship with placebo and nocebo and finishing with an ethical plea for transparency in psychotherapy and of psychotherapists.

Prior discussions of ethics in psychiatric diagnosis have focused on the development of classifications of psychopathology and the social features and implications of the use of psychiatric diagnostic categories. This chapter focuses instead on the ethics and values involved in the conduct of psychiatric diagnostic assessment ethics in the practice of diagnosing in mental health. The authors build an account of ethics of diagnostic practice using virtue epistemology theory, undergirded by Pellegrino’s account of medical morality as helping, healing, caring, and curing. The authors develop a set of diagnostic virtues (receptivity, empathy, inquisitiveness, self-knowledge, rigour, resolve, fallibilism, fecundity, practical wisdom, and faithfulness) and apply them to an illustrative case scenario.

Cinematic depictions of psychotherapy and its practitioners have been very popular since the beginning of film history. Most of these portrayals are not realistic or commendable, but rather obey the laws of film narration, entertainment, and pleasure of spectatorship. Regarding psychotherapy ethics, the quartet of stereotypical images of the crazy (“Dr. Dippy”), the bad (“Dr. Evil”), the good (“Dr. Wonderful”), and the sexually suggestive (“Dr. Horny”) therapist refers to the ethical requirements of the profession and constitutes an index of ethical misconduct. Nevertheless, cinematic depictions of psychotherapeutic work may serve as an ideal tool for teaching psychotherapy ethics, where learning objectives as developing moral sensitivity, the competence to identify, articulate, reflect upon, and handle the moral dimensions and questions arising from therapeutic work, may be targeted very well, especially in view of not so ideal filmic examples.

Freedom of the will is not only an issue in the attribution of moral and legal responsibility—it also fundamentally shapes how we look at ourselves and how we interact with others. This is essential in everyday life but even more so in psychotherapy. In the debate on freedom of will, the main controversy is concerned with the relationship between determinism and free will. In this chapter, different positions are presented and discussed. The compatibilist viewpoint, which claims determinism and freedom of will to be compatible, is defended against competing theories and applied to psychotherapeutic work. Mental disorders affect free will in many ways, as is demonstrated by the examples. Nevertheless, a compatibilist approach to free will can be used as a resource to increase the patient’s autonomy. As a result, it is justified and sometimes appropriate within the therapeutic context to ascribe responsibility and, within certain limits, to express blame.

This chapter considers the role of knowledge and evidence in comparing and contrasting the ethics of non-clinical counseling (NCC) and mainstream mental health care as practiced by psychiatry, clinical psychology, and social work. As helping traditions which mostly eschew diagnostic categorization and approach mental distress from different values, practices, and metaphysical standpoints, the three NCC traditions considered here are found to be prone to errors of omission, e.g., not knowing what one does not know. While mainstream mental health is also subject to these errors, the mainstream’s allegiance to evidence-based practices leaves it prone to neglecting the crucial role of the clinician in dialogue with the patient. The authors conclude by arguing for wider appreciation of the contributions of clinical interpretation from the philosophy of psychiatry.

Psychotherapists treat vulnerable persons in the context of a particular patient–therapist relationship in which the most serious and sensitive topics of human existence are talked about. In conducting psychotherapy research, it can be a challenge to align the ethical prerequisites of practicing psychotherapy with the particular methodological requirements for meaningful studies. In the present contribution, the authors discuss the following topics in the context of psychotherapy research ethics based on current guidelines and a narrative review of the literature: study designs, the process of informed consent to research, confidentiality, different cultural paradigms, Internet-based research, and the role of research ethics committees.

The notion of human dignity conveys the idea that every human being has inherent worth and, therefore, ought to be accorded the highest respect and consideration. In healthcare, dignity provides an overarching moral framework to guide the physician–patient relationship in a great variety of issues, and especially in the promotion of the patient’s well-being and self-determination. Dignity plays also an important role in psychotherapy as the patient–therapist relationship involves confidences of an intimate nature and about very personal decisions and attitudes, and may lead to a patient’s overdependence on the therapist. Taken seriously, the patient’s dignity imposes on the therapist some specific moral duties, such as respecting and promoting patients’ self-determination, as well as patients’ values, beliefs, and life plans. Another direct consequence of the principle of respect for dignity is the requirement to avoid exploitative interactions with patients, in particular, any form of sexual harassment and abuse.

This chapter focuses on what information should be provided to patients about the evidence base supporting the clinical effectiveness of psychotherapy. In particular, the authors consider whether research on the relative efficacy of different forms of psychotherapy should be provided to patients, as well as whether patients should be provided with information on the relative importance of common factors versus specific factors as the causal agents of clinical improvement. After a critical review and discussion of the relatively few scholarly papers that have previously addressed this question, the authors conclude that patients should be provided with an honest, transparent, and impartial summary of the evidence related to their treatment options including information about the common factors. The authors offer this conclusion even while acknowledging that considerable controversy persists about how to interpret the psychotherapy research evidence base. Finally, the authors strongly support continued research into these questions, especially given the relatively limited scholarly attention they have received to date.

The understanding that psychotherapists should not impose their values on their patients is a shared belief in the field. However, little has been written about how not to impose one’s values on patients. This chapter diagrams an approach to evaluate justified and unjustified impositions of values in therapy with various examples. These examples are not intended to be comprehensive, but to provide an introductory overview. The case discussions will function to: (a) provide rough guidance about how to analyze one’s own unique cases, (b) illustrate areas of consensus within the broad psychotherapy field, (c) highlight the large areas of ambiguity and lack of consensus about what constitutes the legitimate and illegitimate imposition of values on patients, and (d) provide sample references from the literature illustrating particular values-imposition discussions and policies. The chapter’s conclusions emphasize the limitations of this exploratory work, and point to areas where additional analysis would be of benefit for clarifying ambiguities of practice.

The ethics of care poses a special case for psychotherapy. At first glance, key elements of care ethics such as acknowledging our dependence on others, attention to emotions, and creating a supportive environment for healing overlap substantially with key characteristics of psychotherapy. Care ethics’ emphasis on attentiveness and empathetic concern, and related acts such as listening and talking to patients point in the direction of salutary therapeutic relationships, and also of valorizing psychotherapy as a practice. Yet psychotherapy has a long history of critical engagement with the therapeutic relationship, using terms and concepts other than “care.” This chapter shows that while relatively little work has been done on care ethics approaches in psychotherapy, such approaches complement traditional attentiveness to the (psycho)therapeutic relationship by asking to what extent psychotherapists are practicing care and what this entails. Conversely, because psychotherapy has long been concerned with intersubjectivity, as exemplified by the concepts of transference and countertransference, it offers valuable theoretical and practical resources for care ethics approaches.

As COVID‐19 continues to challenge the practice of head and neck oncology, clinicians are forced to make new decisions in the setting of the pandemic that impact the safety of their patients, their institutions, and themselves. The difficulty inherent in these decisions is compounded by potentially serious ramifications to the welfare of patients and health‐care staff, amid a scarcity of data on which to base informed choices. This paper explores the risks of COVID‐19 incurred while striving to uphold the standard of care in head and neck oncology. The ethical problems are assessed from the perspective of the patient with cancer, health‐care provider, and other patients within the health‐care system. While no single management algorithm for head and neck cancer can be universally implemented, a detailed examination of these issues is necessary to formulate ethically sound treatment strategies.

Understanding how institutional review boards/research ethics committees (IRBs/RECs) perform risk/benefit assessment is important to help improve their function. In environmental ethics, uncertainty about potential outcomes and the precautionary principle play important roles in regulatory oversight but have received little attention in the context of human research ethics. We carried out an empirical study to gain insight into uncertainty by asking IRB/REC members about confidence in their risk assessments immediately after discussion of new protocols under review. Based on 12 meetings carried out by four IRBs/RECs over a 6-month period, we found a robust, inverse relationship between risk and confidence. As risk increased, confidence decreased. We detected different patterns of consensus between different IRBs/RECs and their members. Our study introduces a novel and relatively easy to implement approach to begin to understand IRB/REC decision making in real time that can be used within or across institutions.

As psychiatric practice becomes more embedded in social, cultural, and financial networks, it is hardly surprising that the scrutiny of psychiatrists by organizations and institutions grows almost daily. This chapter focuses on the scrutiny of psychiatric ethics. Seven papers are reviewed, ranging from the mid-1950s up to 2009. Topics considered include: professional relationships between psychiatrists, physician impairment, confidentiality in the context of dangerousness, standard-of-care disputes, assessments of competency and decision-making capacity, the history and ethics of psychosurgery and neuromodulation, treatment refusal in chronically mentally ill patients, and conflicts of interest in clinical practice guideline authorship. Each paper is summarized with background information, methods, results, and a critical discussion of its significance.

Interactions between patients and therapists outside the walls of the office include different forms, for example, home treatment, outdoor or adventure therapy, and clinical interventions not possible in the office such as in vivo desensitization in the treatment of phobias. Such interactions pose particular ethical questions pertaining to confidentiality, time, location, flexibility, complexity, unpredictability, and safety considerations. Furthermore, they raise complex issues in regard to the standard of care, the acceptability of such intervention and its legitimacy as a reimbursable medical procedure. Professional organizations’ codes of ethics neither specifically mention out-of-office experiences nor state that they are unethical. It is argued that clinically driven, out-of-office interventions with the patient’s welfare in mind are clearly within the standard of care, and are neither unethical per se nor lead to exploitation or harm. Sometimes, not leaving the office can even be unethical as it deprives patients of the best possible care.

Little discussion has appeared in the literature regarding the ethical and value considerations when clinicians select a psychotherapy modality (e.g., CBT, psychoanalytic therapy, family systems, etc.) and format (group, individual, couple, family, systems) to offer to clients before formal treatment negotiations begin. This chapter offers a virtue-ethics framework to consider these ethics and values issues in psychotherapy modality/format selection, and embeds this virtue-ethics framework in a series of seven clinical factors to consider when doing modality/format deliberations. Karl Jaspers’s principles of clinical interpretation (hermeneutics) provide an illustrative framework for the thinking process in making modality/format decisions. The interactions between the seven factors to consider in modality/format deliberations and the eight relevant clinician virtues provide for numerous, but brief, clinical examples of how the factors, the virtues, and clinical hermeneutics combine to provide for conscientious psychotherapy modality/format deliberations.

Online psychotherapy is a fast-growing, low-threshold option to deliver mental healthcare services. In the present chapter, the different terminologies and definitions of online psychotherapy are discussed and a broad overview of the used information technologies is given. Furthermore, the most important ethical arguments debated in the literature are discussed by reviewing, on the one hand, the arguments in favor of online psychotherapy like increased access to care, improvement of treatment, anonymity, and cost effectiveness and, on the other hand, arguments against online psychotherapy like impairment of treatment, confidentiality issues, issues with informed consent, patient identification and emergency situations, legal issues and additionally required skills.

Informed consent, enshrined in many of the codes of conduct of psychology and psychiatry professional organizations, is an integral component behind the ethical practice of psychotherapy. Foundationally, informed consent respects patient autonomy and should be a knowledge sharing process that allows patients greater agency and improved alliance with their clinician. Psychotherapy differs from medical and surgical interventions in that it is a longitudinal, collaborative, and interpersonal treatment. As many psychotherapists are not trained in traditional medical models of care, a medically based framework for informed consent may not be as familiar and appropriate for psychotherapy. These nuances do not diminish the need for informed consent but rather emphasize the distinctiveness of psychotherapy and necessity of adapting to this treatment modality. In this chapter, the informed consent process for psychotherapy is examined, detailing its historical development, legal and ethical foundations, as well as the subtleties and challenges regarding implementation.

Substance abuse in the context of the opioid crisis presents a major public health concern. Despite some evidence that medical students' attitudes towards substance use disorders worsen during medical school, very few studies have examined how students' early clinical experiences with substance use disorders shape their views of this clinical population. This study uses student reflective essays to explore these formative educational experiences.Using content analysis, the authors analyzed a collection of 802 medical student reflective essays written during core clerkships (excluding Psychiatry), coding for ethical and professional themes as well as descriptions of substance use disorders. In addition to the qualitative identification of themes, the authors used chi-square analysis to determine which themes had statistically significant associations with substance use disorders.Fifty-three essays described patients with substance use disorders. The most common substances described were opioids (n = 25), alcohol (n = 18), and cocaine (n = 11). There were five themes statistically associated with substance use disorders (p 0.05): (1) adequate treatment, (2) pain, (3) difficult patient, (4) jumping to conclusions, and (5) malingering.In the sample, students found the treatment of pain to be a significant ethical challenge related to substance use disorders. In considering a comprehensive educational plan, medical educators may need to consider educational venues outside of the Psychiatry clerkship to address substance use disorders.

The idea that mental disorders are value-laden means that they harbor action-guiding meanings and are subject to praise or blame. This domain of values includes a specific kind of value—vice—which describes wrongful, immoral, or criminal thought or conduct (e.g., antisocial personality disorder, pedophilia, conduct disorder, intermittent explosive disorder). Vice-laden mental disorders are problematic because they imply that (1) psychiatrists police antisocial conduct; (2) vice-laden disorders contribute to stigmatizing mental illness; and (3) they generate incoherent social policy and programs that both intrude upon and neglect the “served” population and community welfare. With this background, this chapter addresses the ethical, practical, and political implications of these conditions; presents four models of normative content in vice-laden mental disorders (i.e., coincidental, moralization, medicalization, and mixed); assesses their “pros” and “cons” for public policy; and concludes with considerations for psychiatric and public policy in addressing social problems associated with vice-laden mental disorders.

The University of Texas System established the Transformation in Medical Education (TIME) initiative to reconfigure and shorten medical education from college matriculation through medical school graduation. One of the key changes proposed as part of the TIME initiative was to begin emphasizing professional identity formation (PIF) at the premedical level. The TIME Steering Committee appointed an interdisciplinary task force to explore the fundamentals of PIF and to formulate strategies that would help students develop their professional identity as they transform into physicians. In this article, the authors describe the task force's process for defining PIF and developing a framework, which includes 10 key aspects, 6 domains, and 30 subdomains to characterize the complexity of physician identity. The task force mapped this framework onto three developmental phases of medical education typified by the undergraduate student, the clerkship-level medical student, and the graduating medical student. The task force provided strategies for the promotion and assessment of PIF for each subdomain at each of the three phases, in addition to references and resources. Assessments were suggested for student feedback, curriculum evaluation, and theoretical development. The authors emphasize the importance of longitudinal, formative assessment using a combination of existing assessment methods. Though not unique to the medical profession, PIF is critical to the practice of exemplary medicine and the well-being of patients and physicians.

Clinical research ethics consultation services have been established across academic health centers over the past decade. This paper presents the results of collaboration within the CTSA consortium to develop a standard approach to the collection of research ethics consultation information to serve as a foundation for quality improvement, education, and research efforts. This approach includes categorizing and documenting descriptive information about the requestor, research project, the ethical question, the consult process, and describing the basic structure for a consult note. This paper also explores challenges in determining how to share some of this information between collaborating institutions related to concerns about confidentially, data quality, and informatics. While there is much still to be learned to improve the process of clinical research ethics consultation, these tools can advance these efforts, which, in turn, can facilitate the ethical conduct of research.

Medical students' early clinical encounters may influence their perceptions of geriatrics. This study examines reflective essays written by 3rd-year medical students on required clinical rotations. Using content analysis, the authors analyzed the essays' thematic content. The authors then used chi-squared analysis to compare themes with geriatric patients (age 60+) to themes with other age groups. One hundred twenty out of 802 essays described a geriatric patient. The most common geriatric themes were (1) death and dying, (2) decision making, (3) meaningful physician-patient interactions, (4) quality of care, and (5) professional development. Geriatric essays were more likely to discuss death/dying and risk-benefit themes and less likely to discuss abuse. Geriatric essays were more likely to describe students' moral distress. Geriatric essays with moral distress were more likely to include empathy themes compared to geriatric essays without moral distress. Geriatric patients may pose unique ethical challenges for early clinical students.

Background: Legitimate concern for fetal safety often precludes women who are pregnant or planning to become pregnant from participating in randomized controlled trials (RCTs), preventing the development of an empirically-derived evidence base for the safety and efficacy of treatments. Perinatal science can only move forward when the research community understands and addresses the practical and ethical roadblocks impeding this research. Methods: To understand these challenges better, our study team interviewed 15 perinatal mental health investigators from 12 leading academic institutions in the United States and 6 members of the respective institutional review boards (IRBs). Results: Respondents confirmed seven broad ethical challenges. Through analyzing interview transcripts, we identified four themes: research design/methodology, safety, participant selection/recruitment, and autonomy. Fifteen subthemes further delineate the complexities of the issues revealed in narratives describing specific experien...

Chervenak and McCullough (2011) present a different approach to conceptualizing research ethics in evaluating clinical investigations for pregnant women and fetal patients. In our understanding of ...

The distinction between normality and psychopathology has long been subject to debate. DSM-III and DSM-IV provided a definition of mental disorder to help clinicians address this distinction. As part of the process of developing DSM-V, researchers have reviewed the concept of mental disorder and emphasized the need for additional work in this area. Here we review the DSM-IV definition of mental disorder and propose some changes. The approach taken here arguably takes a middle course through some of the relevant conceptual debates. We agree with the view that no definition perfectly specifies precise boundaries for the concept of mental/psychiatric disorder, but in line with a view that the nomenclature can improve over time, we aim here for a more scientifically valid and more clinically useful definition.

In his response to Reynolds and colleagues' "The Future of Psychiatry as Clinical Neuroscience," the author considers three themes prominent in the history of psychiatry: stigma, conscience, and science, considering each in the past, present, and into the future. A series of conclusions follow these historical perspectives. One, unraveling the web of stigma in the future depends more on moral, educational, and political achievements than neuroscientific ones. Two, psychiatry's future depends upon the public trust, which has fluctuated over its history and into the present era, during which legacies of undue influence and failed regulation have damaged this trust. While explaining the mechanisms for mental disorders is crucial, the returns from these scientific investments are decades away, and failures of conscience today undermine the vital public trust and impede psychiatry's abilities to immediately address the plight of the mentally ill. Three, the researcher-entrepreneur in perennial search of funding has replaced the old model of the curious researcher-practitioner. This drive for funding promotes hubris and failures of conscience in psychiatric science. Moreover, the information explosion and superspecialization of contemporary academic medicine has led to an intellectual fragmentation analogous to the service fragmentation at the beginnings of psychiatry. Attention to integrative synthesis of research information, as well as conscientious moral reflection on scientific advances, will promote humility over hubris: enhancing the public trust, assuring public confidence in psychiatric science, and empowering patients.

This main article for a Philosophy, Psychiatry, & Psychology philosophical case conference is intended to raise philosophical, psychiatric, and public policy issues concerning the relationship between concepts of criminality, mental disorder, and the classification of mental disorders. After introducing the basic problem of the confounding of “vice” and mental disorder concepts in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition—Text Revision, the author summarizes three different cases from the literature that illustrate the problem of the vice–mental disorder relationship. Four general aspects of the conceptual issues are presented to frame the discussion, and general questions in a range of domains are posed for commentators.

TheOxford Handbook of Psychiatric Ethicsis the most comprehensive treatment of the field in history. The editors briefly describe the goals, scope, and organization of the book. Major themes and the state of the field in the twenty-first century are then addressed. Psychiatric ethics is an excellent framework to examine social changes in psychiatry over the past 25 years. These include multiculturalism and its associated diversity of values; the transition to the digital era with new demands on confidentiality, clinical boundaries, and privacy; the empowerment of psychiatric service users as full participants and co-producers of care; the development of new technologies of assessment and treatment, varying in their invasiveness and risk; the recognition of expanded social roles for psychiatrists, and the associated virtues of psychiatric citizenship; and the development of new practice models, settings, participants, and oversight—representing profound challenges and opportunities for the ethical practice of psychiatry.

This chapter provides a detailed argument as to why philosophical ethics is a problematic starting point for theorizing psychiatric ethics practice. Following this critique, the author reviews values-based practice (VBP) as offering a practice framework to theorize the particular domain of psychiatric ethics practice. Values-based psychiatric ethics (VBPE) is based upon VBP and focuses on the role of clinician virtue, as well as analytic and clinical skills in working with stakeholders, a “trumps-hierarchy” heuristic which identifies hidden personal and social values, as well as social power structures, and a focus on technique and immediate practical “doing” in clinical encounters. Detailed examples of application are provided.

Psychiatric diagnosis poses ethical problems because of stigma, the close relationship between personal identity and mental illness, the legal sanctions associated with regulating mentally disordered individuals, and the value-diversity associated with judgments of psychopathology. The ethics of diagnosis can be split into two aspects: first, that of the individual practitioner working with a patient, and second, the developmental process involved in describing psychopathology and classifications of mental illness. The first half of this chapter describes the ethical and aesthetic values involved in good diagnostic practice by clinicians, in reference to Pellegrino’s medical morality of helping/healing/caring/curing. The second half considers the ethics of developing classifications of psychopathology, focusing primarily on the American Psychiatric Association’s DSM manuals and examining them under the ethics lenses of the social aspects of the conduct of science, the ethical aspects of managing a nosological effort, and addressing conflicts between professional/service-oriented interests and selfish/guild interests.