Michael Lavin

ABSTRACT ‘Ulysses contracts’ are an instrument through which a psychiatric patient may prearrange involuntary commitments to be put into effect if the patient satisfies certain diagnostic criteria in the future. Proposals for Ulysses contracts typically impose numerous safeguards. This paper argues against the intuitively plausible safeguard which permits only presently remitted patients to contract. Instead of requiring a patient's remission, it is argued that the appropriate safeguard is the patient's ability, whether remitted or not, to offer good reasons for wishing to contract. In short, what matters is not an executive's character, but an executive's reasons, and a bad executive may have good reasons. Attempts to deny the accessibility of good reasons in unremitted patients are rejected on the ground that psychiatric diagnosis requires psychiatrists to be able to distinguish between good and bad reasons in both remitted and unremitted patients. If psychiatrists cannot do that, psychiatric diagnosis is impossible.

Work by Sales and Lavin has suggested that it is possible to improve the moral and ethical thinking of psychologists. In particular, moral and ethical thinking by psychologists could be improved if psychologists learned to use defensible moral metrics. The usefulness of formal training in ethics and morality, with the implicit condemnation of the moral metrics that might be taught in such training, has been challenged by writers such as Justice Holmes. He has alleged that professionals learn how to behave in their professional roles by practicing them. A variety of problems are noted with Holmes' view. Further, psychologists cannot rely on expert advice from Institutional Review Boards or Ethics Committees, even if they wished to do so. Institutional Review Boards, and by implication Ethics Committees, have serious deficiencies. However, psychologists can make considerable progress in their moral and ethical thinking, if they distinguish ethics from morality and also notice the similarities between moral thinking and scientific thinking and theorizing. A controversy over the recovered-memory therapy is employed to illustrate some of these distinctions and similarities. The argument continues by developing two moral metrics. The first begins with ethics and culminates in moral appraisal. The second makes moral appraisal an earlier step than ethical appraisal. With these metrics described, it is then noted that a popular metric in psychology, that of Koocher and Keith-Spiegel, is inadequate. It is then shown that the two moral metrics earlier described are reasonably believed to be adequate. The adequacy of one of them is directly illustrated with an example involving the question of whether persons with serious mental illnesses should be allowed to enter into contracts that would relax the criteria for their involuntary hospitalization and treatment. It is concluded that teachable, intellectually defensible moral metrics are possible, and that their use would improve the moral and ethical thinking of psychologists

‘Ulysses contracts’ are an instrument through which a psychiatric patient may prearrange involuntary commitments to be put into effect if the patient satisfies certain diagnostic criteria in the future. Proposals for Ulysses contracts typically impose numerous safeguards. This paper argues against the intuitively plausible safeguard which permits only presently remitted patients to contract. Instead of requiring a patient's remission, it is argued that the appropriate safeguard is the patient's ability, whether remitted or not, to offer good reasons for wishing to contract. In short, what matters is not an executive's character, but an executive's reasons, and a bad executive may have good reasons. Attempts to deny the accessibility of good reasons in unremitted patients are rejected on the ground that psychiatric diagnosis requires psychiatrists to be able to distinguish between good and bad reasons in both remitted and unremitted patients. If psychiatrists cannot do that, psychiatric diagnosis is impossible.

I examine two kinds of arguments in favour of imposing restrictions on smoking by hospitalised psychiatric patients. First, I look at patient-centered arguments in favour of restrictions. These arguments focus on the benefits that patients will receive if their smoking is stopped or curtailed. Second, I examine arguments that seek to justify restrictions by citing the costs that smokers impose on others. Neither kind of argument justifies any meaningful restrictions on the smoking of hospitalised psychiatric patients.