Pratiques psychiatriques et perspectives éthiques

While for the general population the range of psychiatric missions is taking on increasing breadth and depth, for patients, psychiatric care is becoming less containing and more constraining. This observation leads to revisiting the ethical principles guiding psychiatric practices. The purpose of this work was to determine the way everyday practices reflect an ethical approach to psychiatric care. In order to establish a reference with which care delivered in institutions can be examined, we conducted semi-directive interviews with 12 hospital psychiatrists who were later informed of the results of the survey. We collected data on the description of psychiatric practices (inpatient and outpatient care) which were analyzed in function of the institutional and clinical rules which could be used to update the principles of independence, charity and prevention of harm. We also studied their concept of the final objective of care, the definition of the domain of psychiatric care, and changes in care practices. A certain number of trends were observed. Globally, the ethical approach is being revisited: in certain instances, the final objective of care is not centered on the patient; in other situations, there is some tension concerning ethical principles; hierarchic structures place predominant weight on the principle of charity, sometimes at the exclusion of the two other principles. Thus, within the context of institutionalized psychotherapy, the ethical dimension of care, to which health professionals have become increasingly aware, is becoming less implicit. What is needed is a clear definition of the field of competence of psychiatrics and a permanent ethical reevaluation of explicitly defined concepts.