The Role of Ethics in Recovery

It was a question of how to make sense of the world and determining what is true and false at the latest session of Grand Rounds, when Michael Campbell took the stage to present on the role of the ethicist and ethics in a recovery focused mental health care centre.

Starting with a definition of Recovery, Campbell said that to recover could either be to regain something that was lost or to add a layer to oneself.  He added that we should consider there being two types of Recovery: Clinical Recovery and Personal Recovery. While both focus on a state of being, they can be very different.

“Clinical Recovery for those with a mental illness is usually observable and objective.  It is usually seen when there is remission or alleviation of symptoms and is usually observed by a clinician – someone external to the patient.  On the other hand, Personal Recovery is service user based and is very dependent on the individual experience and their definition of their state of being,” says Campbell.

Campbell, an ethicist himself, argues that if we accept that all knowledge is a construct that is dependent only on our social experiences and perception, then Personal Recovery is different for everyone. “Personal Recovery is a journey into life, not an outcome to be arrived at,” Campbell adds. 

When deciding on a care plan for someone living with a mental illness, the ethicist recommends that all healthcare practitioners examine their decisions based on the ethical principles of beneficence – acting in the best interest of the patient, non-maleficence - doing no harm, equity, autonomy and justice.  In a recovery based setting, Campbell argues that the Recovery principles in practice should also be considered. 

He outlines these Recovery principles:

  1. Recovery is about Hope - inspiring and supporting a vision of optimism for the future for people living with mental illness.
  2. Recovery is about Identity - a shift from being engulfed by illness and accepting mental illness as a small part of the whole self.
  3. Recovery is about Meaning - finding meaning in life despite the presence of mental illness.
  4. Recovery is about Responsibility - taking responsibility for personal recovery and self- management of symptoms and wellbeing.

“The major role of the ethicist is to ensure that the recovery and ethical principles are included in policies and practices at all times.  It is important that the patients are considered,” declares Campbell.

The ethicist at Ontario Shores also has micro level roles such as being a part of the Recovery Rounds team to advise on issues of restraint and seclusion and Intimacy Recovery for patients.  “The ethicist advises on preventative practices – any practice that restricts a person’s freedom, usually for their safety, and applies a recovery and ethical framework to the decision making,” adds Campbell.

Reflecting on the future of ethics, Campbell thinks Neuroethics and Moral bio enhancements will feature prominently. “For example, neuroethics might question the role of invasive treatments like deep brain stimulation, which may work but do they alter human behavior,” remarks Campbell.

Overall, in recovery based environment, the ethical framework is integral to the development and review of the treatment plan.