The Ethics of Pre-Onset Early Detection and Interventions in Psychiatry

Abstract

In this dissertation, I assess the ethical debate surrounding the development of pre-emptive psychiatry, and propose to reframe it around models of vulnerability. This leads me to advocate for nonspecific staging models over the creation of attenuated syndromes.

Chapter 1 delineates the ‘mid-level’ approaches I selected for the ethical appraisal of various models of vulnerability: mainly, Beauchamp and Childress’ principlism and Nussbaum’s capabilities approach. It is followed in Chapter 2 by an outline of the current state of research in pre-emptive psychiatry. I argue in Chapter 3 that the debate surrounding these new developments has missed an opportunity to discuss the ethical issues they raise in a constructive manner. Various conceptualisations of psychiatric vulnerability ought to be more clearly at the heart of this conversation. I explore in Chapter 4 the wide-ranging relevance of the concept of vulnerability in ethical theory, so as to explain in Chapter 5 how it can serve as the foundation of a normative approach that favours resilience and relational autonomy over outright protective responses to vulnerability. Consequently, I highlight in Chapter 6 the advantages of integrating more traditional nosologies into the larger framework of nonspecific staging models. I aim to show that, through fostering a greater focus on resilience rather than on diagnosis and treatment, hybrid diagnostic models promote a better management of the ethical issues associated with pre-emptive psychiatry.

The main outcome of this project is a new framework for discussions regarding the ethics of pre-onset early detection and interventions in psychiatry, re-centring them around conceptualisations of vulnerability. Altogether, this dissertation shows how ethical concerns arise concretely in pre-emptive psychiatry, and defends its prospects for addressing them.