When a therapist and a patient meet to address the needs created by mental disorder, their developing relationship is bounded by rules that determine the appropriateness of interventions considered and performed. These rules are based not only on knowledge about the biological and psychological bases of disorder, but also on values which, like the therapies that can be employed, not only provide a range of alternatives, but also set limits on actions.

This book is about a particular subset of values dealing with ethics. Ethics is a discipline concerned with understanding the right-making and wrong-making characteristics of actions. The practitioners who analyze the ethical dimensions of human thought and interaction must examine deeply held beliefs derived from personal experience concerning right and wrong, cultural mores founded on the conventions of tradition, values received from and embodied in decisions of courts and legislatures, historical conventions developed by the health care professions over time and embodied in documents such as ethical codes, and scholarly works on ethics.

In this book, we approach ethics through case studies. Our goal is to present case material that can provide clinicians with a basis for learning and reflection, preferably in interaction with their colleagues. The cases used are real and are derived from clinical situations and consultative experiences of the authors, and their colleagues. The use of the case method, as applied to problems of mental illness, was developed by the authors at the Massachusetts Mental Health Center, where ethics rounds were begun in 1979 and continue in the present.