Opportunities in Reform: B ioethics and M ental H ealth Ethics

Last year marks the first year of implementation for both the P atient P rotection and A ffordable C are A ct and the M ental H ealth P arity and A ddiction E quity A ct in the U nited S tates. As a result, healthcare reform is moving in the direction of integrating care for physical and mental illness, nudging clinicians to consider medical and psychiatric comorbidity as the expectation rather than the exception. Understanding the intersections of physical and mental illness with autonomy and self‐determination in a system realigning its values so fundamentally therefore becomes a top priority for clinicians. Yet B ioethics has missed opportunities to help guide clinicians through one of medicine's most ethically rich and challenging fields. B ioethics' distancing from mental illness is perhaps best explained by two overarching themes: 1) An intrinsic opposition between approaches to personhood rooted in B ioethics' early efforts to protect the competent individual from abuses in the research setting; and 2) Structural forces, such as deinstitutionalization, the P atient Rights Movement, and managed care. These two themes help explain B ioethics' relationship to mental health ethics and may also guide opportunities for rapprochement. The potential role for B ioethics may have the greatest implications for international human rights if bioethicists can re‐energize an understanding of autonomy as not only free from abusive intrusions but also with rights to treatment and other fundamental necessities for restoring freedom of choice and self‐determination. B ioethics thus has a great opportunity amid healthcare reform to strengthen the important role of the virtuous and humanistic care provider.