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The context for this interdisciplinary work by a philosopher and a clinician is the psychiatric care provided to those with severe mental disorders. Such a setting makes distinctive moral demands on the very character of the practitioner, it is shown calling for special virtues and greater virtue than many other practice settings

Psychiatrists have written much about the explosive expansion of scientific knowledge of the brain which developed over the late 20th century and the early 21st century. Comparatively little has been written within the field of psychiatry about the changes in society and world culture over this same period, and even less on the scope of psychiatric ethics that would account for these changes. Yet psychiatric ethics is an excellent framework in which to examine social changes in the field over the past 25 years, changes which are dramatic in nature and profound in impact.0Some of these social changes include multiculturalism and its associated diversity of values; the transition to the digital era with its new demands on confidentiality, clinical boundaries, and privacy; the empowerment of psychiatric service users as full participants and co-producers of care; the development of new technologies of assessment and treatment, varying in their invasiveness and risk; the recognition of expanded social roles for psychiatrists, and the associated virtues of psychiatric citizenship; and the development of new practice models, settings, participants, and oversight, all of which represent profound challenges and opportunities for the ethical practice of psychiatry. The 'Oxford Handbook of Psychiatric Ethics' is the most comprehensive treatment of the field in history.

Understanding how institutional review boards/research ethics committees (IRBs/RECs) perform risk/benefit assessment is important to help improve their function. In environmental ethics, uncertainty about potential outcomes and the precautionary principle play important roles in regulatory oversight but have received little attention in the context of human research ethics. We carried out an empirical study to gain insight into uncertainty by asking IRB/REC members about confidence in their risk assessments immediately after discussion of new protocols under review. Based on 12 meetings carried out by four IRBs/RECs over a 6-month period, we found a robust, inverse relationship between risk and confidence. As risk increased, confidence decreased. We detected different patterns of consensus between different IRBs/RECs and their members. Our study introduces a novel and relatively easy to implement approach to begin to understand IRB/REC decision making in real time that can be used within or across institutions.