Ethical issues in the clinical use of diagnostic technologies for rare causes of psychosis
10 affiliations
- 1Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, USA
- 2Department of Psychiatry & Center for Bioethics, Harvard Medical School, Boston, MA, USA
- 3Department of Psychiatry, University of Oxford, Oxford, UK
- 4National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK
- 5Department of Neurology, University of Oxford, Oxford, UK
- 6Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- 7Uehiro Oxford Institute, University of Oxford, Oxford, UK
- 8Faculty of Philosophy, University of Oxford, Oxford, UK
- 9Department of Psychiatry, University of Cambridge, Cambridge, UK
- 10Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
Abstract
An estimated 5% of cases of first episode psychosis are due to rare and sometimes reversible causes that can be identified though diagnostic investigations that are currently less common in psychiatry, such as lumbar puncture, specialized brain imaging, or genetic testing. The current clinical practice of the use of such technologies, however, raises several challenging ethical questions. Drawing on our multi-disciplinary perspective spanning psychiatry, neurology, philosophy, neuroscience, sociology, and medical ethics from three countries we identify emerging ethical issues in the diagnosis of rare causes of psychosis. We group challenges in three main categories 1) diagnostic justice, 2) moral responsibility, and 3) unintended consequences of diagnostic workup. Justice challenges surrounded role of a) “luck”, b) social capital, and c) prior psychiatric diagnoses in determining access to workup. Moral responsibility challenges surround the extent to which a) clinicians should be expected to know the red flags and workup for rare or ultra-rare causes, b) those who run health systems should enable knowledgeable clinicians to provide the requisite workup. Challenges related to unintended consequences include the risk of pursuing workup of rare causes to reinforce a) psychiatric exceptionalism, b) paternalistic decision making that does not allow space for patient preferences. Finally, we reflect on unresolved issues and future directions.
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BibTeX
@article{baum2026ethical,
title = {{Ethical issues in the clinical use of diagnostic technologies for rare causes of psychosis}},
author = {Matthew L. Baum and Graham Blackman and Adam Al-Diwani and Adam Handel and Dominique Endres and Sophie Binks and Jonathan Pugh and John Ward and Julian Savulescu and Ilina Singh and Belinda Lennox},
journal = {The British journal of psychiatry : the journal of mental science},
year = {2026},
month = jun,
doi = {10.1192/bjp.2026.10675},
url = {https://europepmc.org/article/PMC/PMC7619677},
note = {CC BY},
}
RIS
TY - JOUR
TI - Ethical issues in the clinical use of diagnostic technologies for rare causes of psychosis
AU - Matthew L. Baum
AU - Graham Blackman
AU - Adam Al-Diwani
AU - Adam Handel
AU - Dominique Endres
AU - Sophie Binks
AU - Jonathan Pugh
AU - John Ward
AU - Julian Savulescu
AU - Ilina Singh
AU - Belinda Lennox
PY - 2026
DA - 2026/06/16
JO - The British journal of psychiatry : the journal of mental science
DO - 10.1192/bjp.2026.10675
UR - https://europepmc.org/article/PMC/PMC7619677
AB - An estimated 5% of cases of first episode psychosis are due to rare and sometimes reversible causes that can be identified though diagnostic investigations that are currently less common in psychiatry, such as lumbar puncture, specialized brain imaging, or genetic testing. The current clinical practice of the use of such technologies, however, raises several challenging ethical questions. Drawing on our multi-disciplinary perspective spanning psychiatry, neurology, philosophy, neuroscience, sociology, and medical ethics from three countries we identify emerging ethical issues in the diagnosis of rare causes of psychosis. We group challenges in three main categories 1) diagnostic justice, 2) moral responsibility, and 3) unintended consequences of diagnostic workup. Justice challenges surrounded role of a) “luck”, b) social capital, and c) prior psychiatric diagnoses in determining access to workup. Moral responsibility challenges surround the extent to which a) clinicians should be expected to know the red flags and workup for rare or ultra-rare causes, b) those who run health systems should enable knowledgeable clinicians to provide the requisite workup. Challenges related to unintended consequences include the risk of pursuing workup of rare causes to reinforce a) psychiatric exceptionalism, b) paternalistic decision making that does not allow space for patient preferences. Finally, we reflect on unresolved issues and future directions.
SN - 0007-1250
SN - 1472-1465
ER -