Abstract

Guidelines for revisions to Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) asked those proposing changes to consider potential harms to patients. This request has been controversial. This paper argues that seeking to do no harm is appropriate when constructing a scientific classification scheme. I show that in many cases considerations of harm avoidance can play a role in influencing the design of the DSM without the pursuit of scientific knowledge being compromised. I then turn to cases where compromise is required. Through a consideration of cases where lying is required to save lives I suggest that it is widely accepted that harm avoidance can trump truth telling. In extreme circumstances, a psychiatric classification might thus set out to mislead to prevent harm.

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