Exploring (and expanding) the ethical dimensions of mindfulness in clinical practice (and beyond)

The most recent round of adoption of meditation and mindfulness practices in medicine and mental health care began in the 1980s and has now reached high levels of acceptance in mainstream institutions. Currently there are more than 50 major studies of mindfulness-based interventions (MBIs) funded in the millions of dollars by the National Institutes of Health, and an extraordinarily large proportion of doctoral dissertations in psychology and other disciplines are focusing on such interventions. What interests me is that in the academic and professional literature of the past 30 years, there has been little or no discussion of the ethical stance of mindfulness-based clinical work across the professions. My project is an attempt to engage the mindfulness community in dialogue around the many questions that arise as the topic of ethics is considered. Here’s how it looks in the present moment:

The first of the two phases of the project will lay out the major areas of concern in the application of mindfulness in clinical practice — articulating an ethics of mindfulness, starting with the conception that teaching, application, and practice of mindfulness are relational undertakings. As described for the community in my book, Teaching Mindfulness: A Practical Guide for Clinicians and Educators (McCown, et al., 2010), mindfulness is a co-creation of the teacher and students (or of clinician and client) that depends on a non-pathologizing, non-hierarchical environment (a “we-centric space”). The making and holding of such a space is, therefore, key to defining an ethical stance.

I will review Buddhist ethics (both Theravada and Mahayana) as they have been translated and adapted for non-monastic communities of practice in the West, as well as the accounts of relational ethics generated by contemporary thinkers around the disciplines. I will articulate a mindfulness ethic in three domains, answering three questions: (a) Competence - What defines professional “competence” in mindfulness for clinicians/educators? (b) Praxis - What are the impacts of mindfulness (of both practitioner and “student”) on practice in the unfolding relationship moment to moment? (c) Challenges - How does the practitioner respond when the mandatory constraints of the professional role and (even) ethics codes come into conflict with the mindfulness-based relationship/responsibilities? This is the structure of the book that I’m under contract to write for Jessica Kingsley; the book will provide a “conversation piece” for phase two.

The second phase of the project is to come into a dialogue with what mindfulness practitioners are actually doing in the field. How does their mindfulness-based work impact affect their practice in relationship to students (clients)? What are some of the ethical understandings that folks respond from but may not have identified or articulated as ethical? Certainly, much of the practice in the world will not square with my conception, but then again no one knows exactly what it looks like out there. I hope to foster generative dialogue in the community, which is worldwide and spans many professions/disciplines. I also hope to expand the areas in which a relational mindfulness ethic might be of value — areas such as family relationships, political behavior, and community involvement.