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To some degree, all psychiatric encounters, by constraining behavioral variation and autonomous decision making, threaten a personhood already impaired by illness. The challenge presented by this and other factors in Western psychiatry is how to resolve the ethical dilemmas of justice, autonomy, and beneficence inherent in contemporary hospitalization and treatment practices for severely mentally ill persons. The author discusses this challenge in terms of the physician-patient contract, clinical standards for limiting autonomy, and the Kantian concept of equality of mutual respect. The legal code in relation to psychiatry has evolved into a contemporary interpreting mechanism for Kantian cultural tradition.