Can we justify eliminating coercive measures in psychiatry?
The practice of coercive measures in psychiatry is controversial. Although some have suggested that it may be acceptable if patients are a danger to others or to themselves, others committed themselves to eliminate it. Ethical, legal and clinical considerations become more complex when the mental incapacity is temporary and when the coercive measures serve to restore autonomy. We discuss these issues, addressing the conflict between autonomy and beneficence/non-maleficence, human dignity, the experiences of patients and the effects of coercive measures. We argue that an appeal to respect autonomy and/or human dignity cannot be a sufficient reason to reject coercive measures. All together, these ethical aspects can be used both to support and to reject a non-seclusion approach. The total lack of controlled trials about the beneficial effects of coercive measures in different populations however, argues against the use of coercive measures.
Prinsen
E J D
EJ
Zwolse Poort, Institute for Mental Health West-Overijssel, Knapenveldsweg 1/P.O. Box 110, 8102 RR/8000 AC Raalte, The Netherlands. e.prinsen@zwolsepoort.nl
van Delden
J J M
JJ
D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence; D003617:Dangerous Behavior; D004992:Ethics, Medical; D006801:Humans; D001523:Mental Disorders / Q000628:therapy; D008605:Mental Health Services / Q000941:ethics*; D028701:Patient Rights / Q000941:ethics*; D026684:Personal Autonomy; D011570:Psychiatry / Q000941:ethics* / Q000379:methods; D012149:Restraint, Physical / Q000941:ethics* / Q000331:legislation & jurisprudence