title: Which values are important for patients during involuntary treatment? A qualitative study with psychiatric inpatients.
abstract: Involuntary hospital treatment is practised throughout the world. Providing appropriate treatment in this context is particularly challenging for mental health professionals, who frequently face ethical issues as they have to administer treatments in the absence of patient consent. We have explored the views of 59 psychiatric patients who had been involuntarily admitted to hospital treatment across England. Moral deliberation theory, developed in the field of clinical bioethics, was used to assess ethical issues. Interviews were audio recorded and transcribed verbatim, and analysed through thematic content analysis. We have detected a number of circumstances in the hospital that were perceived as potentially conflictual by patients. We have established which patient values should be considered by staff when deliberating on ethically controversial issues in these circumstances. Patients regarded as important having freedom of choice and the feeling of being safe during their stay in the hospital. Patients also valued non-paternalistic and respectful behaviour from staff. Consideration of patient values in moral deliberation is important to manage ethical conflicts. Even in the ethically challenging context of involuntary treatment, there are possibilities to increase patient freedoms, enhance their sense of safety and convey respect.
authors.affiliation: Biomedical Ciences Department, Medical School, Medical Humanities, Universidad Europea de Madrid, Madrid, Spain Unit for Social & Community Psychiatry, Centre for Mental Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Valenti
authors.affiliation: Unit for Social & Community Psychiatry, Centre for Mental Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Domenico
authors.initials: D
authors.lastname: Giacco
authors.affiliation: Unit for Social & Community Psychiatry, Centre for Mental Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Katasakou
authors.affiliation: Unit for Social & Community Psychiatry, Centre for Mental Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Stefan
authors.initials: S
authors.lastname: Priebe
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002755:Choice Behavior / Q000941:ethics; D004739:England; D028663:Ethical Theory; D005260:Female; D005610:Freedom; D006778:Hospitals, Psychiatric / Q000941:ethics; D006801:Humans; D007258:Informed Consent / Q000941:ethics; D007297:Inpatients / Q000523:psychology*; D008297:Male; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy; D008875:Middle Aged; D028681:Moral Obligations; D009723:Nurse-Patient Relations / Q000941:ethics; D061214:Patient Safety; D026684:Personal Autonomy; D010817:Physician-Patient Relations / Q000941:ethics; D036301:Qualitative Research; D012107:Research Design; D012494:Sampling Studies; D011795:Surveys and Questionnaires; D014836:Volition
keywords: Autonomy; Coercion; Involuntary Civil Commitment