title: The attitudes of mental health professionals towards patients' desire for children.
abstract: BACKGROUND
  When a patient with a serious mental illness expresses a desire for children, mental health professionals are faced with an ethical dilemma. To date, little research has been conducted into their strategies for dealing with these issues.
  
  
  METHODS
  Seven focus groups with a total of 49 participants from all professional groups active in mental health (nurses, psychologists, social workers and psychiatrists) were conducted in a 330-bed psychiatric hospital. Group discussions were transcribed verbatim and analysed by the documentary method described by Bohnsack.
  
  
  RESULTS
  Mental health professionals did not feel that their patients' desire for children was as important in daily practice as were parenting issues. When discussing the desire for children on the part of patients, the following themes emerged: "the patient's own decision", "neutrality", "the patient's well-being", "issues affecting the children of mentally ill parents" and "appropriate parenthood". In order to cope with what they perceived as conflicting norms, mental health professionals developed the following (discursive) strategies: "subordination of child welfare", "de-professionalisation", "giving rational advice" and "resignation".
  
  
  CONCLUSIONS
  The theme of "reproductive autonomy" dominated mental health professionals' discourse on the desire for children among psychiatric patients. "Reproductive autonomy" stood in conflict with another important theme (patient's children). Treating reproductive issues as taboo is the result of the gap between MHPs' perceptions of (conflicting) norms when dealing with a patient's desire for children and the limited opportunities to cope with them appropriately.In order to support both patients with a desire for children and mental health professionals who are charged with providing counselling for such patients, there is a need to encourage ethical reflection and to focus on clinical recommendations in this important area.
authors.affiliation: Ulm University, Department of Psychiatry II, Bezirkskrankenhaus Guenzburg, Ludwig-Heilmeyer-Str, 2, 89312 Guenzburg, Germany. silvia.krumm@uni-ulm.de.
authors.forename: Silvia
authors.initials: S
authors.lastname: Krumm
authors.forename: Carmen
authors.initials: C
authors.lastname: Checchia
authors.forename: Gisela
authors.initials: G
authors.lastname: Badura-Lotter
authors.forename: Reinhold
authors.initials: R
authors.lastname: Kilian
authors.forename: Thomas
authors.initials: T
authors.lastname: Becker
mesh_terms: D001291:Attitude of Health Personnel; D026686:Beneficence; D002648:Child; D016241:Child of Impaired Parents; D003376:Counseling; D004992:Ethics, Medical; D005193:Family Planning Services / Q000941:ethics*; D005260:Female; D017144:Focus Groups; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology; D028642:Persons with Psychiatric Disorders / Q000523:psychology; D016487:Parenting / Q000523:psychology*; D026684:Personal Autonomy; D011247:Pregnancy; D011369:Professional-Patient Relations / Q000941:ethics*; D018570:Risk Assessment