title: Ethical deliberations about involuntary treatment: interviews with Swedish psychiatrists.
abstract: BACKGROUND
  Involuntary treatment is a key issue in healthcare ethics. In this study, ethical issues relating to involuntary psychiatric treatment are investigated through interviews with Swedish psychiatrists.
  
  
  METHODS
  In-depth interviews were conducted with eight Swedish psychiatrists, focusing on their experiences of and views on compulsory treatment. In relation to this, issues about patient autonomy were also discussed. The interviews were analysed using a descriptive qualitative approach.
  
  
  RESULTS
  The answers focus on two main aspects of compulsory treatment. Firstly, deliberations about when and why it was justifiable to make a decision on involuntary treatment in a specific case. Here the cons and pros of ordering compulsory treatment were discussed, with particular emphasis on the consequences of providing treatment vs. refraining from ordering treatment. Secondly, a number of issues relating to background factors affecting decisions for or against involuntary treatment were also discussed. These included issues about the Swedish Mental Care Act, healthcare organisation and the care environment.
  
  
  CONCLUSIONS
  Involuntary treatment was generally seen as an unwanted exception to standard care. The respondents' judgments about involuntary treatment were typically in line with Swedish law on the subject. However, it was also argued that the law leaves room for individual judgments when making decisions about involuntary treatment. Much of the reasoning focused on the consequences of ordering involuntary treatment, where risk of harm to the therapeutic alliance was weighed against the assumed good consequences of ensuring that patients received needed treatment. Cases concerning suicidal patients and psychotic patients who did not realise their need for care were typically held as paradigmatic examples of justified involuntary care. However, there was an ambivalence regarding the issue of suicide as it was also argued that risk of suicide in itself might not be sufficient for justified involuntary care. It was moreover argued that organisational factors sometimes led to decisions about compulsory treatment that could have been avoided, given a more patient-oriented healthcare organisation.
authors.affiliation: Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden and Center for Bioethics, Harvard Medical School, Boston, MA, USA. manne.sjostrand@ki.se.
authors.forename: Manne
authors.initials: M
authors.lastname: Sjöstrand
authors.affiliation: Academy for care, work-life and welfare, University College of Borås, Borås, Sweden. lars.sandman@hb.se.|National Centre for Priority Setting in Health-care, Linköping University, Linköping, Sweden. lars.sandman@hb.se.
authors.forename: Lars
authors.initials: L
authors.lastname: Sandman
authors.affiliation: Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden. petter.karlsson82@gmail.com.
authors.forename: Petter
authors.initials: P
authors.lastname: Karlsson
authors.affiliation: Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden. gert.helgesson@ki.se.
authors.forename: Gert
authors.initials: G
authors.lastname: Helgesson
authors.affiliation: Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. stefan.eriksson@crb.uu.se.
authors.forename: Stefan
authors.initials: S
authors.lastname: Eriksson
authors.affiliation: Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden. niklas.juth@ki.se.
authors.forename: Niklas
authors.initials: N
authors.lastname: Juth
mesh_terms: D000328:Adult; D000368:Aged; D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders; D003657:Decision Making / Q000941:ethics*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D009014:Morals; D026706:Paternalism / Q000941:ethics*; D026684:Personal Autonomy; D011570:Psychiatry / Q000941:ethics*; D011613:Psychotherapy; D011795:Surveys and Questionnaires; D013548:Sweden