Compulsory Admission in Hong Kong: Balance between Paternalism and Patient Liberty

Siu, Bonnie W.M.; Fistein, Elizabeth; Leung, H.W.; Chan, L.S.Y.; Yan, C. K.; Lai, Anita C.H.; Yuen, K. K.; Ng, K.K.

doi:10.12809/eaap1825

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…In practice, evaluating the acceptability of a coercive measure often implies evaluating the patients' decision-making capacity (DMC). DMC is an important element to take into account because it refers to the principle of autonomy, and coercions imply overriding patient's autonomy ( 37 , 46 – 48 ). In some countries, the laws regulating coercion do not specifically refer to DMC, but in most countries and legal systems, one of the conditions for justifying coercion with a patient is his/her lack of DMC ( 26 , 27 , 34 , 47 ).…”

Section: Introductionmentioning

confidence: 99%

Coercive Measures in Psychiatry: A Review of Ethical Arguments

et al. 2021

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Introduction: Coercion is frequent in clinical practice, particularly in psychiatry. Since it overrides some fundamental rights of patients (notably their liberty of movement and decision-making), adequate use of coercion requires legal and ethical justifications. In this article, we map out the ethical elements used in the literature to justify or reject the use of coercive measures limiting freedom of movement (seclusion, restraint, involuntary hospitalization) and highlight some important issues.Methods: We conducted a narrative review of the literature by searching the PubMed, Embase, PsycINFO, Google Scholar and Cairn.info databases with the keywords “coercive/compulsory measures/care/treatment, coercion, seclusion, restraint, mental health, psychiatry, involuntary/compulsory hospitalization/admission, ethics, legitimacy.” We collected all ethically relevant elements used in the author's justifications for or against coercive measures limiting freedom of movement (e.g., values, rights, practical considerations, relevant feelings, expected attitudes, risks of side effects), and coded, and ordered them into categories.Results: Some reasons provided in the literature are presented as justifying an absolute prohibition on coercion; they rely on the view that some fundamental rights, such as autonomy, are non-negotiable. Most ethically relevant elements, however, can be used in a balanced weighting of reasons to favor or reject coercive measures in certain circumstances. Professionals mostly agree that coercion is only legitimate in exceptional circumstances, when the infringement of some values (e.g., freedom of movement, short-term autonomy) is the only means to fulfill other, more important values and goals (e.g., patient's safety, the long-term rebuilding of patient's identity and autonomy). The results of evaluations vary according to which moral elements are prioritized over others. Moreover, we found numerous considerations (e.g., conditions, procedural values) for how to ensure that clinicians apply fair decision-making procedures related to coercion. Based on this analysis, we highlight vital topics that need further development.Conclusion: Before using coercive measures limiting freedom of movement, clinicians should consider and weigh all ethically pertinent elements in the situation and actively search for alternatives that are more respectful of patient's well-being and rights. Coercive measures decided upon after a transparent, carefully balanced evaluation process are more likely to be adequate, understood, and accepted by patients and caregivers.

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Section: Introductionmentioning

confidence: 99%

Coercive Measures in Psychiatry: A Review of Ethical Arguments

et al. 2021

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“…In Hong Kong, the Mental Health Ordinance was largely developed from the UK Mental Health Act 1983 and has been last edited in July 2022 (Cheung et al, 2000; Hong Kong e-Legislation, 2022). In a large local public psychiatric hospital, 26.9% of psychiatric admissions were involuntary during 2012–2017 (Siu et al, 2018). However, 22% of these were diagnosed as dementia, developmental disorders, or learning disability, which was excluded in this study.…”

Section: Discussionmentioning

confidence: 99%

Impact of Severe Acute Respiratory Syndrome, Coronavirus Disease 2019, and Social Unrest on Adult Psychiatric Admissions in Hong Kong

Ma,

Chien,

Luo

et al. 2023

J Nerv Ment Dis

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In Hong Kong, two infectious disease outbreaks occurred in 2003 (SARS) and 2020 (COVID-19), and a large-scale social unrest happened in 2019. These were stressful societal events that influenced the mental well-being of the public. We aimed to explore the impact of these events on psychiatric admissions in Hong Kong. Socioeconomic and population-based psychiatric hospital admission data were retrieved from the government and Hospital Authority. Negative binomial time-series regression analysis was applied and we found overall significant reductions of psychiatric admissions during both the SARS and COVID-19 periods (−7.4% to −16.8%). Particularly, the admissions for unipolar disorders (−16.2% to −39.7%) and neuroses (−20.9% to −31.9%) were greatly reduced during the infection outbreaks. But an increase of admissions for schizophrenia (12.0%) was seen during the social unrest period. These findings support introducing early and targeted community mental health care strategies to the vulnerable people during the stressful societal events.

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“…In Hong Kong, compulsory admission is governed by the Mental Health Ordinance (Chapter 136) Section 31 (detention of a patient under observation), Section 32 (extension of period of detention of a patient under observation), Section 36 (detention of certified patients), and the sections in Part IV such as those for Hospital Order, Transfer Order, and Removal Order. Siu et al 5 reviewed the literature and the mental health laws in Hong Kong concerning the 'legal criteria' and 'practical criteria' in the application of compulsory admission by mental health professionals. In addition, the harm principle, the patient's decision-making capacity, and issues of paternalism and patient's liberty were explored.…”

Section: Forensic Psychiatric Services In Hong Kongmentioning

confidence: 99%

Forensic Psychiatric Services in Hong Kong

2018

East Asian Arch Psychiatry

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Compulsory Admission in Hong Kong: Balance between Paternalism and Patient Liberty

Cited by 3 publications

References 19 publications

Coercive Measures in Psychiatry: A Review of Ethical Arguments

Coercive Measures in Psychiatry: A Review of Ethical Arguments

Impact of Severe Acute Respiratory Syndrome, Coronavirus Disease 2019, and Social Unrest on Adult Psychiatric Admissions in Hong Kong

Forensic Psychiatric Services in Hong Kong

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