Ethical issues in family planning for hospitalized psychiatric patients

Abstract

The authors present guidelines based on their experience with a family planning program for patients in mental hospitals. They believe that informed consent for these patients should include an adequate knowledge base, the patients' competence to make decisions, and the absence of coercion. Among safeguards are the reversibility of contraceptive procedures, the separation of the family planning counselor from the treatment staff to avoid possible covert coercion, and careful choice of the stage of hospitalization at which counseling occurs. The authors examine the implications of a patient's refusal to use contraception, noting the impossibility of involuntary contraception and the ethical and legal problems regarding sterilization procedures.

Pregnancy and severe mental illness: Confounding ethical doctrines

“…These include education about resisting unwanted sexual advances, contraception use, the possible benefits and risks of pregnancy, and advocacy of condom use among male partners. A few studies undertaken nearly 50 years ago in some psychiatric hospitals in the uS (43,44) emphasised the acquisition of informed consent for contraception, the importance of voluntarism, and the usage of reversible methods of contraception. Although the presently available long-term and reversible contraceptives may prove to be very successful among this population, but their non-removal on request of patients, or utilising coercion or manipulation in view of the principle of beneficence may be outweighed by respect for the patient's autonomy despite an impaired decision-making (8).…”

Family Planning and the Scope of the “Reproductive Psychiatry” Curriculum

“…The family planning program that was conducted in state mental hospitals in Massachusetts emphasized the importance of obtaining informed consent for contraception, the importance of voluntarism, and the importance of an exclusive reliance on reversible methods of contraception [14,49]. A preventive ethics strategy involves proactively discussing family planning with patients with mental disorders in order to reduce the risk of ethical dilemmas and adverse ethical outcomes [50].…”