Ethics of deliberation, consent and coercion in psychiatry

Abstract

In psychiatry, caregivers try to get free and informed consent of patients, but often feel required to restrict freedom and to use coercion. The present article develops ethical advice given by an Ethics Committee for Mental Health Care. The advice recommends an ethical ideal of shared deliberation, consisting of information, motivation, consensus and evaluation. For the exceptional use of coercion, the advice develops three criteria, namely incapacity to deliberate, threat of serious harm and proportionality between harm and coercion. The article also discusses the viewpoints of the ethical advice and of the European Convention on Human Rights and Biomedicine: is the advice in agreement with the Convention and can the advice refine the guidelines of the Convention for the particular context of psychiatry? Although the Convention emphasises the autonomy of the individual patient, whereas the advice focuses on the relationships between the partners involved, the advice enjoys a complementary and supportive function in the application of the Convention.

Forgetting ourselves: epistemic costs and ethical concerns in mindfulness exercises

“…First, the requirement for informed consent has been supplemented in many practices by a requirement for shared deliberation, in which clients discuss the pros and cons of therapeutic approaches with mental health providers, and aim to come to a shared decision 19. If mental health providers enter such discussions believing that mindfulness exercises have no metaphysical implications, or that it is never reasonable to refuse therapy for these reasons, then they may under-rate patients’ legitimate concerns.…”

Seclusion and its context in acute inpatient psychiatric care

“…Liegeois and Eneman30 provide the following three criteria where coercion maybe contemplated. First, the patient must lack the capacity to deliberate or exercise control in relation to their behaviour.…”

Ethical Aspects of the Prevention of Suicide in Psychiatry

“…In some situations, the client will cooperate; in others, the client may resist so that the freedom-restricting precaution becomes a coercive measure. From an ethical point of view, three criteria for the use of restriction of freedom or coercion can be discerned (Liégeois & Eneman, 2008). All of the criteria are considered essential prerequisites in the justification of a freedom-restricting or coercive measure.…”

“…From an ethical point of view, such decision is best taken in dialogue with the client (Liégeois & Eneman, 2008).…”