Évolution des pratiques institutionnelles : questions éthiques autour de l'enfermement et de l'isolement

Cano, Nicole; Boyer, Laurent

doi:10.3917/inpsy.8707.0589

Cited by 3 publications

(10 citation statements)

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“…( 1 ). Protection from violence is a key reason to use coercive measures limiting freedom of movement in psychiatry ( 2 , 3 ); several authors state this as a reason in favor of such measures, often as the central reason ( 1 , 4 , 6 , 9 , 17 , 18 , 29 , 31 , 40 , 42 , 47 , 72 – 76 , 81 , 88 , 89 , 91 – 93 , 96 – 98 , 105 , 113 , 114 , 127 , 128 , 134 ). Psychiatry is caught between expectations of care, safety, and even sometimes a degree of social control (judicial authority) ( 26 , 42 , 87 , 91 , 110 , 123 ).…”

Section: Resultsmentioning

confidence: 99%

“…This generates tension and pressure that clinicians should be aware of to make an ethical decision. Using coercive actions to prevent a potential and/or indirect risk to others is, in any case, not the same as punishing a person who has already attacked someone else, a role clearly outside the scope of psychiatry ( 31 , 72 , 73 ).…”

Section: Resultsmentioning

confidence: 99%

“…Another element used to legitimize coercion is the therapeutic relationship. Patient-caregiver interactions are valued and, in certain circumstances, may be improved by using coercion ( 4 , 72 , 74 ). For instance, this is the case if the patient, in an advanced care planning phase, has agreed with the caregiver that coercion is the best therapeutic means to overcome a crisis.…”

Section: Resultsmentioning

confidence: 99%

“…If there are other, more human rights-friendly alternatives, this will constitute a reason not to use coercion ( 18 , 32 , 72 ). Some authors attribute the use of unjustified coercion in psychiatry to an inadequate assumption of authority-with-the-right-to-impose ( 42 , 91 ).…”

Section: Resultsmentioning

confidence: 99%

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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: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Coercive Measures in Psychiatry: A Review of Ethical Arguments

et al. 2021

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“…Notre approche se distingue à la fois de celles de Grenouilloux (2012) et Hum (2011), qui se concentrent sur la réflexion éthique menée dans le cadre de comités d'éthique en psychiatrie, mais aussi des études menées sur des pratiques particulières, telles l'isolement (Cano et Boyer, 2011), et de celle de Cano (2009) portant sur des principes éthiques. N. Cano (2009) s'efforce de vérifier l'application de principes éthiques définis ex ante (principes d'autonomie, de bienfaisance et de non-malfaisance), en référence au travail de Beauchamp et Childress, dans les pratiques psychiatriques.…”

Section: Introductionunclassified

Le sens de l’éthique en psychiatrie. Par delà Beauchamp et Childress

Lafaye

2016

Éthique & Santé

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L'éthique médicale s'appuie aujourd'hui de façon privilégiée sur le principisme développé par Beauchamp et Childress. Nous montrons, à partir d'une étude de sociologie qualitative, le sens de l'éthique tel qu'il se trouve spontanément formulé par des médecins psychiatres est irréductible, en particulier à la bienfaisance et à l'autonomie. Nous soulignerons, en premier lieu, que l'éthique s'interprète, du fait de la tradition psychothérapeutique française, en terme moraux par référence à notre humanité, puis que la question de la responsabilité porte la psychiatrie au-delà de l'autonomie. Nous montrons enfin que la question de l'éthique intervient, par excellence, dans la confrontation des normes structurant l'exercice de cette discipline et dans son rapport aux principes constitutionnels.

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Isolement et contention en psychiatrie, facteurs d’influence et alternatives

Morisset¹

2018

Recherche en Soins Infirmiers

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Évolution des pratiques institutionnelles : questions éthiques autour de l'enfermement et de l'isolement

Cited by 3 publications

References 4 publications

Coercive Measures in Psychiatry: A Review of Ethical Arguments

Coercive Measures in Psychiatry: A Review of Ethical Arguments

Le sens de l’éthique en psychiatrie. Par delà Beauchamp et Childress

Isolement et contention en psychiatrie, facteurs d’influence et alternatives

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