Paternalism<i>v</i>. autonomy – are we barking up the wrong tree?

Lepping, Peter; Palmstierna, Tom; Raveesh, Bevinahalli Nanjegowda

doi:10.1192/bjp.bp.116.181032

Cited by 29 publications

(20 citation statements)

References 6 publications

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“…It has been argued through paternalistic grounds that involuntary treatment can be justified, namely that overruling of the patient's autonomy is not always permanent. For example, involuntary treatment during a psychotic episode may restore a patient's capacity, which would allow them to then make autonomous decisions [61].…”

Section: Discussionmentioning

confidence: 99%

“…Ethical issues related to the involuntary treatment of patients with psychiatric illness include conflicts between the principles of beneficence, autonomy and nonmaleficence. In medical ethics, beneficence (do good), nonmaleficence (do no harm), and autonomy should be valued equally [61,85]. Healthcare providers work toward achieving a balance between patients' interests and those of society, and patient autonomy can be compromised when addressing this balance [85].…”

Section: Discussionmentioning

confidence: 99%

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Experiences with legally mandated treatment in patients with schizophrenia: A systematic review of qualitative studies

et al. 2020

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Background: Patients with severe mental illness, including schizophrenia, may be legally mandated to undergo psychiatric treatment. Patients’ experiences in these situations are not well characterized. This systematic review of qualitative studies aims to describe the experiences of patients with schizophrenia and related disorders who have undergone legally mandated treatment. Methods: Four bibliographic databases were searched: CINAHL Plus (1981–2019), EMBASE (1947–2019), MEDLINE (1946–2019), and PsycINFO (1806–2019). These databases were searched for keywords, text words, and medical subject headings related to schizophrenia, legally mandated treatment and patient experience. The reference lists of included studies and systematic reviews were also investigated. The identified titles and abstracts were reviewed for study inclusion. A thematic analysis was completed for the synthesis of positive and negative aspects of legally mandated treatment. Results: A total of 4,008 citations were identified. Eighteen studies were included in the final synthesis. For the thematic analysis, results were collated under two broad themes; positive patient experiences and negative patient experiences. Patients were satisfied when their autonomy was respected, and dissatisfied when it was not. Patients often retrospectively recognized that their treatment was beneficial. Furthermore, negative aspects of the treatment included deficits in communication and a lack of information. Conclusions: Intervention research has historically focused on clinical outcomes and the quantitative aspects of treatment. Thus, this study provides insight into the qualitative aspects of patients’ experiences with legally mandated treatment. Recognizing these opinions and experiences can lead to better attitudes toward treatment for patients with schizophrenia and related psychiatric illnesses.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Experiences with legally mandated treatment in patients with schizophrenia: A systematic review of qualitative studies

et al. 2020

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“…Consideration patient autonomy stands on the opposite side of medical paternalism. 27,28 Paternalistic medicine is deeply embedded in Iranian culture. 29 It seems in this kind of circumstances the nurses may find themselves disempowered by medical paternalism or ill-equipped in the decision-making process and may increase patient dependency inactive relationships.…”

Section: Discussionmentioning

confidence: 99%

The Relationship between Nurses’ Moral Sensitivity and Patients’ Satisfaction with the Care Received in the Medical Wards

et al. 2019

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Introduction: The quality of care affects patients’ satisfaction. To provide high quality care, nurses face ethical challenges in daily practice. Moral sensitivity is the first phase in moral implementation. This study aimed to determine the relationship between nurses’ moral sensitivity and patients’ satisfaction in medical wards. Methods: In descriptive correlational study 198 nurses and 198 patients in 17 medical wards filled out the Moral Sensitivity Questionnaire (MSQ) and Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ), respectively. Nurses were sampled by the census method. For each nurse, a patient was selected randomly from the same ward. Data were analyzed using SPSS version 13. Results: The highest scores were in the dimensions of “relational orientation” and “following the rules”, and the lowest scores were in the dimensions of “autonomy” and “experiencing moral conflicts”. The highest level of patients’ satisfaction was with “nurses’ professional performance” 3.98 (1.09), and the lowest level was with “nurses’ routine work” 2.69 (1.22). There was no significant relationship between the mean of patient satisfaction and moral sensitivity of nurses. Conclusion: Considering that nurses had a higher score in dimension of “following the rules” and a lower score in dimension of “autonomy”, it seems ethical performance in the real situation is not merely due to the nurses’ moral sensitivity and it seems the complexity of the organization causes nurses face difficulties in making decisions related to clinical practice; therefore, policy makers in the health system should be able to identify barriers.

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“…Autonomy appears to have become the unquestionable central ethical principle,[ 16 ] and paternalism has been vilified as universally negative. The general comment on article 12 of the UNCRPD has further cemented this in the international context.…”

Section: Discussionmentioning

confidence: 99%

New legislation, new frontiers: Indian psychiatrists' perspective of the mental healthcare act 2017 prior to implementation

Duffy

Narayan

Goyal

et al. 2018

Indian J Psychiatry

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Context:The mental healthcare act 2017 represents a complete overhaul of Indian mental health legislation.Aims:The aim of this study was to establish the opinions of Indian psychiatrists regarding the new act.Settings:Mental health professionals in Bihar and Jharkhand were interviewed.Design:A focus group design was utilized.Materials and Methods:Key questions explored the positive and negative aspects of the act and the management of the transitional phase. All focus groups were recorded and transcribed.Analysis:Data were coded and analyzed using an inductive approach.Results:Many positive aspects of the new legislation were identified especially relating to rights, autonomy, and the decriminalization of suicide. However, psychiatrists have significant concerns that the new legislation may negatively impact patients and increase stigma. Psychiatrists held varying views on the proposed licensing and inspection of general hospital psychiatric units.Conclusions:Careful evaluation of the new legislation is needed as the concerns raised warrant ongoing monitoring.

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Paternalismv. autonomy – are we barking up the wrong tree?

Cited by 29 publications

References 6 publications

Experiences with legally mandated treatment in patients with schizophrenia: A systematic review of qualitative studies

Experiences with legally mandated treatment in patients with schizophrenia: A systematic review of qualitative studies

The Relationship between Nurses’ Moral Sensitivity and Patients’ Satisfaction with the Care Received in the Medical Wards

New legislation, new frontiers: Indian psychiatrists' perspective of the mental healthcare act 2017 prior to implementation

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