What Is Coercion and Can Its Use Be Justified in Mental Healthcare? An Ethical Analysis

Abstract

The use of coercion within mental healthcare raises many ethically relevant questions. These include the analytical question about which actions amount to coercion, and the normative question whether and in which situations the use of coercion is justified. This chapter aims to provide an overview of answers to these questions. In answer to the analytical question, we discuss the conceptual distinction between formal and informal coercion. While formal coercion includes interventions that are carried out against the will of service users, informal coercion aims at influencing the will and decision-making of service users to enhance compliance with recommended treatment or social rules. In answer to the normative question, we will differentiate two different argumentative strategies: one based on the harm principle and one based on soft paternalism. We also discuss a third position, which holds that the use of coercion is never justified. The chapter closes by introducing self-binding directives, a type of psychiatric advance directive, as a possible way to reconcile autonomy and coercion.