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Ethical deliberations about involuntary treatment: interviews with Swedish psychiatrists
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Prioriteringscentrum, Linköpings universitet. (Vårdens organisering och ledarskap)ORCID iD: 0000-0003-0987-7653
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2015 (English)In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 16, article id 37Article in journal (Refereed) Published
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Abstract [en]

Background: Involuntary treatment is a key issue in healthcare ethics. In this study, ethical issues relating toinvoluntary psychiatric treatment are investigated through interviews with Swedish psychiatrists.

Methods: In-depth interviews were conducted with eight Swedish psychiatrists, focusing on their experiences ofand views on compulsory treatment. In relation to this, issues about patient autonomy were also discussed. Theinterviews were analysed using a descriptive qualitative approach.

Results: The answers focus on two main aspects of compulsory treatment. Firstly, deliberations about when andwhy it was justifiable to make a decision on involuntary treatment in a specific case. Here the cons and pros ofordering compulsory treatment were discussed, with particular emphasis on the consequences of providingtreatment vs. refraining from ordering treatment. Secondly, a number of issues relating to background factorsaffecting decisions for or against involuntary treatment were also discussed. These included issues about theSwedish Mental Care Act, healthcare organisation and the care environment.

Conclusions: Involuntary treatment was generally seen as an unwanted exception to standard care. The respondents’judgments about involuntary treatment were typically in line with Swedish law on the subject. However, it was alsoargued that the law leaves room for individual judgments when making decisions about involuntary treatment. Muchof the reasoning focused on the consequences of ordering involuntary treatment, where risk of harm to thetherapeutic alliance was weighed against the assumed good consequences of ensuring that patients received neededtreatment. Cases concerning suicidal patients and psychotic patients who did not realise their need for care weretypically held as paradigmatic examples of justified involuntary care. However, there was an ambivalence regarding theissue of suicide as it was also argued that risk of suicide in itself might not be sufficient for justified involuntary care. Itwas moreover argued that organisational factors sometimes led to decisions about compulsory treatment that couldhave been avoided, given a more patient-oriented healthcare organisation.

Place, publisher, year, edition, pages
2015. Vol. 16, article id 37
Keywords [en]
Psychiatry, Bioethics, Personal autonomy, Paternalism, Coercion, Involuntary commitment
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
URN: urn:nbn:se:hb:diva-8356DOI: 10.1186/s12910-015-0029-5ISI: 000359415500002PubMedID: 26016885OAI: oai:DiVA.org:hb-8356DiVA, id: diva2:891594
Available from: 2016-01-07 Created: 2016-01-07 Last updated: 2018-05-27Bibliographically approved

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