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  • 1. Sjostrand, Manne
    et al.
    Karlsson, Petter
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Prioriteringscentrum, Linköpings universitet.
    Helgesson, Gert
    Eriksson, Stefan
    Juth, Niklas
    Conceptions of decision-making capacity in psychiatry: interviews with Swedish psychiatrists2015In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 16, article id 34Article in journal (Refereed)
  • 2. Sjöstrand, Manne
    et al.
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Prioriteringscentrum, Linköpings universitet.
    Karlsson, Petter
    Helgesson, Gert
    Eriksson, Stefan
    Juth, Niklas
    Ethical deliberations about involuntary treatment: interviews with Swedish psychiatrists2015In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 16, article id 37Article in journal (Refereed)
    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.

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