The authors present three ethical arguments to address the controversy of mandatory community treatment: rights-based versus beneficence, utilitarian, and communitarian. Each approach suggests that mandatory community treatment can be an ethical intervention for individuals with severe mental disorders in well-defined circumstances.
Full Answer
Is forced treatment in psychiatry ethical and legal?
Forced treatment in psychiatry cannot be defended, neither on ethical, legal or scientific grounds. It has never been shown that forced treatment does more good than harm, and it is highly likely that the opposite is true.
What is mandatory mental health treatment?
Mandated treatment offers access to mental health care that a person might not otherwise have. Some studies suggest that people pursuing court-ordered treatment may be less motivated in treatment or less likely to be honest with clinicians. Because treatment is mandatory, however, court-mandated treatments improve treatment completion rates.
What is forced mental health treatment?
Forced mental health treatment involves abduction, imprisonment, torture, and the list goes on and on, and any other persons besides those in the profession would be prosecuted for what is being done in mental hospitals.
What are the ethical arguments for mandatory community treatment?
The ethics of mandatory community treatment The authors present three ethical arguments to address the controversy of mandatory community treatment: rights-based versus beneficence, utilitarian, and communitarian. Each approach suggests that mandatory community treatment can be an ethical intervention for individuals with severe mental disord …
Is forced treatment ethical?
In summary, although involuntary outpatient treatment restricts patient autonomy, it is still considered ethical if the benefits of treatment and the potential harms of foregoing treatment are adequately established under a civil system that includes sufficient resources to render the treatment worthwhile.
What are some of the ethical issues concerning the treatment of mental illness?
Psychiatric research has several important ethical issues which are different from other medical disciplines. These issues are related to informed consent, confidentiality, conflict of interest, therapeutic misconception, placebo related, vulnerability, exploitation, operational challenges, among others.
What are the ethical principles in mental health?
Mental health providers live out the ethical principles of beneficence, nonmalefi- cence, justice, and respect for persons in their efforts to understand, appreciate, and empathize with their patients' cultural values and to use those abilities in the service of excellent patient care.
Is forced treatment of mentally ill justifiable?
Overview. People with mental illnesses have the right to choose the care they receive. Forced treatment–including forced hospitalization, forced medication, restraint and seclusion, and stripping–is only appropriate in the rare circumstance when there is a serious and immediate safety threat.
What are two ethical or legal rights and responsibilities of a mental health care worker?
respect for their individual human worth and dignity. respect for their privacy. respect for their confidentiality. comprehensive information, education, training and support to facilitate their care and support roles.
What are the ethical issues involved if a psychologist were to try to conduct research using someone with this abnormality as a subject for testing a treatment protocol?
Ethical Issues in PsychologyInformed Consent.Debrief.Protection of Participants.Deception.Confidentiality.Withdrawal.
What are the 5 basic ethical principles?
Moral Principles The five principles, autonomy, justice, beneficence, nonmaleficence, and fidelity are each absolute truths in and of themselves.
What are the 7 ethical principles?
This approach – focusing on the application of seven mid-level principles to cases (non-maleficence, beneficence, health maximisation, efficiency, respect for autonomy, justice, proportionality) – is presented in this paper.
What are the 4 ethical principles?
The Fundamental Principles of Ethics. Beneficence, nonmaleficence, autonomy, and justice constitute the 4 principles of ethics.
What ethical principle does involuntary treatment violate?
Coercive treatment can be justified only when a patient's capacity to consent is substantially impaired and severe danger to health or life cannot be prevented by less intrusive means. In this case, withholding treatment can violate the principle of justice.
Can someone be forced to take mental health medication?
United States. Mentally competent patients have a general right to refuse medical treatment. All states in the U.S. allow for some form of involuntary treatment for mental illness or erratic behavior for short periods of time under emergency conditions, although criteria vary.
Can mentally ill refuse treatment?
It may seem odd that a person can be involuntarily admitted, or “committed,” to a hospital and then refuse treatment. But the right to refuse treatment is also fundamental to the legal requirements for psychiatric treatment.
Is forced treatment good or bad?
It has never been shown that forced treatment does more good than harm, and it is highly likely that the opposite is true. We need to abolish our laws about this, in accordance with the United Nations Convention on the Rights of Persons with Disabilities, which virtually all countries have ratified.
Can forced treatment be defended?
Forced treatment cannot be defended, neither on ethical, legal or scientific grounds. We need to abolish our laws about this, in accordance with the United Nations Convention on the Rights of Persons with Disabilities. 1 The evidence we have tells us that forced treatment increases the harm done not only to patients but also to others. 2,6,14.15 Violence breeds violence, but perhaps the strongest argument against forced drugging and ECT is that, apart from psychiatric patients, only soldiers at war are forced to run risks against their will that might kill them. The difference is that soldiers have usually chosen themselves to become soldiers whereas psychiatric patients have not chosen to become psychiatric patients.
What is court mandated treatment?
Court-mandated treatments imply a dual role for therapy providers not only of caring for, but also of having control over, involuntary clients. The impact of legal coercion on the therapeutic relationship and feelings of stigma is widely regarded as negative and detrimental for treatment outcomes. This point of view stands in contrast to advocates of the perspective that involuntary treatment can ameliorate social functioning and thus promote a better quality of life. Regarding other outcome measures, there is evidence that offender treatment is effective and leads to reduced recidivism in criminal behavior. This narrative review provides an overview of research assessing the effects of mandatory treatment on therapeutic process and outcome factors. We conclude that legal mandatory treatment does not have to necessarily result in perceived coercion and reduced satisfaction with treatment and that a caring and authoritative treatment style aids a favorable therapeutic alliance, motivation, and therapy outcomes.
How does biomedical treatment affect criminal justice?
Biomedical interventions, such as pharmacological and neurological interventions, are increasingly being offered or considered for offer to offenders in the criminal justice system as a means of reducing recidivism and achieving offender rehabilitation through treatment . An offender’s consent to treatment may affect decisions about diversion from the criminal justice system, sentence or parole, and so hope for a preferable treatment in the criminal justice system may influence the offender’s consent. This thematic analysis of three focus group interviews conducted in Canada with members of the public investigates how the public views the use of biomedical treatments within the criminal justice system, and the practice of encouraging offender consent to biomedical treatment through the hope of a reduced criminal sentence. The public focus group discussions followed a semi-structured interview guide, and were based on two hypothetical case examples involving individuals choosing whether to consent to a range of cocaine addiction or anti-libidinal treatments respectively in the hope of receiving a more lenient sentence. The discussions covered a wide range of themes, and here we present the participants’ evaluations of this type of biomedical treatment offer in light of three key theoretical sentencing objectives: the promotion of public safety, the infliction of retributive punishment, and the rehabilitation of offenders. We conclude that public safety was the predominant concern of the participants when evaluating biomedical treatment offered at the time of sentencing to offenders who had committed serious crimes. Another important observation was that the public tended to reframe and evaluate biomedical interventions in terms of retribution and punishment, rather than rehabilitation and reform.
What is the aetiology of developmental and acquired paedophilia?
This article reviews the current neurobiological literature on the aetiology of developmental and acquired paedophilia and examines what the consequences could be in terms of responsibility and treatment for the latter. Addressing the question of responsibility and punishment of offenders with acquired paedophilia from a neurobiological perspective is controversial. Consequently it is essential to avoid hasty conclusions based strictly on neurobiological abnormality justifications. This study establishes a distinction between developmental and acquired paedophilia. The article investigates whether offenders who fulfil the diagnosis of acquired paedophilia should be held fully responsible, particularly in cases where the offender's conduct appears to result from volitionally controlled behaviour that is seemingly incompatible with a neurological cause. Moreover, the article explores how responsibility can be compromised when offenders with acquired paedophilia have (partially) preserved moral knowledge despite their sexual disorder. The article then examines the option of offering mandatory treatment as an alternative to imprisonment for offenders with acquired paedophilia. Furthermore, the article addresses the ethical issues related to offering any form of quasi-coercive treatment as a condition of release. This study concludes that decisions to fully or partially excuse an individual who fulfil the diagnosis of acquired paedophilia should take all relevant information into account, both neurobiological and other environmental evidence, and should proceed on a careful case by case analysis before sentencing or offering treatment. Copyright © 2015 Elsevier Ltd. All rights reserved.
What is neurobiology in criminology?
Current neurobiological research in the field of criminology focuses on the neurobiological characteristics associated with antisocial behavior, the prediction of antisocial behavior later in life based on neurobiological risk factors, and the ways in which neurobiological factors interact with psychological and environmental risk factors. Although the use of neurobiological knowledge has the potential to make several criminal justice practices more objective and humane, it may involve practices that are challenging with respect to stigma, neuro-determinism, autonomy and mental liberty. Four main areas of interest can be identified where neurobiology plays or could play a role: (1) criminological research focused on understanding criminal behavior, (2) the (early) detection/prediction of and intervention in deviant behavior, (3) criminal proceedings: to assess responsibility and inform sentencing, and (4) forensic rehabilitation and treatment settings. In this paper, I discuss the main ethical dilemmas that arise when considering the use of recent neurobiological advances in these areas.
What is the treatment for OUD?
Opioid use disorder (OUD) is highly prevalent among persons who are incarcerated. Medication treatment for opioid use disorder (MOUD), methadone, buprenorphine, and naltrexone, is widely used to treat OUD in the community. Despite MOUD’s well-documented effectiveness in improving health and social outcomes, its use in American jails and prisons is limited. Several factors are used to justify limited access to MOUD in jails and prisons including: “uncertainty” of MOUD’s effectiveness during incarceration, security concerns, risk of overdose from MOUD, lack of resources and institutional infrastructure, and the inability of people with OUD to provide informed consent. Stigma regarding MOUD also likely plays a role. While these factors are relevant to the creation and implementation of addiction treatment policies in incarcerated settings, their ethicality remains underexplored. Using ethical principles of beneficence/non-maleficence, justice, and autonomy, in addition to public health ethics, we evaluate the ethicality of the above list of factors. There is a two-fold ethical imperative to provide MOUD in jails and prisons. Firstly, persons who are incarcerated have the right to evidence-based medical care for OUD. Secondly, because jails and prisons are government institutions, they have an obligation to provide that evidence-based treatment. Additionally, jails and prisons must address the systematic barriers that prevent them from fulfilling that responsibility. According to widely accepted ethical principles, strong evidence supporting the health benefits of MOUD cannot be subordinated to stigma or inaccurate assessments of security, cost, and feasibility. We conclude that making MOUD inaccessible in jails and prisons is ethically impermissible.
What is the future of addiction treatment?
The future of treatment—including addiction treatment—is biotechnological. Depot injections, agonist/antagonist implants, deep brain stimulation, and hapten conjugate vaccines are hailed by researchers and pharmaceutical manufacturers as medicine's best hope to minimize illicit use, to decrease risk of overdose and painful withdrawal, and to prevent diversion of medicines to illicit markets. Marketing and use of new technologies reveal old tensions framing concepts of addiction and its treatment: between medical condition and disorder of the will, between criminal justice and health, and between patient choice and system control. Using the examples of depot naltrexone and implantable and injectable buprenorphine in the U.S., this essay considers the arc of long-acting opioid treatment and implications for the future. These include the rise of Vivitrol courts and “carceral prescription”—where criminal justice systems mandate medicine to lock up brain receptors much as they might lock up people themselves—as well as use of buprenorphine formulations positioned as increasing both patient benefit and provider control. We also consider lessons from debates on long-acting contraceptive technologies such as Norplant and Depo-Provera. While multiple new long-acting formulations are under development, success will be determined less by characteristics of particular formulations and more by whether or not the new technologies are accompanied by a new ethics of addiction treatment that emphasizes therapeutic alliance, concordance over compliance, and a genuine commitment to allowing patients the ability to narrate and be believed in their descriptions of their treatment experiences.
How does adolescence affect the risk of precocious use of psychoactive substances?
The physical, psychological and social modifications in adolescence deepen the condition of vulnerability and increase the risk of precocious use of psychoactive substances (PAS). This cross-sectional study covered 229 adolescent users of PAS under treatment at a psychosocial center for the care of children and adolescents (CAPSIA), during the first ten years of the service, with the purpose of outlining the bio-socio-psychological of the users and profile of the users and identifying risk factors for beginning drug use among adolescents. Most of the medical records belonging to male patients who practice or had practiced misdemeanors as school dropouts and had lived or live with family members who use drugs, and/or in situations of family aggression. Such data reveal a profile of vulnerability that generates a need for additional protection on the part of the diverse services for child and adolescent care, in different spheres.
When does mandatory treatment apply?
What Is Mandated Treatment and When Does It Apply? April 22, 2019 • By Zawn Villines. When mental health conditions contribute to violent or dangerous behavior, affect the way a person treats their children, or increase the risk of recidivism, a court may order treatment. A court may also compel treatment if a person is deemed a risk ...
Who should review mandated treatment?
People undergoing mandated treatment should review all of their options, especially if they are permitted to choose among several therapists or facilities. When court-mandated treatment requires a person to seek treatment from a specific person or organization, advocates such as lawyers and family members can be key.
What is court ordered treatment?
Research on the value of court-ordered treatment is mixed. Mandated treatment offers access to mental health care that a person might not otherwise have. Some studies suggest that people pursuing court-ordered treatment may be less motivated in treatment or less likely to be honest with clinicians.
What is the parole board?
The person is incarcerated, and the parole board offers treatment as a condition of early release. The person is a threat to themselves or others. A person with intense suicidal ideation may be ordered to get a psychiatric evaluation or be held in a mental health facility for a set period of time.
Why is court ordered treatment important?
Because treatment is mandatory, however, court-mandated treatments improve treatment completion rates. The benefits and risks of court-ordered treatment depend on the type of treatment, the client’s commitment to treatment, the skill of the treating clinician, and numerous other factors. The benefits and risks of court-ordered treatment depend on ...
How does incarceration affect mental health?
Researchers have repeatedly documented the harmful effects of incarceration on mental health. When court-mandated treatment helps a person avoid jail or prison time , it may prevent their mental health from deteriorating. Mandated programs also have some shortcomings.
What is informed refusal?
Legal principles of informed consent and informed refusal mean that a person cannot be forced into treatment without a court order. Some states offer a brief exception for 72 hour evaluation holds. In this scenario, however, a mental health professional must believe the person is a threat to themselves or others.
What was the involuntary treatment of psychiatric patients?
In the 19th and first half of the 20th centuries in America, involuntary psychiatric treatment was the domain of psychiatric hospitals, and prolonged commitments were easily obtained with few rights retained by patients. Over time, civil commitment laws were changed to reflect a greater emphasis on patient autonomy.
What happens if you are court ordered to involuntary outpatient treatment?
Patients who are court-ordered to involuntary outpatient treatment have demonstrated past failures to participate in outpatient treatment, subsequent clinical deterioration, and a return to involuntary inpatient treatment once the patient’s symptoms create an imminent risk of harm once again.
Why is civil process required?
It is because of concerns about such violations of a patient’s autonomy that a civil process is required to ensure that the magnitude of beneficence to the patient justifies their loss of autonomy. Ideally, involuntary outpatient treatment is a temporary condition. One hopes that after six months or longer of enforced adherence to treatment, ...
What is ethical issue?
ETHICAL ISSUES. Ethic is defined as “a set of moral principles, especially ones relating to or affirming a specified group, field, or form of conduct.” [5] Technically, ethics talk about morality and desirable way of behaving but may not be binding on an individual.
What are the legal aspects of patient care?
The legal aspects of patient care are determined by country-specific regulations, which in turn are governed by medical ethics. For instance, when an Indian psychiatrist is alleged of “wrongdoing,” it is determined whether he acted contrary to “medical ethics,”[6] or to the pertaining laws in the country.[1] .
What is absconding behavior in patients with mental illness?
Absconding behavior in patients with mental illness. When PWMI abscond from psychiatric hospitals, especially closed wards, it places an enormous burden on the hospital staff in terms of the legal implications. The absconders may not take care of self and may be at risk of harm to self, others, and property.
How many cases were acquitted of mental illness?
The 18 (17.65%) cases out of a total of 102 cases were acquitted on the grounds of mental illness. The Honorable High Courts’ judgment was mostly in line with the judgment of the lower Court and heavily relied on the documentary evidence of mental illness.
Why is lack of history a major problem in forensic psychiatric setting?
Also, because of unawareness regarding mental disorders, the only history obtained from the medical officer is of the patient being irritable or displaying suicidal threats. This is not enough to arrive at a diagnosis. Thus, the lack of adequate history is a major problem in a forensic psychiatric setting.
Is there a need for judicial policy in India?
In recent times, in India, there is an increased focus on training of judiciary and prison medical officers which is a welcome step. There is also a dire need to have a judicial policy that mandates caregiver's and/or family member's presence while referring such individuals to psychiatry hospitals.
Do faculty members have to be involved in legal aspects of patient care?
Third, the faculty members may not involve them in legal aspects of patient care, believing it is not their responsibility. In my place of work, which is a tertiary level teaching public hospital, the psychiatry residents are routinely involved in legal aspects of patient care.
What is mandatory treatment?
Mandatory treatment is defined as “treatment ordered, motivated, or supervised under the criminal justice system.”. Mandatory treatment is defined as “treatment ordered, motivated, or supervised under the criminal justice system.” 1 Going beyond the more common drug court approaches that offer a person charged with a crime the choice ...
Why is mandatory drug treatment important?
Researching the role of mandatory drug treatment is essential because it has wide-reaching policy applications. Of the 2.3 million incarcerated individuals in the United States, 1.5 million meet Diagnostic and Statistical Manual of Mental Disorders, 4th Edition(DSM-IV) criteria for substance abuse disorder, and another 458,000 do not meet strict ...
What comes to mind when hearing the term "coerced" or "compulsory" treatment?
What comes to mind when hearing the term “coerced” or “compulsory” treatment is typically “the kind of person who’s thinking, ‘I don’t want to do this,’ but is forced into a program anyway,” Dr Farabee observed.
What is compulsory drug treatment?
8 Compulsory drug treatment can be defined as “the mandatory enrollment of individuals, who are often but not necessarily drug-dependent, in a drug treatment program.” 8. Although compulsory drug treatment most frequently consists of “forced inpatient treatment,” it can ...
Is pharmacotherapy underused in criminal justice?
Pharmacotherapy. Evidence-based pharmacotherapies for substance use disorders are underused in criminal justice settings. 15 However, research suggests their efficacy in settings of incarceration.
Is motivational interviewing a stand alone treatment?
Motivational interviewing “has been widely validated as a stand-alone treatment, as a precursor to more extensive treatment, or integrated with other components, such as tailored feedback.” 14 Motivational interviewing has shown good outcomes in criminal justice settings and is a “tool for promoting evidence-based practice in the criminal justice system.” 14