What is coercive treatment in mental health?
While coercive actions can be acceptable in order to protect close family and others, medical treatment is not justified for such reasons but should be given only in the interest of patients. Coercive treatment may be required in order to promote the patient's health interests, but health interests have to waive if they go against the autonomous interests of the patient.
When is coercive treatment justified?
Jun 20, 2010 · The term coercion is reserved to describe situations in which clients perceive a lack of control over the decision to enter treatment. In other words, coerced treatment refers to that which is perceived as an imposition and an infringement on autonomy, regardless of the agent or source.
Does coercive treatment for trauma work?
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.
What is coercion in addiction treatment?
Background: Coercive treatment comprises a broad range of practices, ranging from implicit or explicit pressure to accept certain treatment to the use of forced practices such as involuntary admission, seclusion and restraint. Coercion is common in mental health services.
What are coercive interventions?
Coercive medico-legal interventions are often employed to prevent people deemed to be unable to make competent decisions about their health, such as minors, people with mental illness, disability or problematic alcohol or other drug use, from harming themselves or others.
What is psychiatric coercion?
Coercion in psychiatric care is seen in the form of involuntary admission, involuntary treatment, seclusion/restraint, outpatient commitment, and in the Indian context, also includes surreptitious treatment.
What is coercion in medicine?
Coercion is defined as every (medical) measure taken against the (natural) will of the person affected.
Can a person with mental illness give consent?
All mentally capable people have the right to make autonomous decisions for their lives based on free and informed consent.
What are the types of coercion?
These actions may include extortion, blackmail, torture, threats to induce favors, or even sexual assault. In law, coercion is codified as a duress crime.
What is coercive restraint therapy?
The term coercive restraint therapy (CRT) describes a category of alternative mental health interventions that are generally directed at adopted or foster children, that are claimed to cause alterations in emotional attachment, and that employ physically intrusive techniques.Aug 9, 2005
What is meant by coercion?
noun. the act of coercing; use of force or intimidation to obtain compliance. force or the power to use force in gaining compliance, as by a government or police force.
Is medical coercion a crime?
Medical coercion to be made a specific criminal offence that carries a maximum sentence of life imprisonment. Any person, organisation or business will be liable to prosecution for committing, or attempting to commit the offence of medical coercion against any individual or group of people.Apr 1, 2021
Is medical coercion legal?
If a person is suffering from a mental illness that causes them to lack the ability to consent to medical treatments, the court system and law enforcement can force them to be treated by medical professionals.Jun 7, 2018
Can mentally ill patients refuse treatment?
But the right to refuse treatment is also fundamental to the legal requirements for psychiatric treatment. Someone who enters a hospital voluntarily and shows no imminent risk of danger to self or others may express the right to refuse treatment by stating he or she wants to leave the hospital.Aug 6, 2013
What are the 4 types of consent?
Types of consent include implied consent, express consent, informed consent and unanimous consent.
What causes anosognosia?
What Causes It? Experts think anosognosia results from damage to an area of the brain involved in self-reflection. Everyone, regardless of their health status, is constantly updating their mental image of themselves.Oct 20, 2020
What are the principles of coercive treatment?
The author discusses a pragmatic approach to decisions about coercive treatment that is based on four principles from principle-based ethics: respect for autonomy, nonmaleficence, beneficence, and justice . This approach can reconcile psychiatry’s perspective with the U.N. Convention on the Rights of Persons With Disabilities.
What are the principles of ethics in medicine?
On the basis of an analysis of all historical approaches in medical ethics, Beauchamp and Childress ( 3) identified four equivalent principles: respect for the patient’s autonomy, beneficence, nonmaleficence, and justice. With respect to patient autonomy and therapy, the gold standard is the concept of “informed consent.” The physician’s duty is to enable an autonomous decision by the patient, based on free will and in full knowledge of beneficial and potential adverse aspects of the suggested therapy, ideally consenting in shared decision making. There is evidence that shared decision making is as possible in psychiatry as it is in any other medical disciplines ( 4 ). However, ethical principles are sometimes in conflict, rendering decisions about ethically appropriate actions difficult, particularly when, in the view of others, the patient’s expressed intentions seem unreasonable and in contradiction to his or her best interest. The use of coercion in such cases by definition violates the principle of autonomy. Furthermore, coercive treatment can impose harm on the patient because of short-term and long-term medication side effects and psychological distress. Therefore, the use of coercion can be justified only if the principles of beneficence (acting in the patient’s best interest), nonmaleficence, or justice are in strong contradiction to the patient’s expressed will and if convincing observations indicate that the patient’s autonomy is severely undermined.
Why is coercive treatment important?
This is important for treatment of people with impaired responsibility due to mental illness and dangerous behavior against others.
What is capacity to consent?
The ethical concept of capacity to consent differs from legal competence. Capacity to consent is always related to a concrete situation. Patients must be able to understand relevant information, relate that information to their personal situation, and make a balanced decision ( 5 ). Many instruments have been developed to assess capacity, and it is well known that clinicians tend to overestimate their patients’ capacity ( 6 ). In most European countries, however, such instruments are considered to be inappropriate and are not used in practice. Assessment of capacity is viewed as a complex idiographic, empathic procedure that should take into account the patient’s cognitive capacity, emotional and psychopathological features, history, and personality.
Is involuntary treatment justified?
Involuntary treatment is thus justified by improvement of the patient’s health, not by danger to others. As in the case of any citizen, dangerous behavior against others justifies restriction of freedom, but it does not justify involuntary treatment by a physician.
Is coercive treatment ethical?
First, coercive treatment can be ethically justified in a very limited number of cases as a last resort and under strict conditions. The individuals in these cases can be found in psychiatric service settings and in nursing homes that care for patients with primary diagnoses of mental disorders.
Principle-Based Ethics
- Principle-based ethics is now the most common approach in medical ethics. On the basis of an analysis of all historical approaches in medical ethics, Beauchamp and Childress (3) identified four equivalent principles: respect for the patient’s autonomy, beneficence, nonmaleficence, and justice. With respect to patient autonomy and therapy, the gold standard is the concept of “infor…
Autonomy, Insight, and Capacity to Consent
- The ethical concept of capacity to consent differs from legal competence. Capacity to consent is always related to a concrete situation. Patients must be able to understand relevant information, relate that information to their personal situation, and make a balanced decision (5). Many instruments have been developed to assess capacity, and it is well known that clinicians tend to …
Beneficence, Or Acting in A Patient’S Best Interest
- In international statements and guidelines, there is a high level of consensus that only severe danger to a patient’s health or life can justify the use of coercion. However, it may be difficult to reach a consensus on what constitutes a severe danger. In the case of Anna, it is obvious that a disruption of treatment would pose serious threats to her physical health and might endanger he…
Dangerous Behavior Against Others
- If interventions that restrict freedom, such as prolonged involuntary inpatient treatment, seclusion, or even detention in forensic psychiatric units, become necessary as a result of dangerousness or dangerous behavior, psychosocial health is likely to deteriorate severely. Preventing such outcomes can also be considered as acting in the interest of a patient’s health. Thus treatment a…
Nonmaleficence, Or Avoiding Harm
- Avoiding harm is the counterpart of doing good for a patient. Ethical considerations have to take into account the abundant body of conflicting evidence related to antipsychotic treatment along with the patient’s individual attitudes and previous experiences with treatment. Although short-term coercive treatment in emergencies might be considered to pose fewer ethical conflicts tha…
Justice
- When patients like Thomas refuse treatment, psychiatric hospitals may benefit. When such patients are not admitted, it is probably beneficial for the ward atmosphere: an open ward policy can be maintained, ward statistics on the use of coercion may look better, and stigma related to the institution may be reduced. However, allowing the patient to refuse treatment means that in…
Consequences
- Some consequences can also be drawn from this ethical analysis with respect to clinical practice and legislation, and these consequences can be considered as applicable in all countries. First, coercive treatment can be ethically justified in a very limited number of cases as a last resort and under strict conditions. The individuals in these cases can be found in psychiatric service settin…