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Ethical deliberations about involuntary treatment: interviews with Swedish psychiatrists
BACKGROUND: Involuntary treatment is a key issue in healthcare ethics. In this study, ethical issues relating to involuntary psychiatric treatment are investigated through interviews with Swedish psychiatrists. METHODS: In-depth interviews were conducted with eight Swedish psychiatrists, focusing on...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4446957/ https://www.ncbi.nlm.nih.gov/pubmed/26016885 http://dx.doi.org/10.1186/s12910-015-0029-5 |
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author | Sjöstrand, Manne Sandman, Lars Karlsson, Petter Helgesson, Gert Eriksson, Stefan Juth, Niklas |
author_facet | Sjöstrand, Manne Sandman, Lars Karlsson, Petter Helgesson, Gert Eriksson, Stefan Juth, Niklas |
author_sort | Sjöstrand, Manne |
collection | PubMed |
description | BACKGROUND: Involuntary treatment is a key issue in healthcare ethics. In this study, ethical issues relating to involuntary psychiatric treatment are investigated through interviews with Swedish psychiatrists. METHODS: In-depth interviews were conducted with eight Swedish psychiatrists, focusing on their experiences of and views on compulsory treatment. In relation to this, issues about patient autonomy were also discussed. The interviews were analysed using a descriptive qualitative approach. RESULTS: The answers focus on two main aspects of compulsory treatment. Firstly, deliberations about when and why it was justifiable to make a decision on involuntary treatment in a specific case. Here the cons and pros of ordering compulsory treatment were discussed, with particular emphasis on the consequences of providing treatment vs. refraining from ordering treatment. Secondly, a number of issues relating to background factors affecting decisions for or against involuntary treatment were also discussed. These included issues about the Swedish 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 also argued that the law leaves room for individual judgments when making decisions about involuntary treatment. Much of the reasoning focused on the consequences of ordering involuntary treatment, where risk of harm to the therapeutic alliance was weighed against the assumed good consequences of ensuring that patients received needed treatment. Cases concerning suicidal patients and psychotic patients who did not realise their need for care were typically held as paradigmatic examples of justified involuntary care. However, there was an ambivalence regarding the issue of suicide as it was also argued that risk of suicide in itself might not be sufficient for justified involuntary care. It was moreover argued that organisational factors sometimes led to decisions about compulsory treatment that could have been avoided, given a more patient-oriented healthcare organisation. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12910-015-0029-5) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-4446957 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-44469572015-05-29 Ethical deliberations about involuntary treatment: interviews with Swedish psychiatrists Sjöstrand, Manne Sandman, Lars Karlsson, Petter Helgesson, Gert Eriksson, Stefan Juth, Niklas BMC Med Ethics Research Article BACKGROUND: Involuntary treatment is a key issue in healthcare ethics. In this study, ethical issues relating to involuntary psychiatric treatment are investigated through interviews with Swedish psychiatrists. METHODS: In-depth interviews were conducted with eight Swedish psychiatrists, focusing on their experiences of and views on compulsory treatment. In relation to this, issues about patient autonomy were also discussed. The interviews were analysed using a descriptive qualitative approach. RESULTS: The answers focus on two main aspects of compulsory treatment. Firstly, deliberations about when and why it was justifiable to make a decision on involuntary treatment in a specific case. Here the cons and pros of ordering compulsory treatment were discussed, with particular emphasis on the consequences of providing treatment vs. refraining from ordering treatment. Secondly, a number of issues relating to background factors affecting decisions for or against involuntary treatment were also discussed. These included issues about the Swedish 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 also argued that the law leaves room for individual judgments when making decisions about involuntary treatment. Much of the reasoning focused on the consequences of ordering involuntary treatment, where risk of harm to the therapeutic alliance was weighed against the assumed good consequences of ensuring that patients received needed treatment. Cases concerning suicidal patients and psychotic patients who did not realise their need for care were typically held as paradigmatic examples of justified involuntary care. However, there was an ambivalence regarding the issue of suicide as it was also argued that risk of suicide in itself might not be sufficient for justified involuntary care. It was moreover argued that organisational factors sometimes led to decisions about compulsory treatment that could have been avoided, given a more patient-oriented healthcare organisation. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12910-015-0029-5) contains supplementary material, which is available to authorized users. BioMed Central 2015-05-28 /pmc/articles/PMC4446957/ /pubmed/26016885 http://dx.doi.org/10.1186/s12910-015-0029-5 Text en © Sjöstrand et al.; licensee BioMed Central. 2015 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Sjöstrand, Manne Sandman, Lars Karlsson, Petter Helgesson, Gert Eriksson, Stefan Juth, Niklas Ethical deliberations about involuntary treatment: interviews with Swedish psychiatrists |
title | Ethical deliberations about involuntary treatment: interviews with Swedish psychiatrists |
title_full | Ethical deliberations about involuntary treatment: interviews with Swedish psychiatrists |
title_fullStr | Ethical deliberations about involuntary treatment: interviews with Swedish psychiatrists |
title_full_unstemmed | Ethical deliberations about involuntary treatment: interviews with Swedish psychiatrists |
title_short | Ethical deliberations about involuntary treatment: interviews with Swedish psychiatrists |
title_sort | ethical deliberations about involuntary treatment: interviews with swedish psychiatrists |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4446957/ https://www.ncbi.nlm.nih.gov/pubmed/26016885 http://dx.doi.org/10.1186/s12910-015-0029-5 |
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