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Against Ulysses contracts for patients with borderline personality disorder

Patients with borderline personality disorder (BPD) sometimes request to be admitted to hospital under compulsory care, often under the argument that they cannot trust their suicidal impulses if treated voluntarily. Thus, compulsory care is practised as a form of Ulysses contract in such situations....

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Autores principales: Lundahl, Antoinette, Helgesson, Gert, Juth, Niklas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Netherlands 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538402/
https://www.ncbi.nlm.nih.gov/pubmed/32676951
http://dx.doi.org/10.1007/s11019-020-09967-y
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author Lundahl, Antoinette
Helgesson, Gert
Juth, Niklas
author_facet Lundahl, Antoinette
Helgesson, Gert
Juth, Niklas
author_sort Lundahl, Antoinette
collection PubMed
description Patients with borderline personality disorder (BPD) sometimes request to be admitted to hospital under compulsory care, often under the argument that they cannot trust their suicidal impulses if treated voluntarily. Thus, compulsory care is practised as a form of Ulysses contract in such situations. In this normative study we scrutinize the arguments commonly used in favour of such Ulysses contracts: (1) the patient lacking free will, (2) Ulysses contracts as self-paternalism, (3) the patient lacking decision competence, (4) Ulysses contracts as a defence of the authentic self, and (5) Ulysses contracts as a practical solution in emergency situations. In our study, we have accepted consequentialist considerations as well as considerations of autonomy. We conclude that compulsory care is not justified when there is a significant uncertainty of beneficial effects or uncertainty regarding the patient’s decision-making capacity. We have argued that such uncertainty is present regarding BPD patients. Hence, Ulysses contracts including compulsory care should not be used for this group of patients.
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spelling pubmed-75384022020-10-19 Against Ulysses contracts for patients with borderline personality disorder Lundahl, Antoinette Helgesson, Gert Juth, Niklas Med Health Care Philos Scientific Contribution Patients with borderline personality disorder (BPD) sometimes request to be admitted to hospital under compulsory care, often under the argument that they cannot trust their suicidal impulses if treated voluntarily. Thus, compulsory care is practised as a form of Ulysses contract in such situations. In this normative study we scrutinize the arguments commonly used in favour of such Ulysses contracts: (1) the patient lacking free will, (2) Ulysses contracts as self-paternalism, (3) the patient lacking decision competence, (4) Ulysses contracts as a defence of the authentic self, and (5) Ulysses contracts as a practical solution in emergency situations. In our study, we have accepted consequentialist considerations as well as considerations of autonomy. We conclude that compulsory care is not justified when there is a significant uncertainty of beneficial effects or uncertainty regarding the patient’s decision-making capacity. We have argued that such uncertainty is present regarding BPD patients. Hence, Ulysses contracts including compulsory care should not be used for this group of patients. Springer Netherlands 2020-07-16 2020 /pmc/articles/PMC7538402/ /pubmed/32676951 http://dx.doi.org/10.1007/s11019-020-09967-y Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Scientific Contribution
Lundahl, Antoinette
Helgesson, Gert
Juth, Niklas
Against Ulysses contracts for patients with borderline personality disorder
title Against Ulysses contracts for patients with borderline personality disorder
title_full Against Ulysses contracts for patients with borderline personality disorder
title_fullStr Against Ulysses contracts for patients with borderline personality disorder
title_full_unstemmed Against Ulysses contracts for patients with borderline personality disorder
title_short Against Ulysses contracts for patients with borderline personality disorder
title_sort against ulysses contracts for patients with borderline personality disorder
topic Scientific Contribution
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538402/
https://www.ncbi.nlm.nih.gov/pubmed/32676951
http://dx.doi.org/10.1007/s11019-020-09967-y
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