Abstract
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.
Highlights
Patients with borderline personality disorder (BPD) often raise distress and concern among caregivers in psychiatry (Linehan 1993; Lundahl et al 2018)
Our conclusion is that the arguments favouring Ulysses contracts are not solid enough to justify its use when applied as compulsory care of BPD patients
One suggested solution to this problem is the implementation of Ulysses contracts in form of compulsory care, where the decision-competent BPD patient authorizes the caregiver to override her autonomy in order to protect her from acting self-destructively when in a crisis
Summary
Patients with borderline personality disorder (BPD) often raise distress and concern among caregivers in psychiatry (Linehan 1993; Lundahl et al 2018). Our conclusion is that the arguments favouring Ulysses contracts are not solid enough to justify its use when applied as compulsory care of BPD patients.
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