Ethical case discussions before compulsory medication in psychiatry

Abstract

Ethical case discussions in psychiatric hospitals are particularly useful when amoral conflict between respect for the patient's autonomy and well-being becomes apparent when considering the legitimacy of coercive treatment. To date, there is hardly any data on the procedure and the results of such case discussions. We therefore present data from alarge psychiatric clinic. We retrospectively analyzed ethical case discussions prior to compulsory medication in aquantitative and qualitative manner. The study analyzed the protocols of all ethical case discussions over a2-year period. They used the method of principle-based ethical case discussion. The qualitative analysis of selected cases was supplemented by reference to case records. An advance care directive was not available in any of the cases, so that the presumed will was used generally to assess the autonomy perspective. It proved quite complex to address danger to third parties when assessing the beneficence and nonmaleficence perspective. In 5 out of 35 consultations, the compulsory medication was not recommended from an ethical perspective. Ethical case discussions enable aholistic individual examination of moral obligations. They contribute to well-founded decisions and can help to reduce the frequency of coercive medications, suggesting routine use of ethics counselling.