Abstract

BackgroundInvoluntary 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.MethodsIn-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.ResultsThe 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.ConclusionsInvoluntary 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 materialThe online version of this article (doi:10.1186/s12910-015-0029-5) contains supplementary material, which is available to authorized users.

Highlights

  • IntroductionEthical issues relating to involuntary psychiatric treatment are investigated through interviews with Swedish psychiatrists

  • Involuntary treatment is a key issue in healthcare ethics

  • In the interviews, ethical deliberations about compulsory treatment were discussed in relation to issues about autonomy and patients’ decision-making capacity

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Summary

Introduction

Ethical issues relating to involuntary psychiatric treatment are investigated through interviews with Swedish psychiatrists. Laws on involuntary treatment in psychiatry typically call for treatment of psychiatric disorders based on concerns relating to the severity of the patient’s condition, need for treatment, and danger to self or others [5,6,7]. Lack of decision-making capacity, which typically is Sjöstrand et al BMC Medical Ethics (2015) 16:37 defined in terms of abilities for understanding, appreciation, reasoning and communication [8], is generally not held as a necessary criterion for involuntary psychiatric treatment [5,6,7]. Studies have shown that patients with serious psychiatric disorders may have decision-making capacity according to standard criteria [9,10,11]. There are controversial issues relating to the extension of such directives, for instance whether patients should have a right to reject future care [18, 19]

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