French lay people's and health professionals' views regarding the acceptability of involuntary treatment of nursing home residents

Abstract

ObjectivesWe examined the views of lay people and health professionals in France about involuntary treatment of residents in nursing homes. MethodParticipants (101 lay people, 20 nurses, 20 psychologists, and 10 physicians) were presented with a series of stories created by varying the levels of five factors: type of behavioral problem encountered (e.g., night-wandering), associated signs of dementia, physician's effort to explain the reason for treatment, resident's attitude (e.g., lasting reluctance), and physician's decision to prescribe psychotropic drugs or not. Participants were asked to judge the acceptability of the decision in each concrete case. ResultsThree qualitatively different positions were found. The largest group (40% of the participants) viewed treatment of residents' behavioral problems as the most important objective. They felt it also important to respect residents' wishes and, therefore, to spend much time in talking with them about treatment. An almost equally large group (39%)—which included 60% of physicians—viewed respect for residents' autonomy as the most important consideration. A smaller group (21%)—including 40% of the psychologists—focused on the importance of taking time to talk with the residents. They also thought that treating patients against their will was unacceptable. Thus they took autonomy one step further than the preceding group. ConclusionIt is important to reduce as much as possible the conflict between the principles of patient autonomy and perceived beneficence when caring for nursing home patients with behavior problems. This can be done by promoting their decision making abilities.