Soins sans consentement, mesures d’isolement et de contention en pédopsychiatrie : une analyse des défis éthiques en France

Abstract

BackgroundIn France, child psychiatry care can involve significant ethical challenges. Following the last recommendations of the Controller General of places of deprivation of liberty (CGLPL) and the modifications of the law framing the control measures (seclusion room and restraints) in adult psychiatry, it is necessary to reflect on their operationalization in providing care in order to find the balance between the imperatives of protection and the respect of the young people hospitalized in child psychiatry. AimTo develop recommendations concerning the use of seclusion and restraint in child psychiatry in the light of recent legislative changes and associated ethical issues. MethodsWithin the framework of the national commission of psychiatry, a working group bringing together many child psychiatrists was set up in 2021 to reflect on contemporary issues in our discipline. One of the axes studied – in connection with the forensic psychiatry group – was specifically concerned with isolation and restraint in child psychiatry. An analysis of the ethical issues based on the four principles of Beauchamp and Childress is defined and adapted for the child psychiatric context. ResultsThe working group identified the legal and ethical issues specific to their discipline. Based on the ethical analysis of two difficult support situations in child psychiatry: (1) the practice of electroconvulsive therapy with adolescents; and (2) the management of violence in young people with autism and intellectual disabilities, the main conflicts of values were identified referring to the principles of non-maleficience, beneficence, autonomy and justice. ConclusionBased on research in childhood ethics, the relational dimension of autonomy is discussed with reference to the concepts of “shared vulnerability” and “shared care planning”. Specific recommendations for child psychiatry are proposed in order to promote the recognition as moral agents of children and adolescents hospitalized in child psychiatry.