Abstract
BackgroundWhen a patient with a serious mental illness expresses a desire for children, mental health professionals are faced with an ethical dilemma. To date, little research has been conducted into their strategies for dealing with these issues.MethodsSeven focus groups with a total of 49 participants from all professional groups active in mental health (nurses, psychologists, social workers and psychiatrists) were conducted in a 330-bed psychiatric hospital. Group discussions were transcribed verbatim and analysed by the documentary method described by Bohnsack.ResultsMental health professionals did not feel that their patients’ desire for children was as important in daily practice as were parenting issues. When discussing the desire for children on the part of patients, the following themes emerged: “the patient’s own decision”, “neutrality”, “the patient’s well-being”, “issues affecting the children of mentally ill parents” and “appropriate parenthood”. In order to cope with what they perceived as conflicting norms, mental health professionals developed the following (discursive) strategies: "subordination of child welfare", "de-professionalisation", "giving rational advice" and "resignation".ConclusionsThe theme of “reproductive autonomy” dominated mental health professionals’ discourse on the desire for children among psychiatric patients. “Reproductive autonomy” stood in conflict with another important theme (patient’s children). Treating reproductive issues as taboo is the result of the gap between MHPs’ perceptions of (conflicting) norms when dealing with a patient’s desire for children and the limited opportunities to cope with them appropriately.In order to support both patients with a desire for children and mental health professionals who are charged with providing counselling for such patients, there is a need to encourage ethical reflection and to focus on clinical recommendations in this important area.
Highlights
When a patient with a serious mental illness expresses a desire for children, mental health professionals are faced with an ethical dilemma
None of the participants explicitly used the term “reproductive autonomy” throughout all seven focus groups, the hypothesis of “reproductive autonomy” as the leading normative orientation could not be disproved by any negative case
We found that mental health professionals (MHPs) developed specific strategies to deal with conflicting normative orientations: first, subordination of child welfare issues and/or non-prioritisation of risks for children appeared to be a “meaningful” coping strategy: concentration on the treatment mandate was found to be an important argument within focus groups for dealing with a patient’s reproductive autonomy
Summary
When a patient with a serious mental illness expresses a desire for children, mental health professionals are faced with an ethical dilemma. “Balancing ethical tenets in psychiatric practice is often challenging These challenges increase in complexity when clinicians must consider simultaneously patient’s long-standing values and beliefs, and the treatment of psychosis and concomitant physical illness [7]. While these guidelines have been developed to support MPHs’ management of existing pregnancies, there is little literature on providing support and assistance to service users not yet pregnant (or due to be fathers). A study of family planning decisions among women with bipolar disorders revealed that most women were insufficiently informed about issues relating to the course of perinatal illness About half of these women were advised against pregnancy by a (mental) health professional or family member [13]
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