Abstract
BackgroundProfessionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion.MethodsIn 2013 and 2014, 20 focus group interviews with 127 participants were conducted. The interviews were tape recorded and transcribed verbatim. The analysis is inspired by the concept of ‘bricolage’ which means our approach was inductive.ResultsMost participants report positive experiences with participating in ethics reflection groups: A systematic and well-structured approach to discuss ethical challenges, increased consciousness of formal and informal coercion, a possibility to challenge problematic concepts, attitudes and practices, improved professional competence and confidence, greater trust within the team, more constructive disagreement and room for internal critique, less judgmental reactions and more reasoned approaches, and identification of potential for improvement and alternative courses of action. On several wards, the participation of psychiatrists and psychologists in the reflection groups was missing. The impact of the perceived lack of safety in reflection groups should not be underestimated. Sometimes the method for ethics reflection was utilised in a rigid way. Direct involvement of patients and family was missing.ConclusionThis focus group study indicates the potential of ethics reflection groups to create a moral space in the workplace that promotes critical, reflective and collaborative moral deliberations. Future research, with other designs and methodologies, is needed to further investigate the impact of ethics reflection groups on improving health care practices.
Highlights
Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion
Implementation and follow-up was secured from Centre for Medical Ethics (CME), as well as research on several areas utilising a broad range of research methods
The present study shows that systematic ethics reflection makes a difference for the professionals’ perception of and dealing with ethical challenges related to coercion in several ways
Summary
Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion. Ethical challenges in mental health care Professionals within the mental health services face many ethical dilemmas and challenging situations. An ethical challenge occurs where there is doubt, uncertainty or disagreement about what is morally good or right [1,2,3]. Some distinguish between the terms ‘challenge’ and ‘dilemma’ and by that indicate that a dilemma involves facing a situation where there is no good solution, but where you have to make a choice, typically between two alternatives. We prefer to use these terms interchangeably since an ethical challenge could mean that all solutions have serious downsides
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