Central ethical issues in coercive treatment of children and adolescents, with special reference to the reasoning of the staff members

Thorsén, Håkan
January 2007
BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1
Academic Journal
Background The aim of the study was to describe the child and adolescent psychiatric staff opinions about ethical problems in relation to coercion, with specific focus on the ethical justification of different forms of coercion. Methods Two empirical studies were made. The first study used an ethical diary from sixty-seven staff members of different professions, including psychiatrists. The diaries were analyzed with focus on value and interest conflicts. The second study was an interview study with twenty staff members from different professions, where the interviews were analyzed with focus on ethical reflections of varying forms of coercion. Results The main result was that the staff found formal coercion easy to justify from an ethical perspective, whereas informal coercion often created uncertainty with regard to everyday care. Seclusion, body inspection and forced medication were found to be less ethical problematic than restraint by belt, which was found considerably more problematic and sometimes unnecessary as well. The values which the staff has to balance are autonomy and integrity vis a vis health, diminished suffering and personal development. The work with the parents could be of different kinds: cooperation, conflict or totally absent parents. In some cases, the parents were more viewed upon as co-patients. The most evident arguments for coercion were that coercion is justified when it is necessary to protect both the patient and others, when it is considered necessary for good treatment, and when the conditions under which treatment occurs need to be clarified. Conclusion The psychiatric ward staff often reflected about ethical issues, especially about how to handle the patient's autonomy and integrity in everyday care situations. They sometimes questioned formal coercive measures, but nobody questioned the possibility to use formal coercion in certain cases.


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