Evidence and Ethics in Psychiatric Coercive Practices, A Neglected Dilemma?

Abstract

Sound humanitarian psychiatry has for long, perhaps always struggled with the conflict between being therapeutical with the patients best interest at hand and the demand for restricting and applying coercive measures against the patients will and autonomy for the sake of protecting the integrity and security of not only the patient, but also her/his surroundings. This conflict includes a number of ethical issues such as preserving the patients’ autonomy, safeguarding the autonomy and security of the patients’ family as well as societal interests.

At the same time, some psychiatric research deals with the evidence of psychiatrically motivated restrictive and coercive measures and their possible therapuetic effect. Recent reviews have found that there is no evidence for the therapeutic effect of coercive measures. In view of the reasons for coercive measures, the issue of its therapeutical effects seems wrongly addressed.

It will be argued in this presentation that the issue is how psychiatry intended for the most severely disturbed patients should live up to delivering ethically sound services is a question of proper supervision. The presentation will problematise these issues as well as arguing that psychiatry intended for the most severely disturbed has to be politically controled within the frame of a democratic society with sound ethical human principles.