Which values are important for patients during involuntary treatment? A qualitative study with psychiatric inpatients.

Involuntary hospital treatment is practised throughout the world. Providing appropriate treatment in this context is particularly challenging for mental health professionals, who frequently face ethical issues as they have to administer treatments in the absence of patient consent. We have explored the views of 59 psychiatric patients who had been involuntarily admitted to hospital treatment across England. Moral deliberation theory, developed in the field of clinical bioethics, was used to assess ethical issues. Interviews were audio recorded and transcribed verbatim, and analysed through thematic content analysis. We have detected a number of circumstances in the hospital that were perceived as potentially conflictual by patients. We have established which patient values should be considered by staff when deliberating on ethically controversial issues in these circumstances. Patients regarded as important having freedom of choice and the feeling of being safe during their stay in the hospital. Patients also valued non-paternalistic and respectful behaviour from staff. Consideration of patient values in moral deliberation is important to manage ethical conflicts. Even in the ethically challenging context of involuntary treatment, there are possibilities to increase patient freedoms, enhance their sense of safety and convey respect. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.