BACKGROUND: Coercion in mental healthcare has led to ethical debate on its nature and use. However, few studies have explicitly explored patients' moral evaluations of coercion. AIM: The purpose of this study is to increase understanding of patients' moral views and considerations regarding coercion. RESEARCH DESIGN: Semi-structured focus-group and individual interviews were conducted and data were analysed through a thematic content analysis. Participants and research context: A total of 24 adult participants with various mental health problems and experiences with coercion were interviewed in 2012-2013 in three regions of Norway. Ethical considerations: Ethical approval and permissions were obtained according to required procedures. Informed consent and confidentiality were also secured. FINDINGS: Ethical considerations regarding coercion included seven main themes: the need for alternative perspectives and solutions, the existence of a danger or harm to oneself or others, the problem of paternalism, the problem of discrimination and stigma, the need for proportionality, the importance of the content and consequences of coercion and concerns about way that coercion is carried out in practice. DISCUSSION: The participants' views and considerations are in line with previous research and reflect the range of normative arguments commonly encountered in ethical and legal debates. The study accentuates the significance of institutional factors and alternative voluntary treatment opportunities, as well as the legal and ethical principles of proportionality and purposefulness, in moral evaluations of coercion. CONCLUSION: Broader perspectives on coercion are required to comprehend its ethical challenges and derive possible solutions to these from a patient perspective.
BACKGROUND: Coercion in mental healthcare has led to ethical debate on its nature and use. However, few studies have explicitly explored patients' moral evaluations of coercion. AIM: The purpose of this study is to increase understanding of patients' moral views and considerations regarding coercion. RESEARCH DESIGN: Semi-structured focus-group and individual interviews were conducted and data were analysed through a thematic content analysis. Participants and research context: A total of 24 adult participants with various mental health problems and experiences with coercion were interviewed in 2012-2013 in three regions of Norway. Ethical considerations: Ethical approval and permissions were obtained according to required procedures. Informed consent and confidentiality were also secured. FINDINGS: Ethical considerations regarding coercion included seven main themes: the need for alternative perspectives and solutions, the existence of a danger or harm to oneself or others, the problem of paternalism, the problem of discrimination and stigma, the need for proportionality, the importance of the content and consequences of coercion and concerns about way that coercion is carried out in practice. DISCUSSION: The participants' views and considerations are in line with previous research and reflect the range of normative arguments commonly encountered in ethical and legal debates. The study accentuates the significance of institutional factors and alternative voluntary treatment opportunities, as well as the legal and ethical principles of proportionality and purposefulness, in moral evaluations of coercion. CONCLUSION: Broader perspectives on coercion are required to comprehend its ethical challenges and derive possible solutions to these from a patient perspective.
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Keywords:
Coercion; mental healthcare; nursing ethics; patient acceptance of healthcare; user involvement