This article focuses on uses of force in clinical settings after a triggering event-a behavioral or medical crisis-and considers how force should be implemented. The clinical stakes are high, as force can undermine therapeutic capacity in patient-clinician relationships, exacerbate moral distress, and erode trust. Yet they are rarely discussed. This article explores compassionate use of force rather than merely minimally harmful use of force and considers how and by whom force should be executed; the nature and scope of goals, motivations, and protocols that should guide caregivers who must implement force protocols; and what a good compassionate force protocol might look like.To claim one AMA PRA Category 1 Credit TM for the CME activity associated with this article, you must do the following: (1) read this article in its entirety, (2) answer at least 80 percent of the quiz questions correctly, and (3) complete an evaluation. The quiz, evaluation, and form for claiming AMA PRA Category 1 Credit TM are available through the AMA Ed Hub TM .
This commentary explores the utility of hope as a therapeutic tool for intervention in the case of a patient with a mental illness that is refractory to treatment over time, who expresses her intention to commit suicide. It begins with a short discussion differentiating a deliberative consideration of suicide from an impulsive act. Then the commentary defines hope, how it might be used as a therapeutic tool, and which limitations a clinician might confront in such a case. This commentary also considers the role of a physician in orientation not only to the patient but also to her own thoughts, feelings, and emotions regarding a patient's expressed desire to end her life.
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