A no-win situation: psychiatrists navigating competing obligations between free will, paternalism, duty of care, and position of guarantee

Abstract

This paper examines the ethical tensions psychiatrists encounter in balancing competing obligations to patients and society, heightened in the COVID-19 era. With reference to the Italian situation, legal concepts such as duty of care or the rule of law defined “position of guarantee” engender heightened duties of care but generate discordance concerning patient autonomy. As a matter of fact, Italian psychiatrists are considered responsible for the effects of their interventions on patients and their behaviors. Consequently, managing involuntary treatment, assessing risk, and worrying about liability strain practitioners' efforts to uphold non-maleficence. As mental healthcare needs escalate globally amidst resource constraints, the application of ethical principles is imperative. Evidence-based approaches prioritizing collaborative harm reduction over social control must be reinforced through education, oversight, and organizational policies. With balanced civil commitment criteria and realistic expectations acknowledging risk prediction limits, therapeutic alliances can be maintained. Greater investment in community-based systems can mitigate coercion and marginalization. Psychiatrists worldwide endeavor to uphold beneficence and non-maleficence within shifting accountability landscapes. This perspective advocates collective efforts to promote patient welfare through equitable, quality care. Navigating the multifaceted nexus of competing obligations demands thoughtful dialogue and judicious reforms responsive to both practitioner and patient needs. By engaging with ethical complexities with scientific rigor and compassion, psychiatry can uphold humane, ethical standards despite mounting challenges.