Can paternalism be justified in mental health care?

Abstract

Whilst current mental health care provision has made a substantial move towards empowering its users it retains a paternalistic approach with legislation such as 'supervised discharge'. This apparent paradox creates potential dilemmas for the mental health nurse and suggests there is a need for critical analysis of the justification for paternalism within mental health care. This paper discusses the conflict between the ethical principles of autonomy and beneficence which paternalism invokes. On reviewing the ethical theories of deontology and utilitarianism it appears that a prerequisite for autonomy is rationality, the absence of which provides justification of 'weak' paternalism. However, this paper contends that the assessment of rationality has the potential to be subjective and value laden. The use of competency tests can also be problematic by masking the essential ethical dilemma that is intrinsic to such assessment. A case study is used to illustrate the strengths and weaknesses of the competing arguments. This leads to the conclusion that whilst there may be some situations when the use of paternalism can be justified in mental health care, it should be exercised with caution. When there is disagreement between nurse and patient on what is considered to be in the patient's best interests, it should not be assumed that the patient is wrong or irrational.

Acceptability of compulsory powers in the community: the ethical considerations of mental health service users on Supervised Discharge and Guardianship

“…The requirements of compulsory mental healthcare in the community contradict what it means to be autonomous, 41 leading Watts and Priebe to ask, ''Are the restrictions of the asylum being transported to the community without the statutory controls?'' 27 Although the requirements to which these service users are subject vary in their intrusiveness, they structure their lives in a similar, though lesser way than hospital.…”

Why the professional-Client Ethic is Inadequate in Mental Health Care

“…8,12,13 However, there are at least three potential interested parties that may affect the judgement of health professionals: the patient (and relatives), the organization (e.g. hospital, Department of Health), and the public.…”

Empowerment versus power: consumer participation in mental health services

“…The difficulty, of course, is in separating the justified from the 'symptomatic' opinions. As argued by Breeze (1998) in a discussion of ethics and paternalism, rationality, which is a prerequisite for the ethical principle of autonomy, or self-rule, is a subjective and value-laden judgement. If it is entirely up to health workers to decide which views are rational, then opinions that are difficult to deal with, pose political problems or are simply at odds with 'professional' judgement, could be erroneously labelled as symptomatic or irrational.…”