Ethical Practice in Emergency Psychiatry

Ethical Issues in Clinical Decision-Making about Involuntary Psychiatric Treatment: A Scoping Review

“…Regarding the relevant ethical values for patients undergoing involuntary treatment, some articles highlight issues such as freedom of choice, autonomy, participation in the decision-making process, and a sense of security during hospitalization, in addition to the need to receive sufficient information to be heard and treated with respect, trust, and in a non-paternalistic way [55,56,63,64]. Other factors identified as influential for patients include their perception of the team's attitude and whether they have the necessary qualifications to provide good care (beneficence), and the expectation of positive results, namely therapeutic value or contribution to the recovery process [55,56,63].…”

“…Responsible practice requires assessing the patient's decision-making capacity when creating the directive and subsequently when making a decision [70]. Another article argues that advanced psychiatric directives cannot prevent involuntary commitment when appropriate because they overlap with the duties of state police [64].…”

“…From the users' perspective, the most frequently mentioned gaps result from the experience of not being heard, lacking information, and not being involved in decision-making about treatment plans; that is, when their dignity and respect are compromised [43,48,53,56,64]. Family members also point out this gap, highlighting the lack of involvement despite their availability in patient care [65].…”

“…Family members also point out this gap, highlighting the lack of involvement despite their availability in patient care [65]. Users also indicated the physical environment's shortcomings and a lack of daily activities in the hospital [41,53,56]; their perception that coercion did not help them recover [54]; or the side effects of medication [64]. The finding that involuntary community treatment does not reduce readmission rates or their duration, nor does it increase readmission time or adherence to treatment, are other aspects described in the analyzed articles [57].…”

“…Another risk results from coercion possibly harming family relationships, as patients tend to feel abandoned, and the family may experience a complex and traumatic process [65]. Some authors also warn that involuntary treatment may lead to a loss of self-confidence and impaired therapeutic interactions, severely interrupting any voluntary search for help [47,57,64,71]. The use of advance directives in patients is also considered a risk as they can be misused, particularly when pressure is exerted [50,70].…”