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Central ethical issues in coercive treatment of children and adolescents, with special reference to the reasoning of the staff members

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Background

The aim of the study was to describe the child and adolescent psychiatric staff opinions about ethical problems in relation to coercion, with specific focus on the ethical justification of different forms of coercion.

Methods

Two empirical studies were made. The first study used an ethical diary from sixty-seven staff members of different professions, including psychiatrists. The diaries were analyzed with focus on value and interest conflicts. The second study was an interview study with twenty staff members from different professions, where the interviews were analyzed with focus on ethical reflections of varying forms of coercion.

Results

The main result was that the staff found formal coercion easy to justify from an ethical perspective, whereas informal coercion often created uncertainty with regard to everyday care. Seclusion, body inspection and forced medication were found to be less ethical problematic than restraint by belt, which was found considerably more problematic and sometimes unnecessary as well. The values which the staff has to balance are autonomy and integrity vis a vis health, diminished suffering and personal development. The work with the parents could be of different kinds: cooperation, conflict or totally absent parents. In some cases, the parents were more viewed upon as co-patients. The most evident arguments for coercion were that coercion is justified when it is necessary to protect both the patient and others, when it is considered necessary for good treatment, and when the conditions under which treatment occurs need to be clarified.

Conclusion

The psychiatric ward staff often reflected about ethical issues, especially about how to handle the patient's autonomy and integrity in everyday care situations. They sometimes questioned formal coercive measures, but nobody questioned the possibility to use formal coercion in certain cases.

Author information

Correspondence to Håkan Thorsén.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Thorsén, H. Central ethical issues in coercive treatment of children and adolescents, with special reference to the reasoning of the staff members. BMC Psychiatry 7, S107 (2007) doi:10.1186/1471-244X-7-S1-S107

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Keywords

  • Staff Member
  • Psychiatric Ward
  • Ethical Reflection
  • Coercive Measure
  • Ward Staff