LAW, ETHICS AND MEDICINE

Pressure and coercion in the care for the addicted: ethical perspectives

M J P A Janssens, M F A M Van Rooij, H A M J ten Have, F A M Kortmann and F C B Van Wijmen

Correspondence to:
Correspondence to:
Dr M van Rooij
Department of Psychiatry, University Medical Center St Radboud, PO Box 9101, 6500 HB, Nijmegen, the Netherlands; m.vanrooij{at}czzopsy.umcn.nl

The use of coercive measures in the care for the addicted has changed over the past 20 years. Laws that have adopted the "dangerousness" criterion in order to secure patients’ rights to non-intervention are increasingly subjected to critique as many authors plead for wider dangerousness criteria. One of the most salient moral issues at stake is whether addicts who are at risk of causing danger to themselves should be involuntarily admitted and/or treated. In this article, it is argued that the dilemma between coercion on the one hand and abandonment on the other cannot be analysed without differentiated perspectives on the key notions that are used in these debates. The ambiguity these notions carry within care practice indicates that the conflict between the prevention of danger and respect for autonomy is not as sharp as the legal systems seem to imply. Some coercive measures need not be interpreted as an infringement of autonomy—rather, they should be interpreted as a way to provide good care.

Keywords: coercion; autonomy; paternalism; harm; addiction

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This article has been cited by other articles:

• Widdershoven, G., Berghmans, R. (2007). Coercion and pressure in psychiatry: lessons from Ulysses. J. Med. Ethics 33: 560-563 [Abstract] [Full Text]  
• Abma, T. A, Widdershoven, G. A. (2006). Moral deliberation in psychiatric nursing practice.. Nurs Ethics 13: 546-557 [Abstract]