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J Med Ethics 2009;35:69-73 doi:10.1136/jme.2007.022780
  • Research ethics

Can we justify eliminating coercive measures in psychiatry?

  1. E J D Prinsen1,
  2. J J M van Delden2
  1. 1
    Zwolse Poort, Institute for Mental Health West-Overijssel, Raalte, The Netherlands
  2. 2
    Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
  1. Dr E J D Prinsen, Zwolse Poort, Institute for Mental Health West-Overijssel, Knapenveldsweg 1/P.O. Box 110, 8102 RR/8000 AC Raalte, The Netherlands; e.prinsen{at}zwolsepoort.nl
  • Received 20 August 2007
  • Revised 25 February 2008
  • Accepted 28 April 2008

Abstract

The practice of coercive measures in psychiatry is controversial. Although some have suggested that it may be acceptable if patients are a danger to others or to themselves, others committed themselves to eliminate it. Ethical, legal and clinical considerations become more complex when the mental incapacity is temporary and when the coercive measures serve to restore autonomy. We discuss these issues, addressing the conflict between autonomy and beneficence/non-maleficence, human dignity, the experiences of patients and the effects of coercive measures. We argue that an appeal to respect autonomy and/or human dignity cannot be a sufficient reason to reject coercive measures. All together, these ethical aspects can be used both to support and to reject a non-seclusion approach.

The total lack of controlled trials about the beneficial effects of coercive measures in different populations however, argues against the use of coercive measures.

Footnotes

  • Competing interests: None.

Responses to this article

  • We should not eliminate coercive measures in psychiatry. The priority of the good on the just.
    • Maurizio Soldini
    J Med Ethics published online January 21, 2009
  • Psychiatric coercion
    • Thomas Szasz
    J Med Ethics published online January 5, 2009

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