We do good not eliminating coercive measures in psychiatry.

The priority of the good on the just one

Prinsen and van Delden ask if we can justify eliminating coercive measures in psychiatry, because the practice of coercive measures in psychiatry is controversial. They say also that because there are conflict between autonomy and beneficence/non-maleficence, human dignity, the experiences of patients and the effects of coercive measures, 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. And so the authors argue that reasons such as respect for autonomy and the violation of human dignity are not sufficient reasons to eliminate seclusion. Altogether, at least in some interpretation, these norms can be used both to support and to reject a non-seclusion approach.

The precaution principle of "primum non nocere" should guide our actions. The authors choose a perspective of beneficence. This perspective is a good choice if beneficence is inserted not in the context of a pragmatic point of view that belongs to the theory of the principialism but in the context of the ethics of practical virtues.

I agree with Prinsen and van Delden that reasons such as respect for autonomy and the violation of human dignity are not sufficient reasons to eliminate seclusion. The mental illness is either a myth or scientific object or something else; but mental illness is real. And the patient above all is real and psychiatrists move in the effective and real practice with difficulties of personal, social and ethical character.

Asking "Can we justify eliminating coercive measures in psychiatry?" is a badly phrased question, since this is not a justice issue but an issue of being well and good, and is not an issue that we can justify.

I support the priority of being good and well on being just . I support with force the priority of practical reasoning. Also in medicine and in particular in psychiatry.

1. E J D Prinsen and J J M van Delden, Can we justify eliminating coercive measures in psychiatry? J Med Ethics 2009; 35: 69-73

Asking “Can we justify eliminating coercive measures in psychiatry?” underscores the importance of paying attention to our moral and political presumptions and illustrates the social value and moral wickedness of psychiatry as a system of social control. The question implies that eliminating psychiatric deprivations of liberty needs to be justified but continuing to inflict such deprivations in the name of mental illness needs not.

Psychiatry is presented to the public as a medical specialty “like any other.” This is a lie. Physicians do not write papers asking “Can we justify eliminating coercive measures in nephrology or ophthalmology?”

Asking “Can we justify continuing to use coercive measures in psychiatry?” is like asking “Can we justify torture as a method of judicial interrogation?” The question indicts the questioner.

"Freedom” declared Benjamin Franklin, “is not a gift bestowed upon us by other men, but a right that belongs to us by the laws of God and nature." Assuredly, freedom is not a gift bestowed upon us by arrogant and ignorant psychiatrists who expect to justify its deprivation by “controlled clinical trials.”

No competing interest.