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Coercion in psychiatry: is it right to involuntarily treat inpatients with capacity?
  1. Harry Hudson
  1. Bristol Medical School, University of Bristol Faculty of Medical and Veterinary Sciences, Bristol, UK
  1. Correspondence to Mr Harry Hudson, Bristol Medical School, University of Bristol Faculty of Medical and Veterinary Sciences, Bristol BS40 5DU, UK; hh17595{at}bristol.ac.uk

Abstract

Psychiatric inpatients with capacity may be treated paternalistically under the Mental Health Act 1983. This violates bodily autonomy and causes potentially significant harm to health and moral status, both of which may be long-lasting. I suggest that such harms may extend to killing moral persons through the impact of psychotropic drugs on psychological connectedness. Unsurprisingly, existing legislation is overwhelmingly disliked by psychiatric inpatients, the majority of whom have capacity. I present four arguments for involuntary treatment: individual safety, public safety, authentic wishes and protection of autonomy. I explore these through a case study: a patient with schizophrenia admitted to a psychiatric hospital under the Mental Health Act 1983 after an episode of self-poisoning. Through its discussion of preventative detention, the public safety argument articulates the (un)ethical underpinnings of the current position in English law. Ultimately, none of the four arguments are cogent—all fail to justify the current legal discrimination faced by psychiatric inpatients. I conclude against any use of involuntary treatment in psychiatric inpatients with capacity, endorsing the fusion approach where only psychiatric patients lacking capacity may be treated involuntarily.

  • coercion
  • psychopharmacology
  • mentally ill and disabled persons
  • right to refuse treatment
  • concept of mental health
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Footnotes

  • Contributors HH is the sole author of this work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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