RT Journal Article
SR Electronic
T1 Threats and offers in community mental healthcare
JF Journal of Medical Ethics
JO J Med Ethics
FD BMJ Publishing Group Ltd and Institute of Medical Ethics
SP 204
OP 209
DO 10.1136/medethics-2011-100158
VO 38
IS 4
A1 Michael Dunn
A1 Daniel Maughan
A1 Tony Hope
A1 Krysia Canvin
A1 Jorun Rugkåsa
A1 Julia Sinclair
A1 Tom Burns
YR 2012
UL http://jme.bmj.com/content/38/4/204.abstract
AB Making threats and offers to patients is a strategy used in community mental healthcare to increase treatment adherence. In this paper, an ethical analysis of these types of proposal is presented. It is argued (1) that the primary ethical consideration is to identify the professional duties of care held by those working in community mental health because the nature of these duties will enable a threat to be differentiated from an offer, (2) that threatening to act in a way that would equate with a failure to uphold the requirements of these duties is wrong, irrespective of the benefit accrued through treatment adherence and (3) that making offers to patients raises a number of secondary ethical considerations that need to be judged on their own merit in the context of individual patient care. The paper concludes by considering the implications of these arguments, setting out a pathway designed to assist community mental healthcare practitioners to determine whether making a specific proposal to a patient is right or wrong.