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 Dunn, Michael A1 Maughan, Daniel A1 Hope, Tony A1 Canvin, Krysia A1 Rugkåsa, Jorun A1 Sinclair, Julia A1 Burns, Tom 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.