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‘Coercive’ Measures

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Ethics in Psychiatry

Part of the book series: International Library of Ethics, Law, and the New Medicine ((LIME,volume 45))

Abstract

This chapter examines a range of treatment pressures in mental health care. Conceptual distinctions can be drawn between interventions commonly termed ‘coercive’. These include ‘compulsion’, ‘coercion’ (narrowly defined), ‘exploitation’, ‘deception’ and ‘inducements’. These may be placed on a rough hierarchy of moral seriousness. Justifications for coercive interventions are discussed and a ‘capacity-best interests’ framework is recommended as applicable across the whole range of interventions. Measures that may reduce the need for coercion are examined, the most promising being certain types of ‘advance statement’ which enhance patients’ involvement in their treatment.

The aim of this chapter is to examine what might broadly be termed ‘coercive’ measures in mental health care. I will examine the distinctions between ‘compulsion’, ‘coercion’ (used in a more precise sense) and ‘inducements’ as types of treatment pressure directed at patients who are reluctant to accept treatment. I will then examine justifications for their use, and finally, means that might lead to a reduction in the necessity for their use.

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Notes

  1. 1.

    I will use the term coercion in two senses: first, in a general sense of a morally significant treatment pressure; second, in the sense of a specific, narrowly defined form of treatment pressure. When used in the narrow sense, the word coercion will be italicized.

  2. 2.

    With regard to unreflective or unconscious exploitation of a patient by a narcissistic therapist see Chapter 18.

  3. 3.

    See the Chapter 29 Abuse of psychiatry for political purposes by van Voren about the involuntary detention of political dissidents in the former Soviet Union.

Abbreviations

AS:

Advance Statements

CCs:

Crisis Cards

F-PAD:

Facilitated PAD

IOT:

Involuntary Outpatient Treatment

JCPs:

Joint Crisis Plans

MCA:

Mental Capacity Act 2005

PADs:

Psychiatric Advance Directives

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Authors and Affiliations

  1. Health Service and Population Research Department, King’s College London, Institute of Psychiatry, London, SE5 8AF, UK

    George Szmukler

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  1. George Szmukler
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Correspondence to George Szmukler .

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Editors and Affiliations

  1. Charité Campus Benjamin Franklin, Klinik für Psychiatrie/ Psychotherapie, Universitätsklinikum Berlin, Eschenallee 3, Berlin, 14050, Germany

    Hanfried Helmchen

  2. chemin Colladon 14, Geneve, 1209, Switzerland

    Norman Sartorius

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Szmukler, G. (2010). ‘Coercive’ Measures. In: Helmchen, H., Sartorius, N. (eds) Ethics in Psychiatry. International Library of Ethics, Law, and the New Medicine, vol 45. Springer, Dordrecht. https://doi.org/10.1007/978-90-481-8721-8_20

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  • DOI: https://doi.org/10.1007/978-90-481-8721-8_20

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