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Hospitalization of patients against their will is an issue that is often considered to be unethical among health care providers. This is particularly due to the legal requirement in which all patients have a right to informed consent before they are provided any healthcare service. However, the need to hospitalize psychiatric patients against their will is an issue that exhibits controversy as pertains health care ethics, and is against the right of patients to make treatment decisions (Sandman & Munthe, 2010, 2). This is particularly because, due to the condition of psychiatric patients, health care providers have to make a decision in order to improve the health of such patients. The study, therefore, focuses on arguing on the need for psychiatric patients to be hospitalized against their will.
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Arguments for Coercive care
The hospitalization and treatment of patients against their will is considered as a case of paternalism. A psychiatrist can act in a paternalistic way towards a patient in the event where it is of benefit to the patient. This is regardless that by doing so, their action is a violation of the moral rule that an individual has a right to determine his/her future, which especially concerns the right to also refuse treatment (Hughes, Hayward & Finlay, 2009, 153). The study by Owen et al. (2009) also denotes that the justification of forced care is attributed to the risk of a patient to harm themselves and their lack of capacity to consent for treatment (p. 34).
The need for involuntary treatment action can be opted for particularly where the patients’ health is deteriorating because of their refusal for treatment. This is despite efforts being tried to build trusting relationships. In the focus to the adolescents, the study by Sandman & Munthe (2010) demonstrates that the consideration of psychiatrists in relation to coercive care criteria among the minors should be viewed in a broader perspective in comparison to the adults. The adoption of coercive care is with the objective to achieve preventive measures among the psychiatric patients by assisting them make well-informed choices (p.13).
Arguments in support of psychiatric patients being hospitalized against their will have been supported by various studies. Zuckerberg (2012) further illustrates the existence of various arguments towards the justification of coercive care. The study illustrates that the commonly utilized view in justifying the use of coercive care is the protection argument (p. 280). This is especially due to the value for autonomy that there is the justification towards the treatment of patients who are incompetent against their will and thus, making them dangerous. In this case, a person is autonomous if they can determine their life by engaging in competent decisions without inside or outside interference. On the other hand, where an individual is depressed, they cease to have a full understanding on what they are doing and also stop being rational, and are, therefore considered not to be autonomous. As a result, Owen et al. (2009) denotes that a real respect for autonomy will demand the need for intervention with the focus to restore it. This leads to a scenario in which psychiatric patients have to be hospitalized against their will (p.3).
The lack of personal responsibility
People who lack the ability to take responsibility for themselves, and are likely dangerous towards those around them, ought to be provided some protection from themselves by the society through the use of coercive care. This is due to their likelihood to engage in overt violence and suicide attempts (Sibitz et al., 2011, 239). This policy is further reinforced by irreversibility of suicide while the intervention can be reversible. Therefore, a psychiatrist can be justified to intervene and treat psychotic illnesses. The action is necessitated by the fact that, in the scenario where a patient is psychotic, they fail to clearly perceive the reality. As a result, they are unable to have an understanding of the alternatives that they face, which makes them lack the capacity to make decisions concerning their future (Quinlan & Coffey, 2015, 25). Thus, in this scenario, the patient’s central values, as well as of the other patients are at a threat since the patient is unable to take responsibility and consequently the need to violate their autonomy. In such cases, the psychiatric does impose his/her own values to the affected patients (Owen et al., 2009, 32). Furthermore, apart from the perspective of the patient being mentally ill as well as incompetent, there is the justification of involuntary treatment in case where its benefits outweigh its perceived harm (Brooks, 2007, 225).
As a result, such actions are considered sufficient for a justification of involuntary hospitalization and the provision of treatment. Thus, the argument, in this case, is that, where there exists an effective treatment, there is the justification of the policy towards involuntary detainment of dangerous mentally ill patients. Besides, involuntary intervention is also justified on the basis of the argument on the potential continuation and worsening of the mental illness and increases their chances of self-harm (Sibitz et al., 2011, 239). This is especially because some patients may exhibit symptoms such as compulsive behavior and hallucinations that can contribute to such patients injuring themselves, as well as others. As a result, immediate action is a necessity since seeking their consent for voluntary treatment will less likely be successful. These measures will, therefore, assist in maintaining the safety and well-being of the others within the society.
Psychiatric patients’ failure to acknowledge they are sick
Moreover, a psychiatric patient should be hospitalized against their will if they refuse to acknowledge that they have a disease, and thus, the need for a psychiatrist to declare such patients ill. This is normally manifested in a scenario where a psychotic patient denying they are ill on the basis of the argument that they are enjoying themselves (Hughes et al., 2009, 153). In this case, where someone prefers to be psychotic rather than being sane, their desire is considered to be irrational. As a result, such individuals are perceived not to be competent enough to refuse treatment (Sibitz et al., 2011, 242). It is, therefore, due to the value of appropriate high emotions that such patients will be considered to have a disease, and consequently the need for them to be hospitalized even against their will.
On the other hand, the study by Brooks (2007) observes that where a patient exhibit serious mental-disorders, they are too psychotic to have an understanding of long-term risks associated with not being provided some medication (p. 221). In this case, the common risk associated to it that the patient may not be aware of is besides being a threat to themselves and others, they do not understand of their need for care (Zuckerberg, 2012). This further influences the action of the health care providers to hospitalize them against their will in order to ensure a controlled and safe medication process. As a result, such patients are often in great need of care, which can only be realized through the use of coercion. In this case, the use of coercion is not in the perspective of security, but as a means of achieving control of the illness (Quinlan & Coffey, 2015, 27).
Moreover, psychiatric patients’ treatment against their will can also be attributed to solidarity argument. This is particularly where health care staff argue that they have a wider obligation in ensuring they take care of the society’s welfare. The healthcare providers view is that, if such patients are left unattended, their situation will become worse and the possibility of such patients becoming isolated in the society (Owen et al., 2009, 3). In such a scenario, the health care providers are, therefore, justified to implement involuntary treatment. This is especially where they understand of the possibility of effective treatment existing. In this case, therefore, such unethical conducts are justified if the actions manifest a reasonable chance of having significant benefits to the patients. This is also demonstrated in the study by Sandman & Munthe (2010) noting that, psychiatric treatment is necessary in order to realize an improvement in the quality of the patient’s life, as well as those people living with such a person (p. 28). As a result, it is not recommendable for patients to make a determination towards the goals of a therapy. This is because, in many instances, the perception of patients concerning facts is distorted by their illness, which thus, makes them unable to carry out a rational evaluation of existing options.
Besides, as per the code of conduct guideline among the health care providers; they have a responsibility towards placing priority the life of the patient and thus, promote equal access to health care (Zuckerberg, 2012, 282). Therefore, on the basis of this clarification argument, it assures the staff that they are at liberty to use coercive measures where necessary in the process of their service delivery. The main driving factor for the healthcare providers in such a way is because they believe in the best interest of the patient. This is especially because such patients may refuse, or are unable to give any consent due to their mental state, hence the doctors action is for the best interest of the patient (Owen et al., 2009, 20).
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Arguments against coercive care
Psychiatric patients also have a right to refuse treatment, with it being also recognized as their fundamental legal requirements. Therefore, for a patient to voluntary enter to a hospital, and not show any likelihood of being of danger to others or self, they have a right to self-determination (Owen et al., 2009, 19). Moreover, engaging in coercive care is considered as unethical behavior which violates the patient’s integrity and denies such patients a right to make any decision concerning their treatment (Sibitz et al., 2011, 243). Besides, professional staffs are not permitted to treat a patient against their will unless they seek court decision (Brooks, 2007, 220). This is particularly due to the need to adhere to consent to medical treatment, which is a law that relates to the treatment of psychiatric patients. Therefore, forcing medical treatment on the patients will be contravening prohibition against inhuman and degrading treatment which is under the Protection of Human Rights Act (Zuckerberg, 2012, 282).
Moreover, forced medication will be a violation of patient’s autonomy and will consequently undermine the trust in the patient-physician relationship (Sibitz et al., 2011, 243). Also, engaging in forceful treating exhibits major risk for the clinician since their actions will be taking law into their hands and is therefore illegal. As a result, forced medication should be carried out as a last resort while having placed into consideration the necessary exceptions before hospitalizing psychiatric patients against their will. Therefore, regardless that mental illness among patients is a justification for involuntary treatment, it does not imply that psychiatrists should treat all patients who are mentally ill against their will. Additionally, a psychiatrist is not entitled to drag a patient from their home in order to subject them to systematic desensitization since they are competent to disagree with the treatment.
Taking a Stance
Regardless that it is essential to seek the consent of a patient and the understanding that every patient has a right to accept or refuse treatment, handling cases of psychiatric patients is often a challenge. This is particularly due to the concern that psychiatrist patients are likely to harm self or others unknowingly and not willing to undergo any treatment. Therefore, despite the likelihood to infringe their rights, I, therefore, find it necessary for psychiatric patients to be hospitalized against their will in order to prevent them from engaging in risky activities, and improve their healthy well-being. This particularly due to the significant danger that psychiatric patients can impact to self and others and should be adopted as a last resort.
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Regardless of hospitalization of psychiatric patients being a subject of controversy, the many benefits associated towards its implementation demonstrates on the need to support it. The final goal is towards restoring the normal mental functioning of the patient. This is with the aim of resulting in an increase in the capacity of the patient to make autonomous decisions and eventually agree towards voluntary hospitalization and treatment.
- Brooks, R. A. (2007). Psychiatrists’ opinions about involuntary civil commitment: results of a national survey. The Journal of the American Academy of Psychiatry and the Law, 35, 2, 219-28.
- Hughes, R., Hayward, M., & Finlay, M. (2009). Patients’ perceptions of the impact of involuntary inpatient care on self, relationships and recovery. Journal of Mental Health, 18, 2, 152-160.
- Owen, G. S., Freyenhagen, F., Richardson, G., & Hotopf, M. (2009). Mental Capacity and Decisional Autonomy: An Interdisciplinary Challenge. Inquiry, 52, 1, 19-32.
- Quinlan, C., & Coffey, A. (2015). Mental health nurses’ perspectives on Psychiatric advance directives. Mental Health Practice, 18, 7, 25-30.
- Sandman, L., & Munthe, C. (2010). Shared Decision Making, Paternalism and Patient Choice. Health Care Analysis, 18, 1, 60-84.
- Sibitz, I., Scheutz, A., Lakeman, R., Schrank, B., Schaffer, M., & Amering, M. (2011). Impact of coercive measures on life stories: qualitative study. The British Journal of Psychiatry : the Journal of Mental Science, 199, 3, 239-44.
- Zuckerberg, J. (2012). Jurisdiction of Mental Health Tribunals to Provide Positive Remedies, Application, Challenges, and Prospects, 5(7), 267-268.