The Role of Ethics in Reducing and Improving the Quality of Coercion in Mental Health Care

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• 作者：Reidun Norvoll ; Marit Helene Hem ; Reidar Pedersen
• 关键词：Coercion ; Ethics ; Clinical ethics support ; Mental health policy ; Quality improvement and research
• 刊名：HEC Forum
• 出版年：2017
• 出版时间：March 2017
• 年：2017
• 卷：29
• 期：1
• 页码：59-74
• 全文大小：
• 刊物类别：Humanities, Social Sciences and Law
• 刊物主题：Ethics; Medical Law; Philosophy of Medicine; Theory of Medicine/Bioethics;
• 出版者：Springer Netherlands
• ISSN：1572-8498
• 卷排序：29

文摘

Coercion in mental health care gives rise to many ethical challenges. Many countries have recently implemented state policy programs or development projects aiming to reduce coercive practices and improve their quality. Few studies have explored the possible role of ethics (i.e., ethical theory, moral deliberation and clinical ethics support) in such initiatives. This study adds to this subject by exploring health professionals’ descriptions of their ethical challenges and strategies in everyday life to ensure morally justified coercion and best practices. Seven semi-structured telephone interviews were carried out in 2012 with key informants in charge of central development projects and quality-assurance work in mental health services in Norway. No facilities used formal clinical ethics support. However, the informants described five areas in which ethics was of importance: moral concerns as implicit parts of local quality improvement initiatives; moral uneasiness and idealism as a motivational source of change; creating a normative basis for development work; value-based leadership; and increased staff reflexivity on coercive practices. The study shows that coercion entails both individual and institutional ethical aspects. Thus, various kinds of moral deliberation and ethics support could contribute to addressing coercion challenges by offering more systematic ways of dealing with moral concerns. However, more strategic use of implicit and institutional ethics is also needed.