Substance use disorder and compulsory commitment to care: a care-ethical decision-making framework
Autor: | Chris Gastmans, Joris Vandenberghe, Marie Nicolini |
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Rok vydání: | 2017 |
Předmět: |
coercion
Adult Male Psychotherapist Substance-Related Disorders media_common.quotation_subject Coercion ethical dilemma Decision Making compulsory commitment to care Procedural justice Respect involuntary hospitalisation 03 medical and health sciences Dignity 0302 clinical medicine Mentally Ill Persons medicine substance abuse Humans care ethics 030212 general & internal medicine media_common Aged Aged 80 and over procedural justice substance use disorder Ethical decision Public Health Environmental and Occupational Health Middle Aged Mental illness medicine.disease psychiatry 030227 psychiatry Therapeutic relationship Ethical dilemma Commitment of Mentally Ill Female addiction Psychology Autonomy |
Zdroj: | Scandinavian journal of caring sciences. 32(3) |
ISSN: | 1471-6712 1237-1246 |
Popis: | In the era of deinstitutionalisation of psychiatric patients, steady or even increasing rates of compulsory commitment to care (CCC) are an intriguing phenomenon to analyse. From a clinical, legal and ethical perspective, CCC continues to be a controversial practice in psychiatry, and perhaps even more so when applied to patients with severe substance use disorder (SUD). Several reasons make it controversial. The lack of consensus about the benefits of CCC and professional disagreement about what mental illness and autonomy mean in the case of SUD make it difficult to apply ethically sound clinical decision-making in CCC. Also, the medico-legal framework underlying CCC use sometimes appears to foster the use of reductionist clinical evaluation. Layered on top of these issues is how stakeholders view coercion. There is a discrepancy between clinicians' and patients' perception of coercion, which leads to clinician-patient differences on whether CCC is necessary. Moreover, the way in which the evaluation is typically carried out influences patients' perception of coercion and subsequently their motivation for participating fully in treatment. In this article, we explore the value of care ethics, often applied to care practices such as nursing, when applied to more procedural medical practices, such as decision-making regarding CCC. The care-ethical approach views decision-making as part of a dynamic care process, within which the lived experience, interpretative dialogue and promotion of dignity are core features. Embracing this new framework means a paradigm shift in when the therapeutic relationship begins, namely, investing in it occurs while conducting an evaluation for a possible CCC procedure. Unlike in current typical evaluations, early cultivation of the therapeutic relationship enables the patient to participate in the definition of his needs, reduces perceived coercion and negative emotions and enhances treatment motivation. Finally, implications of this novel approach for clinical practice are formulated and discussed. ispartof: SCANDINAVIAN JOURNAL OF CARING SCIENCES vol:32 issue:3 pages:1237-1246 ispartof: location:Sweden status: published |
Databáze: | OpenAIRE |
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