The right to accept and the right to refuse

Area of Science:

• Bioethics
• Legal Studies
• Public Health Policy

Background:

• The principle of symmetry in patient rights suggests that competence to consent to hospitalization implies competence to refuse it.
• Current civil commitment practices in Nordic countries often operate under a narrow definition of coercion.
• This narrow definition creates an imbalance in patient autonomy and rights concerning involuntary hospital admission.

Purpose of the Study:

• To analyze the conflict between Nordic civil commitment acts and the ideal of symmetry in patient rights.
• To differentiate between narrow and wide concepts of coercion in the context of hospital admission.
• To critically evaluate the normative implications of asymmetrical patient competence and rights in current legislation.

Main Methods:

• Conceptual analysis distinguishing between narrow and wide definitions of coercion.
• Examination of the presupposed or explicit use of coercion concepts within Nordic civil commitment legislation.
• Normative ethical discussion on the implications of asymmetrical patient rights.

Main Results:

• Nordic civil commitment acts predominantly utilize a narrow concept of coercion.
• This narrow concept results in an asymmetrical application of patient competence and rights.
• The ideal of symmetry supports a wider concept of coercion, but does not mandate its adoption.

Conclusions:

• The current narrow concept of coercion in Nordic civil commitment laws violates the ideal of symmetry.
• A shift towards a wider concept of coercion is normatively supported by the principle of symmetry.
• Empirical data on practical implications is necessary to justify a legislative change from a narrow to a wide concept of coercion.