Ethical issues in family planning for hospitalized psychiatric patients

The authors present guidelines based on their experience with a family planning program for patients in mental hospitals. They believe that informed consent for these patients should include an adequate knowledge base, the patients' competence to make decisions, and the absence of coercion. Among safeguards are the reversibility of contraceptive procedures, the separation of the family planning counselor from the treatment staff to avoid possible covert coercion, and careful choice of the stage of hospitalization at which counseling occurs. The authors examine the implications of a patient's refusal to use contraception, noting the impossibility of involuntary contraception and the ethical and legal problems regarding sterilization procedures.