The use of ultimatums in psychiatric care

One way in which psychiatrists deal with the problem of a patient who does not follow treatment recommendations is to issue an ultimatum, refusing treatment unless the patient abides by the doctor's treatment plan. The author examines a series of cases to outline seven general principles that can help the psychiatrist decide whether to use an ultimatum and to help make its use a thoughtful clinical intervention rather than an expression of exasperation. The guidelines address practical considerations, such as the complicating fact that ultimatums limit the psychiatrist's future responses to the patient, and ethical issues, such as the possible intrusion of the psychiatrist's self-interest or institutional pressures into treatment ultimatums.