Substance use disorder and compulsory commitment to care: a care-ethical decision-making framework.

Area of Science:

• Psychiatry
• Bioethics
• Clinical Psychology

Background:

• Compulsory commitment to care (CCC) rates remain high despite deinstitutionalization, particularly for severe substance use disorder (SUD).
• CCC is ethically controversial due to disagreements on mental illness, autonomy, and the impact of medico-legal frameworks on clinical evaluation.
• Discrepancies in perceived coercion between clinicians and patients complicate CCC decision-making and treatment motivation.

Purpose of the Study:

• To explore the application of care ethics to decision-making processes for compulsory commitment to care (CCC).
• To investigate how a care-ethical framework can address ethical challenges in CCC for patients with severe substance use disorder (SUD).
• To propose a paradigm shift in CCC evaluations by integrating care ethics into the therapeutic relationship.

Main Methods:

• Exploration of care ethics principles, including lived experience, interpretative dialogue, and dignity promotion.
• Analysis of the application of care ethics to procedural medical practices like CCC decision-making.
• Formulation of implications for clinical practice based on a care-ethical approach.

Main Results:

• A care-ethical approach reframes CCC decision-making as a dynamic care process, emphasizing patient experience and dialogue.
• Early cultivation of the therapeutic relationship during CCC evaluation, guided by care ethics, can reduce perceived coercion.
• This approach enhances patient participation in defining needs, reduces negative emotions, and improves treatment motivation.

Conclusions:

• Care ethics offers a valuable framework for ethically navigating compulsory commitment to care (CCC) in psychiatry, especially for severe substance use disorder (SUD).
• Integrating care ethics into CCC evaluations represents a paradigm shift, fostering a stronger therapeutic alliance from the outset.
• This approach has significant implications for improving clinical practice, patient-centeredness, and treatment outcomes in involuntary psychiatric care.