[How do employees of psychiatric hospitals evaluate medical ethical conflicts in coercive measures]

The practice of coercive treatment in psychiatric hospitals raises numerous medical, juridical and ethical questions. Moreover, coercive measures lead to the contradiction of certain medical ethical principles. We examined the attitudes of psychiatric hospital employees towards ethical conflicts in medicine and asked them how they decide for or against coercive measures through the help of a hypothetical case.

In a questionnaire, 73 psychiatric hospital employees of various professions were asked about their attitudes towards several ethical conflicts in medicine. They were requested to decide for or against the use of coercive measures in the case of a hypothetical patient suffering from schizophrenia.

The majority of the respondents agreed that in conflicts between principles of medical ethics the focus of treatment should be on the wellbeing of the patient (89 %) rather than on that of society (11 %). They also favored the principle of autonomy (58 %) over paternalism (42 %). The principle of nonmaleficence appeared to be equally important as beneficence (51 % vs. 49 %). Less invasive coercive measures (assistance through a person in charge) were preferred to more invasive ones (coercive medication), as our case vignette showed. There were no highly significant correlations found between sociodemographic factors (taking work experience and profession into account), judgement about medical ethical conflicts and the decision for or against coercive treatment. Both employees of closed wards with mid-long work experience (6-15 years) as well as nursing staff were more likely to choose coercive treatment. No statistically significant correlation could be determined between the preference of medical ethical principles and decisions about coercive treatment.

Coercive treatment leads to ethical conflicts in medicine. The impact of such conflicts on the application of coercive measures through employees of psychiatric hospitals should be further explored and examined.