A qualitative study of forensic patients' perceptions of quasi-coercive offers of biological treatment

At various points in the trajectory through the criminal justice system, a person may be encouraged by the hope of legal benefit to consent to medical treatment. This benefit may consist of diversion from prosecution, a favorable sentence, or parole. This form of legal encouragement has been referred to as legal leverage, quasi-coercive, or quasi-compulsory treatment. In this article, we analyze interviews with 15 men convicted of sexual offenses to explore their reactions to two hypothetical scenarios involving men consenting to a range of treatments intended to reduce risk of recidivism. In particular, we explore their reactions to quasi-coercive treatment using both real and hypothetical forms of biological therapy (e.g., drugs, brain stimulation, surgery), as opposed to psychological counselling. Here, we consider the extent to which these individuals perceive the situation to be coercive, the factors affecting these perceptions, and the ways in which physicians may mitigate perceived coercion. We found there is usually some degree of coercion identified when treatment consent is given in exchange for potential legal benefit, although this fact alone did not necessarily render the practice unacceptable. The degree of concern expressed over this potential coercion was related to the invasiveness and/or permanence of the treatment, and all participants highlighted the necessity of obtaining fully informed consent in the context of legally motivated treatment offers.