Ethical Issues in Clinical Decision-Making about Involuntary Psychiatric Treatment: A Scoping Review.

Area of Science:

• Psychiatry
• Bioethics
• Mental Health Law

Background:

• Involuntary psychiatric treatment remains a contentious issue in mental healthcare.
• Ethical considerations are central to clinical decision-making regarding compulsory treatment for mental disorders.

Purpose of the Study:

• To systematically map and analyze the existing literature on ethical issues in clinical decision-making for involuntary psychiatric treatment.
• To identify ethical foundations, criteria, risks, and strategies related to involuntary mental healthcare.

Main Methods:

• A comprehensive scoping review was conducted using five major databases: Embase, PsycINFO, CINAHL, Medline, and Scopus.
• Inductive content analysis was applied to 35 selected studies from 14 countries, identified from an initial pool of 342 articles.

Main Results:

• Key themes included ethical foundations (autonomy, beneficence, justice), criteria for treatment, identified risks, and strategies for mitigation.
• Significant findings indicate a lack of effective communication and a power imbalance during involuntary admissions, often disenfranchising service users.
• Coercive measures were frequently employed without clear rationale, exacerbated by family reliance on hospital admission.

Conclusions:

• Ethical principles must be carefully balanced in involuntary treatment decisions.
• Addressing communication deficits and power dynamics is crucial for improving involuntary psychiatric care.
• Future research should focus on context-specific, co-produced, and participatory approaches to understand legal capacity and involuntary admission complexities.