Perspectives on the use of coercion in highly specialised rehabilitation: a focus group study

Few systematic studies have examined decisions about the use of coercion to provide somatic health care within highly specialised physical medicine and rehabilitation. The aim of the study was to investigate the factors likely to influence decisions about the use of coercion in this context.

We invited 18 doctors from a specialist rehabilitation hospital to participate in semi-structured focus groups. Thirteen agreed to take part. Data from the discussions were analysed using a five-step thematic analysis based on a predefined theoretical framework.

A range of factors relating to the legal framework, doctors, patients, patients' families, the organisation and the wider institutional context were thought to influence decisions about the use of coercion. These factors were grouped into three overarching themes that captured the perceived challenges of the decision-making process: (i) tension between the legal framework and everyday clinical practice; (ii) clinical uncertainty as a barrier to assessing the patient's capacity to consent; and (iii) ethical dilemmas in balancing patient autonomy with beneficence.

The findings suggest that doctors' clinical standards, assessments and judgement are given significant weight in decisions regarding the use of coercion in highly specialised rehabilitation.