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Cited by 94Ethics and bioethics in healthcareEthics in medical practiceHealthcare Decision-Making and Restraints

Paternalism, autonomy and reciprocity: ethical perspectives in encounters with patients in psychiatric in-patient care

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Pelto-Piri, Veikko, Engström, Karin, Engström, Ingemar·2013·BMC Medical Ethics
DOI 10.1186/1472-6939-14-49PMC PMC4029406
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Abstract

BACKGROUND: Psychiatric staff members have the power to decide the options that frame encounters with patients. Intentional as well as unintentional framing can have a crucial impact on patients' opportunities to be heard and participate in the process. We identified three dominant ethical perspectives in the normative medical ethics literature concerning how doctors and other staff members should frame interactions in relation to patients; paternalism, autonomy and reciprocity. The aim of this study was to describe and analyse statements describing real work situations and ethical reflections made by staff members in relation to three central perspectives in medical ethics; paternalism, autonomy and reciprocity. METHODS: All staff members involved with patients in seven adult psychiatric and six child and adolescent psychiatric clinics were given the opportunity to freely describe ethical considerations in their work by keeping an ethical diary over the course of one week and 173 persons handed in their diaries. Qualitative theory-guided content analysis was used to provide a description of staff encounters with patients and in what way these encounters were consistent with, or contrary to, the three perspectives. RESULTS: The majority of the statements could be attributed to the perspective of paternalism and several to autonomy. Only a few statements could be attributed to reciprocity, most of which concerned staff members acting contrary to the perspective. The result is presented as three perspectives containing eight values.•Paternalism; 1) promoting and restoring the health of the patient, 2) providing good care and 3) assuming responsibility.•Autonomy; 1) respecting the patient's right to self-determination and information, 2) respecting the patient's integrity and 3) protecting human rights.•Reciprocity; 1) involving patients in the planning and implementation of their care and 2) building trust between staff and patients. CONCLUSIONS: Paternalism clearly appeared to be the dominant perspective among the participants, but there was also awareness of patients' right to autonomy. Despite a normative trend towards reciprocity in psychiatry throughout the Western world, identifying it proved difficult in this study. This should be borne in mind by clinics when considering the need for ethical education, training and supervision.

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  • Literature on paternalism in psychiatric care suggests that professionals often curtail patients' autonomy under the guise of protection, benevolence, and normative ideals of functioning.

    “Literature on paternalism in psychiatric care suggests that professionals often curtail patients’ autonomy under the guise of protection, benevolence, and normative ideals of functioning [172,173,174].”

    From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [174]

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Research works printed but not linked: 1

  1. Engström K Delaktighet under tvång. Om ungdomars erfarenhet i barn- och ungdomspsykiatrisk slutenvård. [Participation under coercion. On young people’s experiences in child and adolescent psychiatric inpatient care. In Swedish]. PhD Thesis 2008 Örebro: Örebro University

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Authors
Pelto-Piri, V., Engström, K., & Engström, I.
Affiliations
  • Stockholm University (SE)
  • Örebro University (SE)
ORCID
Engström, Ingemar
Venue
BMC Medical Ethics
Publisher
Springer Science and Business Media LLC
Published
2013-12
Volume
14
Issue
1
Pages
49-49
ISSN
1472-6939 (ISSN-L)
DOI
10.1186/1472-6939-14-49
PMC
PMC4029406
OpenAlex
W2084074418
Cited by
94
References
29
Citations by year
2026: 11 · 2025: 17 · 2024: 8 · 2023: 8 · 2022: 8 · 2021: 5 · 2020: 7 · 2019: 7 · 2018: 5 · 2017: 6 · 2016: 6 · 2015: 1 · 2014: 3 · 2013: 1
FWCI
3.75
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Medical Ethics (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
  • Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
Keywords
paternalism, patient autonomy, reciprocity, ethical perspectives, child and adolescent psychiatry, patient participation, trust, ethics education, medical ethics
MeSH terms
Patient Care, Humans, Inpatients, Patient Participation, Physician-Patient Relations, Psychiatry, Personal Autonomy, Paternalism, Patient Rights, Trust, Qualitative Research

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