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Cited by 59Healthcare Decision-Making and RestraintsEthics in medical practiceEthics and bioethics in healthcare

Ethical challenges in connection with the use of coercion: a focus group study of health care personnel in mental health care

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Hem, Marit Helene, Molewijk, Bert, Pedersen, Reidar·2014·BMC Medical Ethics
DOI 10.1186/1472-6939-15-82PMC PMC4269949
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Abstract

BACKGROUND: In recent years, the attention on the use of coercion in mental health care has increased. The use of coercion is common and controversial, and involves many complex ethical challenges. The research question in this study was: What kind of ethical challenges related to the use of coercion do health care practitioners face in their daily clinical work? METHODS: We conducted seven focus group interviews in three mental health care institutions involving 65 multidisciplinary participants from different clinical fields. The interviews were recorded and transcribed verbatim. We analysed the material applying a 'bricolage' approach. Basic ethical principles for research ethics were followed. We received permission from the hospitals' administrations and all health care professionals who participated in the focus group interviews. RESULTS: Health care practitioners describe ethical dilemmas they face concerning formal, informal and perceived coercion. They provide a complex picture. They have to handle various ethical challenges, not seldom concerning questions of life and death. In every situation, the dignity of the patient is at stake when coercion is considered as morally right, as well as when coercion is not the preferred intervention. The work of the mental health professional is a complicated "moral enterprise". The ethical challenges deserve to be identified and handled in a systematic way. This is important for developing the quality of health care, and it is relevant to the current focus on reducing the use of coercion and increasing patient participation. Precise knowledge about ethical challenges is necessary for those who want to develop ethics support in mental health care. Better communication skills among health care professionals and improved therapeutic relationships seem to be vital. CONCLUSIONS: A systematic focus on ethical challenges when dealing with coercion is an important step forward in order to improve health care in the mental health field.

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  • Although each professional's approach does influence how care is perceived and the extent to which it is experienced as coercive, the literature also highlights that healthcare workers are trapped within systems that prevent them from intervening in ways that align with their professional values.

    “Although each professional’s approach does influence how care is perceived and the extent to which it is experienced as coercive [47,83,153], the literature also highlights that healthcare workers are trapped within systems that prevent them from intervening in ways that align with their professional values, which are centered on supporting, not controlling, the person [181,182,183].”

    From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [181]

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  1. The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1472-6939/15/82/prepub

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Authors
Hem, M. H., Molewijk, B., & Pedersen, R.
Affiliations
University of Oslo (NO)
Corresponding author
Hem, Marit Helene
ORCID
Venue
BMC Medical Ethics
Publisher
Springer Science and Business Media LLC
Published
2014-12
Volume
15
Issue
1
Pages
82-82
ISSN
1472-6939 (ISSN-L)
DOI
10.1186/1472-6939-15-82
PMC
PMC4269949
OpenAlex
W2167581669
Cited by
59
References
47
Citations by year
2026: 2 · 2025: 6 · 2024: 8 · 2023: 9 · 2022: 3 · 2021: 4 · 2020: 4 · 2019: 5 · 2018: 5 · 2017: 2 · 2016: 9 · 2015: 2
FWCI
5.13
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Medical Ethics (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
Helsedirektoratet
Topics
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
  • Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Keywords
coercion in mental health care, ethical considerations, ethical dilemmas, healthcare workers, patient dignity, therapeutic relationship, communication skills, patient participation, life and death decisions
MeSH terms
Adult, Attitude of Health Personnel, Mental Disorders, Coercion, Female, Health Personnel, Humans, Male, Mental Health Services, Middle Aged, Norway, Patient Participation, Professional-Patient Relations, Focus Groups, Ethics, Clinical, Moral Obligations, Narration

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