The moral permissibility of coercive treatment in psychiatry

Abstract

The advent of psychopharmacological interventions in the middle of the 20th century accompanied by the improvements in psychotherapy has improved the outcomes of treatment of mental illness from the dark days of chronic institutionalisation in mental asylums to the ushering in of an era of deinstitutionalisation. Today it is established that psychiatric treatment is beneficial to people with mental illness and untreated mental illness has negative biopsychosocial consequences. However, some people with severe mental illness such as those with schizophrenia and bipolar disorder or other disorders such as anorexia nervosa, refuse psychiatric treatment despite its established benefits. In these cases, coercive treatment, which is involuntary psychiatric treatment without the patient’s consent, may be a consideration even if these people are not infringing on the rights of others. If coercive treatment is considered in these people with mental illness, there could be concerns about respect for autonomy and the infringement of coercive treatment on their rights. In this research report the autonomy of people with mental illness and the respect for their rights is weighed against the benefits of psychiatric treatment. It is argued that in some cases of mental illness the objection to psychiatric treatment may be non- autonomous as the person with mental illness may lack decisional capacity. It is further argued that psychiatric treatment has benefits that far outweigh the temporary infringement on rights by coercive treatment. The overall argument of this research report is therefore that coercive treatment in psychiatry is morally permissible, and that society has a moral obligation to treat people with mental illness even if that treatment includes coercive treatment in selected cases.