PS 1997; 48:1567-1570
Copyright © 1997 by American Psychiatric Association
Ethical benefits and costs of coercion in short-term inpatient psychiatric care
L Kjellin, K Andersson, IL Candefjord, T Palmstierna and T Wallsten
Department of Psychiatric Research, Vasteras Hospital, Sweden.
OBJECTIVE: The study examined the outcome of psychiatric inpatient care in
terms of patients' reports of ethical benefits, which were defined as
fulfillment of the ethical principles of beneficence and autonomy, and
ethical costs, which were defined as any violation of those principles.
METHODS: A consecutive sample of 84 committed patients and a random sample
of 84 voluntarily admitted patients in psychiatric care in two Swedish
counties were studied. The patients were assessed twice by a psychiatrist,
at admission and at discharge or after three weeks of care. They were also
interviewed by a clinical psychologist at discharge or after three weeks.
Four aspects of the ethical benefits or costs of their care were
examined--whether they reported improvement in mental health, being treated
with respect, not being violated as a person, and not being exposed to
measures against their will (aside from commitment). RESULTS: The great
majority of all patients reported improvement as a result of the
psychiatric care. A third of the committed patients and more than half of
the voluntarily admitted patients experienced ethical benefits only,
without ethical costs. Twenty-three percent of the committed patients and
13 percent of the voluntary patients experienced ethical costs only,
without ethical benefits. Some of the patients who experienced ethical
costs only were also rated by a psychiatrist as not improved. CONCLUSIONS:
Few patients had no measurable benefits of care. For committed as well as
voluntary patients, an association was found between perceived respect for
autonomy and self-reported improvement in mental health.
