Psychiatr Serv 54:866-870, June 2003
© 2003 American Psychiatric Association
Ethical Exploration of the Least Restrictive Alternative
Chih-Yuan Lin, M.D.
Although there have been critiques about the application of the "least restrictive alternative" to mental health policies in the past three decades, no critical analysis of the ethical logic of this principle has been put forward. The author explores three main ethical theories—liberalism, utilitarianism, and communitarianism—and explains how liberalism and subjective utilitarianism, which evidently uphold the least restrictive alternative in the name of individual rights and preference for liberty, effectively disenfranchise patients and members of their family. Contrarily, objective utilitarianism, with its highlight on cost-effectiveness analysis, would actually lay solid ground for mental health policies that attend not simply to ideological belief but rather to the question of which treatments can most cost-effectively meet the complex needs of patients. In addition, under communitarianism the evidence derived from cost-effectiveness analysis can be used to reinterpret the traditional value in mental health policies and thereby lead to the policy in favor of the most cost-effective alternative.
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