Ethical challenges when using coercion in mental healthcare: A systematic literature review

2016 ◽  
Vol 25 (1) ◽  
pp. 92-110 ◽  
Author(s):  
Marit Helene Hem ◽  
Elisabeth Gjerberg ◽  
Tonje Lossius Husum ◽  
Reidar Pedersen
Keyword(s):  
Patient Autonomy ◽  
Moral Distress ◽  
Mental Healthcare ◽  
Healthcare Personnel ◽  
Ethical Challenge ◽  
Ethical Challenges ◽  
Best Interest ◽  
Ethical Considerations ◽  
Search Terms ◽  
Healthcare It

Background: To better understand the kinds of ethical challenges that emerge when using coercion in mental healthcare, and the importance of these ethical challenges, this article presents a systematic review of scientific literature. Methods: A systematic search in the databases MEDLINE, PsychInfo, Cinahl, Sociological Abstracts and Web of Knowledge was carried out. The search terms derived from the population, intervention, comparison/setting and outcome. A total of 22 studies were included. Ethical considerations: The review is conducted according to the Vancouver Protocol. Results: There are few studies that study ethical challenges when using coercion in an explicit way. However, promoting the patient’s best interest is the most important justification for coercion. Patient autonomy is a fundamental challenge facing any use of coercion, and some kind of autonomy infringement is a key aspect of the concept of coercion. The concepts of coercion and autonomy and the relations between them are very complex. When coercion is used, a primary ethical challenge is to assess the balance between promoting good (beneficence) and inflicting harm (maleficence). In the included studies, findings explicitly related to justice are few. Some studies focus on moral distress experienced by the healthcare professionals using coercion. Conclusion: There is a lack of literature explicitly addressing ethical challenges related to the use of coercion in mental healthcare. It is essential for healthcare personnel to develop a strong awareness of which ethical challenges they face in connection with the use of coercion, as well as challenges related to justice. How to address ethical challenges in ways that prevent illegitimate paternalism and strengthen beneficent treatment and care and trust in connection with the use of coercion is a ‘clinical must’. By developing a more refined and rich language describing ethical challenges, clinicians may be better equipped to prevent coercion and the accompanying moral distress.

scholarly journals Patients’ moral views on coercion in mental healthcare

2016 ◽  
Vol 25 (6) ◽  
pp. 796-807 ◽  
Author(s):  
Reidun Norvoll ◽  
Reidar Pedersen
Keyword(s):  
Mental Health Problems ◽  
Mental Healthcare ◽  
Institutional Factors ◽  
Ethical Challenges ◽  
Ethical Considerations ◽  
Thematic Content Analysis ◽  
Individual Interviews ◽  
Ethical Debate ◽  
Adult Participants ◽  
Ethical Approval

Background: Coercion in mental healthcare has led to ethical debate on its nature and use. However, few studies have explicitly explored patients’ moral evaluations of coercion. Aim: The purpose of this study is to increase understanding of patients’ moral views and considerations regarding coercion. Research design: Semi-structured focus-group and individual interviews were conducted and data were analysed through a thematic content analysis. Participants and research context: A total of 24 adult participants with various mental health problems and experiences with coercion were interviewed in 2012–2013 in three regions of Norway. Ethical considerations: Ethical approval and permissions were obtained according to required procedures. Informed consent and confidentiality were also secured. Findings: Ethical considerations regarding coercion included seven main themes: the need for alternative perspectives and solutions, the existence of a danger or harm to oneself or others, the problem of paternalism, the problem of discrimination and stigma, the need for proportionality, the importance of the content and consequences of coercion and concerns about way that coercion is carried out in practice. Discussion: The participants’ views and considerations are in line with previous research and reflect the range of normative arguments commonly encountered in ethical and legal debates. The study accentuates the significance of institutional factors and alternative voluntary treatment opportunities, as well as the legal and ethical principles of proportionality and purposefulness, in moral evaluations of coercion. Conclusion: Broader perspectives on coercion are required to comprehend its ethical challenges and derive possible solutions to these from a patient perspective.

scholarly journals Neonatologists’ decision-making for resuscitation and non-resuscitation of extremely preterm infants: ethical principles, challenges, and strategies—a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alice Cavolo ◽  
Bernadette Dierckx de Casterlé ◽  
Gunnar Naulaers ◽  
Chris Gastmans
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Preterm Infants ◽  
Moral Distress ◽  
Ethical Decision Making ◽  
Ethical Challenge ◽  
Best Interest ◽  
Clinical Trial Registration ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract Background Deciding whether to resuscitate extremely preterm infants (EPIs) is clinically and ethically problematic. The aim of the study was to understand neonatologists’ clinical–ethical decision-making for resuscitation of EPIs. Methods We conducted a qualitative study in Belgium, following a constructivist account of the Grounded Theory. We conducted 20 in-depth, face-to-face, semi-structured interviews with neonatologists. Data analysis followed the qualitative analysis guide of Leuven. Results The main principles guiding participants’ decision-making were EPIs’ best interest and respect for parents’ autonomy. Participants agreed that justice as resource allocation should not be considered in resuscitation decision-making. The main ethical challenge for participants was dealing with the conflict between EPIs’ best interest and respect for parents’ autonomy. This conflict was most prominent when parents and clinicians disagreed about births within the gray zone (24–25 weeks). Participants’ coping strategies included setting limits on extent of EPI care provided and rigidly following established guidelines. However, these strategies were not always feasible or successful. Although rare, these situations often led to long-lasting moral distress. Conclusions Participants’ clinical–ethical reasoning for resuscitation of EPIs can be mainly characterized as an attempt to balance EPIs’ best interest and respect for parents’ autonomy. This approach could explain why neonatologists considered conflicts between these principles as their main ethical challenge and why lack of resolution increases the risk of moral distress. Therefore, more research is needed to better understand moral distress in EPI resuscitation decisions. Clinical Trial Registration: The study received ethical approval from the ethics committee of UZ/KU Leuven (S62867). Confidentiality of personal information and anonymity was guaranteed in accordance with the General Data Protection Regulation of 25 May 2018.

Nursing students’ ethical challenges in the clinical settings: A mixed-methods study

2018 ◽  
Vol 26 (7-8) ◽  
pp. 1983-1991 ◽  
Author(s):  
Roghayeh Mehdipour Rabori ◽  
Mahlagha Dehghan ◽  
Monirosadat Nematollahi
Keyword(s):  
Mixed Methods ◽  
Nursing Students ◽  
Clinical Education ◽  
Learning Process ◽  
Moral Distress ◽  
Mixed Methods Study ◽  
Ethical Challenge ◽  
Clinical Settings ◽  
Ethical Challenges ◽  
Ethical Conflicts

Background: Nursing students experience ethical conflicts and challenges during their clinical education. These may lead to moral distress and disturb the learning process. Objectives: This study aimed to explore and to evaluate the nursing students’ ethical challenges in the clinical settings in Iran. Research design: This was a mixed-methods study with an exploratory sequential design. Participants and research context: A total of 37 and 120 Iranian nursing students participated in the qualitative and quantitative phases, respectively. Ethical considerations: The ethical committee of Kerman University of Medical Sciences, Iran, approved the protocol of the study. Findings: Three main categories were extracted from qualitative data including Low attention of nurses to the patients’ preferences; Lack of authority; and Inadequate support. A total of 97% of the students had more than one ethical challenge in clinical settings and 48% of them stated that their challenges did not resolve. The total score of perceived ethical challenges was 62.03 ± 9.17, which was moderate. The highest mean score related to the “Low attention of nurses to the patients’ preferences” subscale. Discussion: The finding confirmed most of the existing results of other international researches about the frequency and kinds of baccalaureate nursing students’ ethical challenges. Conclusion: Identifying student ethical challenges helps teachers to manage their clinical learning process better. This study may provide a view for the nurses, clinical educators, and managers toward nursing students’ ethical challenges and their impact on nursing students’ clinical experiences.

scholarly journals Carmi Syndrome in a Preterm Neonate: A Multidisciplinary Approach and Ethical Challenge

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Timothy D. Hicks ◽  
Himanshu Singh ◽  
Michel Mikhael ◽  
Anita R. Shah
Keyword(s):  
Multidisciplinary Approach ◽  
Preterm Neonate ◽  
Ethical Challenge ◽  
Ethical Challenges ◽  
Health Care Teams ◽  
Best Interest ◽  
Pyloric Atresia ◽  
Tissue Separation ◽  
Multisystem Involvement ◽  
Carmi Syndrome

Epidermolysis bullosa (EB) is characterized by blistering of the skin and mucosal erosions caused by hemidesmosomal abnormalities. EB is divided into 3 major subgroups depending on the particular location of tissue separation: EB simplex, dystrophic EB, and junctional EB. Junctional EB (JEB) can further be broken down into Herlitz, non-Herlitz, and JEB with pyloric atresia (Carmi syndrome) depending on genetic and histologic testing. When extensive, management of a patient with EB can be challenging due to not only cutaneous but also extracutaneous manifestations as well. Families and health care teams are often faced with difficult decisions in their infant’s best interest. We report a case of a preterm neonate with Carmi syndrome and unique findings on immunofluorescence studies. The patient’s course was complicated by multisystem involvement and ultimately death. A multidisciplinary approach was crucial in the light of diagnostic, therapeutic, and ethical challenges.

Experiences of Hearing Parents Following the Diagnosis of Their Child's Hearing Loss

2018 ◽  
Vol 30 (2) ◽  
Author(s):  
Ronel Sanet Davids ◽  
Mariana De Jager
Keyword(s):  
South Africa ◽  
Hearing Loss ◽  
Thematic Analysis ◽  
Qualitative Methodology ◽  
Cape Town ◽  
Best Interest ◽  
Ethical Considerations ◽  
Hearing Parents ◽  
Phenomenological Design ◽  
Depth Interviews

An estimated 90 per cent of children with a hearing loss are born to hearing parents. Most parents are unprepared for the diagnosis, leaving them shocked, confused, sad and bewildered. This article reports on a study aimed at exploring and describing the experiences of hearing parents regarding their child’s hearing loss. The study was conducted in Cape Town, South Africa. The study applied a qualitative methodology with a phenomenological design. Purposive sampling was implemented and data were collected by means of unstructured in-depth interviews. Data were analysed using thematic analysis. Ethical considerations were adhered to. The main findings of the study indicated that hearing parents experience a myriad of emotions when their child is diagnosed with a hearing loss. This study advocates for various stakeholders in the helping profession to collaborate in the best interest of hearing parents and a child with hearing loss. Furthermore, these findings serve as guidelines for professionals working with these families.

The neuroethical future of wearable and mobile health technology

2017 ◽  
Author(s):  
Karola V. Kreitmair ◽  
Mildred K. Cho
Keyword(s):  
Mobile Health ◽  
Ethical Issues ◽  
Health Technology ◽  
The Self ◽  
Ethical Challenges ◽  
Mobile Health Technology ◽  
Healthcare Settings ◽  
Healthcare It ◽  
Mobile Mental Health ◽  
Privacy And Confidentiality

Wearable and mobile health technology is becoming increasingly pervasive, both in professional healthcare settings and with individual consumers. This chapter delineates the various functionalities of this technology and identifies its different purposes. It then addresses the ethical challenges that this pervasiveness poses in the areas of accuracy and reliability of the technology, privacy and confidentiality of data, consent, and the democratization of healthcare. It also looks at mobile mental health apps as a case study to elucidate the discussion of ethical issues. Finally, the chapter turns to the question of how this technology and the associated “quantification of the self” affect traditional modes of epistemic access to and phenomenological conceptions of the self.

scholarly journals Ethical challenges of the healthcare transition to adult antiretroviral therapy (ART) clinics for adolescents and young people with HIV in Uganda

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Scovia Nalugo Mbalinda ◽  
Sabrina Bakeera-Kitaka ◽  
Derrick Lusota Amooti ◽  
Eleanor Namusoke Magongo ◽  
Philippa Musoke ◽  
...  
Keyword(s):  
Young People ◽  
Patient Autonomy ◽  
Ethical Issues ◽  
Transition Process ◽  
Hiv Care ◽  
Ethical Challenges ◽  
Successful Transition ◽  
Healthcare Transition ◽  
Increased Risk ◽  
Retention In Hiv Care

Abstract Background Whereas many adolescents and young people with HIV require the transfer of care from paediatric/adolescent clinics to adult ART clinics, this transition is beset with a multitude of factors that have the potential to hinder or facilitate the process, thereby raising ethical challenges of the transition process. Decisions made regarding therapy, such as when and how to transition to adult HIV care, should consider ethical benefits and risks. Understanding and addressing ethical challenges in the healthcare transition could ensure a smooth and successful transition. The purpose of this study was to analyze the ethical challenges of transitioning HIV care for adolescents into adult HIV clinics. Methods Data presented were derived from 191 adolescents attending nine different health facilities in Uganda, who constituted 18 focus group discussions. In the discussions, facilitators and barriers regarding adolescents transitioning to adult HIV clinics were explored. Guided by the Silences Framework for data interpretation, thematic data analysis was used to analyze the data. The principles of bioethics and the four-boxes ethics framework for clinical care (patient autonomy, medical indications, the context of care, and quality of life) were used to analyze the ethical issues surrounding the transition from adolescent to adult HIV care. Results The key emerging ethical issues were: reduced patient autonomy; increased risk of harm from stigma and loss of privacy and confidentiality; unfriendly adult clinics induce disengagement and disruption of the care continuum; patient preference to transition as a cohort, and contextual factors are critical to a successful transition. Conclusion The priority outcomes of the healthcare transition for adolescents should address ethical challenges of the healthcare transition such as loss of autonomy, stigma, loss of privacy, and discontinuity of care to ensure retention in HIV care, facilitate long-term self-care, offer ongoing all-inclusive healthcare, promote adolescent health and wellbeing and foster trust in the healthcare system. Identifying and addressing the ethical issues related to what hinders or facilitates successful transitions with targeted interventions for the transition process may ensure adolescents and young people with HIV infection remain healthy across the healthcare transition.

Researching moral distress among New Zealand nurses

2014 ◽  
Vol 22 (1) ◽  
pp. 117-130 ◽  
Author(s):  
Martin Woods ◽  
Vivien Rodgers ◽  
Andy Towers ◽  
Steven La Grow
Keyword(s):  
New Zealand ◽  
Nurse Educators ◽  
Moral Distress ◽  
Response Rate ◽  
Ethical Considerations ◽  
Optimal Care ◽  
Adequate Response ◽  
Human Ethics ◽  
Distress Scale ◽  
Service Managers

Background: Moral distress has been described as a major problem for the nursing profession, and in recent years, a considerable amount of research has been undertaken to examine its causes and effects. However, few research projects have been performed that examined the moral distress of an entire nation’s nurses, as this particular study does. Aim/objective: The purpose of this study was to determine the frequency and intensity of moral distress experienced by registered nurses in New Zealand. Research design: The research involved the use of a mainly quantitative approach supported by a slightly modified version of a survey based on the Moral Distress Scale–Revised. Participants and research context: In total, 1500 questionnaires were sent out at random to nurses working in general areas around New Zealand and 412 were returned, giving an adequate response rate of 27%. Ethical considerations: The project was evaluated and judged to be low risk and recorded as such on 22 February 2011 via the auspices of the Massey University Human Ethics Committee. Findings: Results indicate that the most frequent situations to cause nursing distress were (a) having to provide less than optimal care due to management decisions, (b) seeing patient care suffer due to lack of provider continuity and (c) working with others who are less than competent. The most distressing experiences resulted from (a) working with others who are unsafe or incompetent, (b) witnessing diminished care due to poor communication and (c) watching patients suffer due to a lack of provider continuity. Of the respondents, 48% reported having considered leaving their position due to the moral distress. Conclusion: The results imply that moral distress in nursing remains a highly significant and pertinent issue that requires greater consideration by health service managers, policymakers and nurse educators.

Intensive care nurses’ experiences of Covid-19 care: A practical and ethical challenge – a qualitative descriptive design

2021 ◽  
pp. 205715852110627
Author(s):  
Anna-Lena Stenlund ◽  
Gunilla Strandberg
Keyword(s):  
Intensive Care ◽  
Qualitative Content Analysis ◽  
Treatment Strategies ◽  
Ethical Challenge ◽  
Ethical Challenges ◽  
Structured Interviews ◽  
Intensive Care Nurses ◽  
Qualitative Descriptive ◽  
Heavy Burden ◽  
New Treatment

The Covid-19 pandemic has generated new experiences of intensive care. It has entailed new working methods, treatment strategies, and ethical dilemmas. The aim of this study was to describe intensive care nurses’ experiences of Covid-19 care and its ethical challenges. Data collection consisted of 11 individual semi-structured interviews and a qualitative content analysis was used. The COREQ checklist was followed. Three main themes emerged: to meet Covid-19 patients’ needs for specifically tailored intensive care; to have a changed approach to the excluded relatives is unethical, but defensible; and to strive to protect ethical values needs to be considered as good enough. In conclusion, ICU nurses shouldered a heavy burden in taking responsibility for the safety of these patients, continuously learning about new treatment strategies. Caring for Covid-19 patients was to strive to make the best of the situation.

Stand-Up and Be Counted: Exploring The Role of Comedy in Society

2021 ◽  
Author(s):  
Peter Robinson ◽  
Zoe Turner
Keyword(s):  
Social Impact ◽  
Social Issues ◽  
Positive Impact ◽  
Mental Healthcare ◽  
Significant Other ◽  
Art Form ◽  
Healthcare It ◽  
Perceived Price ◽  
Key Issues ◽  
Sensitive Issues

Comedy is a multidimensional, diverse and versatile spectacle, an identifiable art form and source of entertainment and it has a rich historical identity and purpose. It contributes to cultural identities and has more recently been proven to provide positive impacts in mental healthcare. It offers social and cultural benefit and influences social change. The growth of live comedy has a strong background in working-class venues which has possibly predisposed it to being perceived as less significant other performance arts such as dance and theatre. Given the untapped potential for further research this empirical paper sought to evaluate the potential opportunities for comedy to make a greater positive impact on local communities. To facilitate this, data was collected through surveys administered online and in comedy clubs in the West Midlands (UK). A total of 179 questionnaires were received, supported with in-depth interviews with comedy club managers. Key issues for live comedy engagement were found to include a lack of awareness, perceived price barriers and a lack of publicity. 70% of respondents agreed that live comedy could have a wider, positive social impact and also offers a platform to address difficult social issues. A number of participants expressed the importance of communitas and the opportunity to discuss difficult and sensitive issues in a structureless state of liminality.

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