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Tijdschrift voor Psychiatrie 44 (2002) 7, 437 - 445


Ulysses Arrangements: autonomy, coercion or care?

I. Gremmen, A. Beekman, S. Sevenhuijsen, G.A.M. Widdershoven, R. Zuijderhoudt

background The Dutch cabinet considers changing the law in order to provide for the opportunity to make Ulysses arrangements (Ulysses contracts) in psychiatry. A Ulysses arrangement would entail a client's deliberate and freely given consent that, in case of a future crisis situation, involuntary commitment or treatment may be opted for on a less strict basis than current law allows for. The moral justification for involuntary commitment or treatment would reside in the autonomous choice made previously by the client.
aim To explore what an ethics of care perspective can contribute to the debate on Ulysses arrangements.
method Qualitative analysis of interviews with persons directly involved in the issue of Ulysses arrangements.
results An ethics of care perspective clarifies how Ulysses arrangements might 'work' in the relationships between the persons involved. Furthermore, it introduces moral concepts such as responsibility and mutuality into the debate on Ulysses arrangements.
conclusion An ethics of care perspective broadens and deepens the debate on Ulysses arrangements by paying due respect to relational moral considerations which get too little attention in an individual autonomy perspective.

keywords ethics of care, psychiatry, Ulysses contracts