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Tijdschrift voor Psychiatrie 47 (2005) 8, 519 - 528

Essay

Paternalism and autonomy in mental health care

T.R.V. Nys

Recently, there has been a demand for more coercive action and paternalism in the field of mental health care. This demand, however, is encountering strong opposition because coercion and paternalism seem to be at variance with the right to autonomy. In this article, a three part definition of paternalism is taken as starting point and it is shown how the mental health services, by their tactics, are trying to tone down the paternalistic character of their interventions. Nevertheless, these attempts on the part of the mental health care services to justify their tactics can still be criticised for their paternalistic traits. Next, two alternative theories are briefly discussed which indicate that the autonomy of caretakers is also under attack. Moreover, their autonomy is an important source of their paternalism. Finally, an indepth debate on values is proposed, at the earliest opportunity.

keywords autonomy, competence, consent, paternalism