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Tijdschrift voor Psychiatrie 46 (2004) 6, 369 - 378

Essay

Dealing with freedom and coercion in mental health care: some ethical advice

A. Liégeois, M. Eneman

summary This article reproduces the ethical advice given by the Ethical Committee for Mental Health Care set up by the Brothers of Charity in Flanders. The advice relates to the ethical dilemma with which caregivers are often confronted: how can they respect their clients' freedom as much as possible and when are they justified in restricting their clients' freedom or in using coercion? The research method consists in having discussions about ethics and in studying the literature. Instead of addressing the subject of freedom and coercion from the purely individual point of view of the caregiver or the patient, the ethical advice addresses the subject from a relational point of view, involving consultation with caregivers, patients and their families. Consequently, the general model for making choices in mental health care is consultation, in the course of which all parties communicate with each other, explain and justify their views, and strive for a consensus. Consultation is the best way to obtain consent. However, in particular situations consultation has to be restricted. In some situations restriction of freedom or the use of coercion can be justified if the following conditions prevail: the client is insufficiently competent to make personal choices, there is a threat of serious damage to health, integrity or the care environment, and the degree to which freedom is restricted is in proportion to the seriousness of the damage.

keywords coercion, consultation, ethics, informed consent, freedom