COERCION IN PSYCHIATRIC-CARE - PROBLEMS OF MEDICAL-ETHICS IN A COMPREHENSIVE EMPIRICAL-STUDY

In a study of involuntary psychiatric care in two Swedish counties psychiatric examinations and interviews were carried out with 100 committed and '' voluntarily admitted patients, and 155 relatives of these patients were interviewed. Questionnaires were sent to psychiatric staff, health and welfare personnel of primary care and a representative sample of the general public. As a frame of reference, a two-dimensional model for description and analysis of ethical conflicts was developed. The first dimension specifies the relevant principles of medical ethics and the second specifies the persons involved. The results indicate ethical ''benefits'' (fulfilment of ethical principles) and ethical ''costs'' (violation of ethical principles) for both committed and voluntarily admitted patients, as well as for other groups involved. The study shows the need and feasibility of comprehensive studies of coercion, and the need to develop concepts and methods in such studies as well as for quasiexperimental investigations of involuntary psychiatric care.