Paternalisme og autonomi om tvangsanvendelse ved personlig intervju
Paternalism and autonomy
There is an obvious need for research exploring the frequency of coercive interventions, how they are experienced and whether they benefit patients. The ethical issue of continuing to permit coercion without some scientific documentation that coercion provides therapeutic effects, is according to some commentators morally wrong.
This research project is part of a joint study involving all the five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden). The Nordic study called “Paternalism and Autonomy, a Nordic Study on the use of Coercion in the Mental Health Care System”, consists of three major research areas. One concerns the moral and legal justification for civil commitment, the second is epidemiologically oriented comparing commitment rates between and within the participating countries, while the third part focus on the patients´ perception of being coerced in relation to their hospital admission.
The studies included in the project is limited to an intensive study of four psychiatric institutions across Norway. We address the second and third research area as defined by the Nordic study, but in addition to the standard protocol, recorded not only coercion in the admission process, but also coercive interventions during the inpatient period and patients´ subjective outcome reported as satisfaction with the treatment and hospital stay at discharge. Thus, we have studied three well defined aspects of coercion. First (paper submitted to the Nordic J of Psychiatry), cumulative incidence rates for the frequency of civil commitment and its duration at each study site were calculated and compared with official rates published by National Statistics based on data from the Norwegian Patient Registry (NPR), second (paper published in the Nordic Journal of Psychiatry, 2002), legal and perceived coercion during the admission process were examined, and finally (paper referred to in this report), the relation between different measures for coercion and subjective outcome as measured by patients satisfaction with the treatment and hospital stay were explored.