The UN Convention on the Rights of Persons with Disabilities (CRPD) has sparked significant debate and influenced mental health legislation reforms in many countries worldwide (Gill and Sartorius 2...

Hempeler and coauthors convincingly show that context is a crucial facet of properly assessing and resolving the ethical tensions inherent to informal coercion in a mental health context (Hempeler...

In psychiatric care, informal coercion is a relatively frequently used means of achieving certain behavior in people with a mental disorder without having to use formal coercion in the form of a le...

Psychiatry is the only branch of medicine legally ­permitted to treat people against their will. In most countries, decisions related to involuntary detention and treatment involve a brief court pr...

When does an interaction between a mental health clinician and a patient cross the line from a reasonable offer of care to coercion? In a classic account of coercion in psychiatry, Szmukler and App...

In my commentary on Hempeler et al.’s (2024) important contribution to the ethics of psychiatry I will argue that psychiatric practices are necessarily unruly, and that this fact has important impl...

Hempeler et al.’s (2024) focus on informal coercion in mental health treatment in this issue’s target article is critically important for multiple reasons, several of which warrant explicit recogni...

Hempeler et al. (2024) provide convincing reasons for why we should view a broad set of treatment pressures as coercive. They’re correct that in order for us to understand the ways in which patient...

Practitioners of psychiatry rely on techniques to influence and aid service users in making decisions regarding their treatment. However, these techniques, referred to as treatment pressures, can o...

Hempeler et al. (2024) present a recipient-focused and context-sensitive account of coercion in mental healthcare. They define coercion in terms of the user having a justified belief that they are...

Hempeler et al. (2024) argue that earlier attempts to model coercive treatment pressures fail to do justice to the fundamental power imbalance in mental healthcare. On their view, we must take seri...

In their very interesting paper Hempeler et al. propose and argue for the following account of informal coercion in mental healthcare:“A coerces B into φ-ing if, and only if,A proposes that B do φ;...

We commend Hempeler et al. (2024) on their important manuscript outlining a context-sensitive and patient-centered model for informal coercion in mental healthcare. Indeed, in clinical experience a...

While principle-based ethics is well known and widely accepted in psychiatry, much less is known about how decisions are made in clinical practice, which case scenarios exist, and which challenges exist for decision-making. Protocols of the central ethics committee responsible for four psychiatric hospitals over 7 years (N=17) were analysed. While four cases concerned suicide risk in the case of intended hospital discharge, the vast majority (N=13) concerned questions of whether the responsible physician should or should not initiate the use (...) of coercion in patients lacking mental capacity. The committee’s recommendations were non-uniform. Forced feeding and electroconvulsive therapy were endorsed in each one case. In two cases of intermittent loss of capacity due to heavy drinking or intermittent severe suicidal ideation, a self-binding contract was recommended and the use of coercion was considered as justified for a very limited period. In all other cases, most of which involved involuntary treatment, the use of coercion was not endorsed. Without exception, the recommendations were accepted with relief by the physicians and their treatment teams, who feared liability in the event of harm to the patient. Eventually, a model of a decision algorithm was derived from the ethical arguments in the protocols. (shrink)