Reflexionando sobre las medidas coercitivas en salud mental. Análisis bioético y antropológico

Abstract

Coercive measures in mental health mean a significant suffering for patients, families and professionals. They generate ethical debate about their legitimacy and / or their rejection. Such ethical challenges for Nursing have been partially delimited. The theoretical, philosophical and ethical aspects that derive from its use have been studied by Nursing, although they have been superficially analyzed. This article sheds light on that gap and explains the concepts "vulnerability", "best interest", and "capacity". Besides, this article presents some ethical theories to support the relationship. Finally, some empirical studies are presented on the perception of those affected by these coercive practices. Objective: The main objective of this article is to elaborate an anthropological and ethical theoretical framework that encourages critical reflection on the reasons for the use or abandonment of containment measures in mental health. Methodology: Theoretical reflection on the subject, using the relevant and updated bibliography extracted from the Pubmed search engine. The following keywords in English are used: challenges, ethics, mental health, nursing, coercion, and coercive measures to detect the underlying ethical issues. On the other hand, we use the terms vulnerability, mental capacity, and best interest for its conceptual analysis. Results: We provide an anthropological and ethical theoretical framework so that Nursing knows how to understand and justify more rigorously the issue of contentions in mental health. Conclusion: Coercive measures generate controversy and dispute between those who apply them and those who receive them. The literature has detected a considerable number of underlying ethical dilemmas; however, the idea that there is a conceptual deficiency is shared. Although it is possible to identify some key concepts, such as those provided in this article, which allows us to have conceptual tools to better understand this healthcare context; We believe that the application of coercive measures must be guided by an ethic of care, a hermeneutical ethic and a cordial dialogic ethic, which mark rights and duties.