Same, same but different: How the interplay of legal procedures and structural factors can influence the use of coercion

Abstract

Although clinicians and scientists have made persistent effort to reduce the use of coercive measures such as mechanical restraint, seclusion, and forced medication, it is required in some situations and staff members are thus confronted with a clinical and ethical dilemma: Coercive measures can save lives (e.g., when treating a Delirium Tremens) but can be linked with many negative consequences, ranging from a degradation of the therapeutic relationship to symptoms of posttraumatic stress disorder (1, 2). Moreover, the issue of perceived coercion has become a major concern over the past years. Patients' feelings of not being respected and involved in decision-making processes can lead to higher levels of perceived coercion (3). Participation and freedom of choice regarding therapy and medication were described as highly relevant to patients (4).