État des lieux des preuves d'efficacit

Abstract

Coercive measures in healthcare are frequently used worldwide, and are especially visible and discussed in psychiatry. Ethical, moral and legal questions have become increasingly frequent over past decades, as medical practice has evolved towards more respectful treatment of patients' autonomy and rights. In parallel, medicine evolved towards evidencebased practice. In this context, the aim of this narrative literature review was to identify scientific evidence for physical coercive measures (seclusion and restraint), with a wider discussion of the results, including ethical aspects. A French and English literature search of PubMed, MEDLINE, Cochrane, Embase, PsycINFO, Google Scholar and CAIRN.INFO was made. Results show variations in coercive care in terms of type, frequency and duration due to differences among countries and hospital practice. Furthermore, its definitions and indications are not clear. We have found no published randomised controlled studies that demonstrate evidence of therapeutic aims and efficiency of coercion. At present, the data are insufficient to assess the clinical or ethical legitimacy of coercion. As a result, a clear consensus for its legitimacy has not yet emerged, despite the fact that the practice of coercive care remains ubiquitous, frequent and limiting of patients' rights. This article should motivate every healthcare provider to further reflect and implement clear clinical guidelines for adequate treatment, which respect the rights of the patients involved and which follow evidence-based medicine standards.