Staff’s normative attitudes towards coercion: the role of moral doubt and professional context—a cross-sectional survey study

BMC Medical Ethics

Research Article

Tonje Husum¹  Reidar Pedersen¹  Bert Molewijk²  Olaf Aasland³  Almar Kok⁴ 

[1] Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway;Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway;Department Medical Humanities, EMGO+, VU University medical centre (VUmc), Amsterdam, The Netherlands;Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway;Institute for Studies of the Medical Profession, Oslo, Norway;Department Epidemiology & Biostatistics, EMGO+, VU University medical centre (VUmc), Amsterdam, The Netherlands;

关键词: Coercion;    Critical reflection;    Epistemic uncertainty;    Ethics;    Ethics support;    Mental health care;    Moral case deliberation;    Moral doubt;    Normative attitude;   

DOI  :  10.1186/s12910-017-0190-0

 received in 2016-09-23, accepted in 2017-04-22,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe use of coercion is morally problematic and requires an ongoing critical reflection. We wondered if not knowing or being uncertain whether coercion is morally right or justified (i.e. experiencing moral doubt) is related to professionals’ normative attitudes regarding the use of coercion.MethodsThis paper describes an explorative statistical analysis based on a cross-sectional survey across seven wards in three Norwegian mental health care institutions.ResultsDescriptive analyses showed that in general the 379 respondents a) were not so sure whether coercion should be seen as offending, b) agreed with the viewpoint that coercion is needed for care and security, and c) slightly disagreed that coercion could be seen as treatment. Staff did not report high rates of moral doubt related to the use of coercion, although most of them agreed there will never be a single answer to the question ‘What is the right thing to do?’.Bivariate analyses showed that the more they experienced general moral doubt and relative doubt, the more one thought that coercion is offending. Especially psychologists were critical towards coercion. We found significant differences among ward types. Respondents with decisional responsibility for coercion and leadership responsibility saw coercion less as treatment. Frequent experience with coercion was related to seeing coercion more as care and security.ConclusionsThis study showed that experiencing moral doubt is related to some one’s normative attitude towards coercion. Future research could investigate whether moral case deliberation increases professionals’ experience of moral doubt and whether this will evoke more critical thinking and increase staff’s curiosity for alternatives to coercion.

【 授权许可】

CC BY   
© The Author(s). 2017