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Obtaining Informed Consent for Research Studies
Published in Lynne M. Bianchi, Research during Medical Residency, 2022
Whenever you or a member of your research team present an informed consent document or answer participant questions, it is essential that the conversations be free of coercion and undue influence. Coercion refers to intimidation or a threat of harm. Undue influence means a person is swayed to do something, often without considering the consequences.
Psychometric measurement of professional identity through values in nursing and medicine
Published in Roger Ellis, Elaine Hogard, Professional Identity in the Caring Professions, 2020
Four basic principles to guide the professional approach to patients and their care are autonomy, justice, beneficence and avoidance of maleficence. Each of these principles can of course be broken down into more specific values. As the analysis becomes more detailed and fine-grained, values get closer to specific behaviours and shade into competencies. For example, autonomy for the patient requires informed consent and decision-making, and freedom from coercion. Informed consent requires knowledge of procedures and risks and effective communication. Freedom from coercion requires respect for persons and sensitivity to feelings.
Legal regulation and policy on the use of restraint and coercive measures in health care institutions in the Netherlands
Published in Bernadette McSherry, Yvette Maker, Restrictive Practices in Health Care and Disability Settings, 2020
The term ‘coercion’ covers not only involuntary treatment, as defined earlier, but also the situation where a person is pressured to accept a treatment or intervention which they do not wish to receive. This may occur, for example, where an individual is told that they will be physically restrained if they do not accept certain medication, or vice versa, leading them to agree to the intervention which they regard as least bad in the circumstances. However, true consent is not given in such a situation, and such treatment can also be regarded as involuntary (Janssen 2012: Chapter 1). Since coercive treatment may involve elements which give the appearance of consent, such as the signing of a consent form or acceptance of treatment without demonstrating physical resistance, it may not be classified as involuntary by health care providers in situations where they are obliged to record all incidents of involuntary treatment. This form of coercion, resulting from placing individuals under pressure to make a certain choice, is not regulated under Dutch law.
Patients’ experiences with physical holding and mechanical restraint in the psychiatric care: an interview study
Published in Nordic Journal of Psychiatry, 2023
Mads C. Lynge, Søren T. Dixen, Katrine S. Johansen, Signe W. Düring, Annick U.-Parnas, Julie Nordgaard
The question of whether mechanical restraint is worse than physical holding is complex, and based on the information from the informants; it seems clear that there is no simple answer. The core issue in all kinds of coercion is, that the patient‘s autonomy is overruled. Perhaps it is the experience of having one‘s autonomy violated that is the most difficult aspect of being subjected to coercion and to a lesser degree the kind of coercion – through the duration of the coercive measure seems an important factor. It remains an unsolved question how patients relate to the proposed hierarchy of coercion. However, it can be argued if there’s any point in bringing down one specific type of coercion with the result of increasing another type of coercion that may be just as bad for the patients. Hopefully, more research will emerge from this explorative study mapping the hierarchy of coercion and the justification for initiatives to bring down a certain kind of coercion. Needless to say, the prevention of coercion, in general, ought to be the primary aim.
Non-coercive techniques for the management of crises in mental health settings in Germany—a narrative review
Published in International Review of Psychiatry, 2023
Kliniken Landkreis Heidenheim gGmbH was recently featured in the WHO Guidance on community mental health services. Promoting person-centred and rights-based approaches (WHO, 2021a). As a general hospital department for psychiatry, psychotherapy, and psychosomatic medicine, the institution provides adult mental health services for a region of 130,000 inhabitants in southwest Germany. For several years, the department has reported low rates of coercion in mental health care while it provides a comprehensive service open to everyone in the region. Similar to most psychiatric institutions in Germany, the department admits most patients voluntarily but also accepts people according to regional mental health law and federal guardianship procedures against their will for a period of detention in the hospital. Table 1 compares the rates of coercive interventions in Heidenheim with those in Germany.1 The definition of coercion for this paper includes involuntary admission (detention in hospital), mechanical restraint, seclusion, and coercive medication.
Beyond Mediation: A Toolkit Approach to Preventing and Managing Conflict with Patients and Families in Difficulty
Published in The American Journal of Bioethics, 2023
Liza-Marie Johnson, Andrew Elliott, Kimberly E. Sawyer, Katherine B. Steuer, Deena R. Levine
More significant ethical critiques in the article are that the agreements are coercive considering the power imbalance between hospitals and patients and lack of other health care facilities for many patients. This is an important ethical concern for organizations to keep in mind in thinking about the consequences, as well as how the agreements are both drafted and presented. Yet failure to protect staff or to protect patients from medical neglect pose their own significant ethical risks. Legitimate concerns about patient-provider contracts call for preventive strategies including anti-bias training and a trauma-informed approach, as well as thoughtful crafting when implemented. Bi-directional agreements to facilitate care may be a resource for alignment and support both staff and patients and families in difficulty.