What is it about?
We argue that insufficient evidence exists for the efficacy of involuntary hospitalization in reducing suicides among psychiatric patients. Furthermore, we argue that the culture of litigation around psychiatry in recent decades has made clinicians too quick to employ coercive hospitalization, even at the expense of the patients long term well being. We argue against the status quo in most American states, which transfers the responsibility for a suicidal patient's life from the patients themselves, onto psychiatric clinicians. Instead, we suggest that decision-making capacity be the standard clinicians use to assess whether a suicidal patient should be involuntarily hospitalized. Such a change has the potential to reduce suicides in the long run, by encouraging competent patients to develop the coping skills necessary to overcome their suicidal urges.
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Why is it important?
This paper is unique in that it argues that for some psychiatric patients, increasing their autonomy may paradoxically do more to reduce their risk to themselves than the traditional method of reducing their autonomy via hospitalization.
Perspectives
As a psychiatry resident working in california, I have often felt that there are many patients who would be better served as outpatients or in a partial hospitalization program, but who we choose to involuntarily hospitalize due to legal pressures leading us to practice "defensive medicine." I wrote this paper to argue for equal application of decision capacity evaluation laws to mental health patients. If we allow suicidal patients with capacity to say no to hospitalization, they would benefit from not being exposed to coercion and the stresses of the psych ward, and practitioners would be less likely to practice overly defensive medicine.
Adam Borecky
Loma Linda University
Read the Original
This page is a summary of: Reweighing the Ethical Tradeoffs in the Involuntary Hospitalization of Suicidal Patients, The American Journal of Bioethics, September 2019, Taylor & Francis,
DOI: 10.1080/15265161.2019.1654557.
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