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Coercive Measures in Medicine
Swiss Academy of Medical Sciences
Swiss Academy of Medical Sciences
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e_RL_ZMM.pdf
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Abstract
"Coercive measures always represent a serious infringement of an individual’s rights to selfdetermination and to personal freedom. Although the avoidance of compulsion is a primary objective in medicine, coercive measures cannot always be avoided as a last resort. In the case of acute danger to the patient or to others, these measures are sometimes the only way to avoid more serious harm. Coercive medical measures1 always involve a conflict of medical-ethical principles. On the one hand there is the question of “doing good” or “avoiding harm”, while on the other is the requirement to respect the autonomy of the patient as far as possible. In principle, all action must be taken with the agreement of the patient (informed consent). Coercion can therefore only be used in exceptional cases. In emergencies where the patient is at substantial risk of harming him/herself or others, the need for coercion is usually undisputed. The question is more difficult in situations that are not emergencies but where aspects of safety or harm to health are foremost, notably in geriatric medicine and psychiatry. In these cases it is often unclear whether the principle “for the good of” the patient really justifies the resulting constraints on the rights and freedom of the individual, that is, the violation of the patient’s autonomy. In Switzerland there have so far been no uniform legal bases for coercive measures at the Federal level. The modalities for the coercive medical measures that take place can therefore differ according to the customs of individual institutions and Cantonal regulations. However, whenever there is a possibility that coercion may be necessary, the constitutional rights of the individual and – if they exist–Cantonal laws must of course be respected. The present Guidelines are intended to clarify this difficult situation in an area where laws differ widely. They are addressed to the entire healthcare team in medical institutions (hospitals and nursing homes), to medical professionals in private practice, and to those involved in outpatient healthcare. The Guidelines are mainly concerned with the following issues: • Under what ethical and legal conditions are coercive measures permissible and justified? • What steps should be taken in order to avoid the coercion envisaged? • How should the persons concerned and, where relevant, their carers, legal representatives or relatives, be informed? • If they prove unavoidable, in what way can coercive measures be carried out with as little harm to the patient as possible? • What type of follow-up care should be provided for persons who undergo coercive measures? • How should the chosen procedure be documented?"
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2005
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With permission of the license/copyright holder