Krumm Silvia, Checchia Carmen, Badura-Lotter Gisela, Kilian Reinhold, Becker Thomas
Ulm University, Department of Psychiatry II, Bezirkskrankenhaus Guenzburg, Ludwig-Heilmeyer-Str, 2, 89312 Guenzburg, Germany.
BMC Med Ethics. 2014 Mar 2;15:18. doi: 10.1186/1472-6939-15-18.
When a patient with a serious mental illness expresses a desire for children, mental health professionals are faced with an ethical dilemma. To date, little research has been conducted into their strategies for dealing with these issues.
Seven focus groups with a total of 49 participants from all professional groups active in mental health (nurses, psychologists, social workers and psychiatrists) were conducted in a 330-bed psychiatric hospital. Group discussions were transcribed verbatim and analysed by the documentary method described by Bohnsack.
Mental health professionals did not feel that their patients' desire for children was as important in daily practice as were parenting issues. When discussing the desire for children on the part of patients, the following themes emerged: "the patient's own decision", "neutrality", "the patient's well-being", "issues affecting the children of mentally ill parents" and "appropriate parenthood". In order to cope with what they perceived as conflicting norms, mental health professionals developed the following (discursive) strategies: "subordination of child welfare", "de-professionalisation", "giving rational advice" and "resignation".
The theme of "reproductive autonomy" dominated mental health professionals' discourse on the desire for children among psychiatric patients. "Reproductive autonomy" stood in conflict with another important theme (patient's children). Treating reproductive issues as taboo is the result of the gap between MHPs' perceptions of (conflicting) norms when dealing with a patient's desire for children and the limited opportunities to cope with them appropriately.In order to support both patients with a desire for children and mental health professionals who are charged with providing counselling for such patients, there is a need to encourage ethical reflection and to focus on clinical recommendations in this important area.
当患有严重精神疾病的患者表达生育意愿时，心理健康专业人员面临着伦理困境。迄今为止，针对他们处理这些问题的策略的研究甚少。
在一家拥有330张床位的精神病医院，对来自心理健康领域所有专业群体（护士、心理学家、社会工作者和精神科医生）的49名参与者进行了7次焦点小组访谈。小组讨论内容逐字记录，并采用博恩萨克描述的文献法进行分析。
心理健康专业人员认为，在日常实践中，患者的生育意愿不如养育问题重要。在讨论患者的生育意愿时，出现了以下主题：“患者自己的决定”“中立性”“患者的福祉”“影响精神病患者子女的问题”以及“适当的父母身份”。为了应对他们认为相互冲突的规范，心理健康专业人员制定了以下（话语）策略：“儿童福利的从属地位”“去专业化”“给出理性建议”和“听之任之”。
“生殖自主权”主题主导了心理健康专业人员关于精神病患者生育意愿的论述。“生殖自主权”与另一个重要主题（患者的子女）相冲突。将生殖问题视为禁忌，是因为心理健康专业人员在处理患者生育意愿时对（相互冲突的）规范的认知与适当应对这些规范的有限机会之间存在差距。为了支持有生育意愿的患者以及负责为这类患者提供咨询的心理健康专业人员，有必要鼓励进行伦理反思，并关注这一重要领域的临床建议。
