Molewijk Bert, Kok Almar, Husum Tonje, Pedersen Reidar, Aasland Olaf
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.
BMC Med Ethics. 2017 May 25;18(1):37. doi: 10.1186/s12910-017-0190-0.
The 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.
This paper describes an explorative statistical analysis based on a cross-sectional survey across seven wards in three Norwegian mental health care institutions.
Descriptive 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.
This 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.
使用强制手段存在道德问题，需要持续进行批判性反思。我们想知道，不知道或不确定强制手段在道德上是否正确或合理（即经历道德疑虑）是否与专业人员对使用强制手段的规范性态度有关。
本文描述了一项基于对挪威三个精神卫生保健机构七个病房的横断面调查的探索性统计分析。
描述性分析表明，总体而言，379名受访者a）不太确定强制手段是否应被视为冒犯行为，b）同意为了护理和安全需要使用强制手段的观点，c）略有不同意见，认为强制手段可被视为治疗方法。工作人员报告称，与使用强制手段相关的道德疑虑发生率不高，尽管他们中的大多数人都同意，对于“什么是正确的做法？”这个问题永远不会有单一答案。双变量分析表明，他们经历的普遍道德疑虑和相对疑虑越多，就越认为强制手段是冒犯行为。尤其是心理学家对强制手段持批评态度。我们发现不同病房类型之间存在显著差异。对强制手段有决策责任和领导责任的受访者较少将强制手段视为治疗方法。频繁经历强制手段与更多地将强制手段视为护理和安全保障有关。
本研究表明，经历道德疑虑与某人对强制手段的规范性态度有关。未来的研究可以调查道德案例审议是否会增加专业人员的道德疑虑体验，以及这是否会引发更多批判性思维并增加工作人员对替代强制手段的好奇心。
