Merkt Helene, Haesen Sophie, Eytan Ariel, Habermeyer Elmar, Aebi Marcelo F, Elger Bernice, Wangmo Tenzin
Institute for Biomedical Ethics, University Basel, Basel, Switzerland.
Service des mesures institutionnelles, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
BMC Med Ethics. 2021 Sep 16;22(1):123. doi: 10.1186/s12910-021-00688-2.
Mental health professionals (MHP) working in court-mandated treatment settings face ethical dilemmas due to their dual role in assuring their patient's well-being while guaranteeing the security of the population. Clear practical guidelines to support these MHPs' decision-making are lacking, amongst others, due to the ethical conflicts within this field. This qualitative interview study contributes to the much-needed empirical research on how MHPs resolve these ethical conflicts in daily clinical practice.
31 MHPs working in court-mandated treatment settings were interviewed. The interviews were semi-structured and our in-depth analysis followed the thematic analysis approach.
We first outline how mental health professionals perceive their dual loyalty conflict and how they describe their affiliations with the medical and the justice system. Our findings indicate that this positioning was influenced by situational factors, drawing the MHPs at times closer to the caring or controlling poles. Second, our results illustrate how participating MHPs solve their dual loyalty conflict. Participants considered central to motivate the patient, to see the benefits of treatment and its goals. Further, transparent communication with patients and representatives of the justice system was highlighted as key to develop a trustful relationship with the patient and to manage the influences from the different players involved.
Even though individual positioning and opinions towards dealing with the influences of the justice system varied, the results of our research show that, in spite of varying positions, the underlying practice is not very different across participating MHPs. Several techniques that allow developing a high-quality therapeutic alliance with the patient are key elements of general psychotherapy. Transparency appears as the crucial factor when communicating with the patient and with representatives of the justice system. More specifically, patients need to be informed since the beginning of therapy about the limits of medical confidentiality. It is also recommended to develop guidelines that define the level of detailed information that should be disclosed when communicating with the authorities of the justice system.
在法庭强制治疗环境中工作的心理健康专业人员（MHP）面临伦理困境，因为他们在确保患者福祉的同时还要保障公众安全，承担着双重角色。由于该领域存在伦理冲突等原因，缺乏明确支持这些心理健康专业人员决策的实用指南。这项定性访谈研究有助于开展急需的实证研究，以了解心理健康专业人员在日常临床实践中如何解决这些伦理冲突。
对31名在法庭强制治疗环境中工作的心理健康专业人员进行了访谈。访谈采用半结构化形式，我们的深入分析遵循主题分析方法。
我们首先概述心理健康专业人员如何看待他们的双重忠诚冲突，以及他们如何描述与医疗系统和司法系统的关系。我们的研究结果表明，这种定位受情境因素影响，有时会使心理健康专业人员更倾向于关怀或控制的极端。其次，我们的结果说明了参与研究的心理健康专业人员如何解决他们的双重忠诚冲突。参与者认为激励患者、让其看到治疗益处及其目标至关重要。此外，与患者和司法系统代表进行透明沟通被强调为与患者建立信任关系以及应对不同相关方影响的关键。
尽管个体在应对司法系统影响方面的定位和观点各不相同，但我们的研究结果表明，尽管立场各异，但参与研究的心理健康专业人员的基本做法并无太大差异。一些有助于与患者建立高质量治疗联盟的技巧是一般心理治疗的关键要素。在与患者和司法系统代表沟通时，透明度似乎是关键因素。更具体地说，从治疗开始就需要告知患者医疗保密的限度。还建议制定指南，明确与司法系统当局沟通时应披露的详细信息级别。
