Liégeois Axel
Faculty of Theology and Religious Studies, KU Leuven (Catholic University of Leuven), Leuven, Belgium.
Organization Brothers of Charity, Gent, Belgium.
Front Psychiatry. 2023 Feb 23;14:1083176. doi: 10.3389/fpsyt.2023.1083176. eCollection 2023.
Mental health professionals have a contradictory social mission: respecting the autonomy of persons with mental illness while at the same time providing them with unsolicited or assertive care when necessary. The aim of this contribution is therefore to reflect on the ethical question of how care professionals can provide assertive care in an ethically responsible manner. To answer this question, we take a relational view of human beings, draw on the Ethics Committee for Mental Health Care of the Organization Brothers, and invoke a case to shape the ethical reflection. In a relational view, assertive care starts by building a relationship of trust between the care partners: care users, next of kin and care professionals. We can distinguish different forms of assertive care based on the degree of decision-making capacity and the responsibility of the care users. The first two degrees of assertive care occur when care users are still fully capable of making decisions about care and of taking own responsibility: the care professionals [1] make themselves available for possible care, or [2] inform about possible care in the most objective way possible. When care users are partially capable of decision-making, the care partners share responsibility in six possible degrees of assertive care: the professionals [3] advise on possible care, [4] negotiate good care, [5] attract into assertive care, [6] persuade to assertive care, or exert [7] external or [8] internal pressure. If care users are completely incapable of decision-making in care, the care professionals and next of kin take on vicarious responsibility in two degrees of assertive care: the professionals [9] take over the care, or [10] carry out coercion. Which degree of assertive care is most appropriate must be considered in each situation. Criteria for determining the appropriateness of assertive care are the degree of decision-making capacity of the care users and the degree of the threat and seriousness of harm. As the threat of serious harm increases and the care users' decision-making capacity decreases, forms of assertive care with a more freedom-restricting character are ethically justifiable.
既要尊重精神疾病患者的自主权，又要在必要时主动为他们提供未经请求或坚定的护理。因此，本文的目的是思考护理专业人员如何以符合伦理道德的方式提供坚定护理这一伦理问题。为了回答这个问题，我们采用一种关于人的关系视角，借鉴兄弟组织心理健康护理伦理委员会的观点，并引入一个案例来形成伦理反思。在关系视角下，坚定护理始于护理伙伴（护理使用者、亲属和护理专业人员）之间建立信任关系。我们可以根据护理使用者的决策能力程度和责任来区分不同形式的坚定护理。当护理使用者仍完全有能力就护理做出决策并承担自身责任时，会出现前两种坚定护理程度：护理专业人员[1]随时准备提供可能的护理，或[2]以尽可能客观的方式告知可能的护理。当护理使用者部分具备决策能力时，护理伙伴在六种可能的坚定护理程度中分担责任：专业人员[3]就可能的护理提供建议，[4]协商优质护理，[5]吸引进入坚定护理，[6]劝说接受坚定护理，或施加[7]外部或[8]内部压力。如果护理使用者完全没有能力就护理做出决策，护理专业人员和亲属在两种坚定护理程度中承担替代责任：专业人员[9]接管护理，或[10]实施强制。在每种情况下都必须考虑哪种程度的坚定护理最合适。确定坚定护理适当性的标准是护理使用者的决策能力程度以及伤害的威胁程度和严重性。随着严重伤害的威胁增加且护理使用者的决策能力下降，具有更多限制自由性质的坚定护理形式在伦理上是合理的。
