Autonomy integrity: Another way to understand autonomy in psychiatry?

Abstract

The decision to involuntary hospitalize a patient underlines an inherent contradiction in psychiatry between the need for care and the lack of consent to care. The growing importance of respect for individual liberties in our society fosters the renewal of questions about the best way to respect patients’ autonomy in psychiatry. As a clinical ethics support service, we carried out a prospective and qualitative study on involuntary hospitalization in psychiatry in three psychiatric wards. The goal was to understand the stakeholders’ perceptions and ethical arguments about involuntary hospitalization (42 cases, 161 semi-structured interviews: with 35 patients, 30 relatives, 37 psychiatrists, and 19 nurses). It seems that the solutions provided by the law, as well as the development of tools for the defense of patients’ rights, do not exhaust the questioning on the respect for patients’ autonomy in psychiatry. Beyond the conflict between need for care and respect for freedoms, we understood from the patients’ discourse in the study that their priority is to be respected in their integrity. It therefore seems necessary to think and develop ways to respect what will be called the patients’ “autonomy-integrity.”