Suicidalitet og tvang : Juridiske og etiske aspekter ved bruk av tvang overfor suicidale pasienter

Abstract

To the extent possible, psychiatric treatment should be based on the patient’s voluntary consent. However, when the patient presents a high risk of suicide and refuses treatment, many clinicians consider it necessary to use coercive measures. This paper aims to identify,clarify and discuss legal and ethical justifications of involuntary hospitalisation of suicidal patients.

The Norwegian Mental Health Care Act allows use of coercion under certain conditions. The discussion in this paper demonstrates that in the case of suicidal patients, it is unclear whether these conditions are met.

The ethics of suicide are complex. This paper will only outline and discuss some of the ethical principles relevant in this context: namely the principle of autonomy and the principle of beneficence. These two principles can be conflicting when a suicidal patient refuses treatment. Determining whether it is ethically sound to use coersive measures against suicidal patients, requires a balancing of these two principles/considerations. The discussion of ethics in this paper aims to show that it often, but not always, is ethically valid to intervene in the case of suicidal patients.

Suicidal crises are in many cases conditional to circumstances that can be altered, be it psychiatric disorders or external factors and events. This paper argues that in these situations, intervention without the patient’s consent may be justified on a short term in the absence of “serious mental illness” (alvorlig sinnslidelse). The law should consequently allow for intervention based on high risk of suicide without evidence of serious mental illness.