In 1990, the US Congress passed the
Patient Self-Determination Act (PSDA). It was the first federal state
legislation that encouraged the recognition of the patient’s rights to
autonomy. American laws and ethics have acknowledged the requirements of this
Act. However, the laws and ethics have also identified conditions
under which mandating treatment is permitted. The general argument in favor
of mandated treatment states that an individual’s rights to autonomy are denied
now to lay a foundation for long-term autonomy in the future. This
assessment narrates two scenarios (1 & 3).
Scenarios
Scenario 1 presents a patient who
wishes to terminate his treatment, but the concerned psychiatrist believes the treatment should be continued. As a consultant in this situation, I permit
mandated treatment because American laws and ethics restrict a person’s
autonomy if he/she poses potential harm to others. The evidence from this
patient’s records already confirms that he had engaged in violent behavior several
times and had been to inpatient treatment for the behavior. Moreover, this will
be in line with the principle of beneficence because the mandated treatment will protect the rights
of the community members by eliminating the chances of the potential harm the
patient could cause.
Scenario 3 presents a weak woman
who cannot leave the house and wishes to go for psychotherapy, but her daughter
refuses to let her. I recommend that the older adult is taken for psychotherapy
to show respect for the patient’s right to self-determination. American
Psychological Association (2017) also recognizes respect for people’s rights
and dignity (Principle E), among others, the right to self-determination. This
implies that mandated treatment is unnecessary, as the patient can make
meaningful decisions.
Unfortunately, no evidence
informs about the difference in the effectiveness
of the treatment with or without coercion. This also contributes to the
difficulty in evaluating the effectiveness of mandated treatment. Moreover,
there needs to be more evidence proving that the centers used for mandated
treatment provide a favorable environment or that the range of approaches used is
appropriate, safe, and ethical.
In addition, Walker, Cole, &
Logan (2009) found that closer examination of patients is needed to select approaches to reduce or
eliminate the problematic situation. While many studies have not found
evidence for improved outcomes concerning mandated approaches, some have
discovered the possibility of harmful results. As a mental
health professional charged with cases involving mandated treatment, it is
possible to develop the belief that I know what better fits the interest of
patients and end up violating some patients’ rights. The client factors that
might limit mandatory treatment's benefits include contrary demands;
unwillingness to pay attention to training, counseling, and teachings on improvement; and temporary mandatory treatment, as allowed by the rights of
autonomy.
Conclusion
Mandating treatment has gained
popularity in different parts of the world, but there is still little evidence
to confirm its effectiveness, safety, and adherence to ethical standards.
Studies that have discovered negative results from the treatment, mainly due to
abuse of patients, recommend government intervention in determining evidence-based
alternative strategies. Researchers have reported study outcomes such as a lack
of improvement and harmful results; hence, the effectiveness of mandated
treatment has yet to be fully proven.