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  • Writer's picturejustinenazworth
    • Nov 9, 2018
    • 5 min read

The Ethics of Mandated Treatment

The scenarios selected for this discussion are scenarios 2 and 3.


One of the major ethical principles and implications of mandated treatment revolves are an individual’s rights to autonomy and free will. It is widely understood within ethical codes and established laws that we each have the fundamental right to refuse treatment, even if that refusal shortens the lifespan or adversely impacts others (Caplan, 2008). However, should this extend to persons who clearly do not harness the full capacity to be autonomous and/or self-determining? In my opinion, I do believe that there are instances and situations that require mandated treatment in an effort to help a patient regain their ability to be effectively independent and self-determining.


Scenario 2:

The client is scenario two is a long-term patient with bi-polar disorder. During a recent therapy session, the patient was quite excited and talking rapidly about an upcoming gambling trip that was sure to win her millions of dollars. A bit concerned, the therapist began asking questions that ultimately led to the revelation that the client had ceased taking her prescribed bi-polar medication, due to the client reportedly feeling so “happy.” The client also revealed that she no longer felt it necessary to participate in therapy and planned to discontinue treatment.


In this type of situation, mandated treatment would be recommended. The client is going through a manic episode, which is often characterized as feelings of extreme energy, overly good mood, fast and erratic talking, reckless decision-making (such as gambling), etc. This could lead to other dangerous and risky behavior that could have adverse impacts on not only the patient, but others as well. Bipolar disorder is a condition that is typically and primarily managed through medication and psychotherapy to ensure the overall stability of the patient. Going off of medication abruptly could have detrimental effects and wreak havoc on the patient’s biochemistry, which could lead to a worsening of bipolar symptoms. Thus, it can be said that many patients with this condition are not wholly autonomous and involuntary/mandated treatment may be the only way to ensure that they get the treatment they need. In the (2014) article, “Compulsory treatment of addiction in the patient’s best interests: More rigorous evaluations are essential,” authors explicate how many developed countries have legislation that permits involuntary treatment of patients with serious mental illnesses; however, before such mandated treatment is doled out, a professional practitioner must certify that the individual is afflicted by a mental disorder that necessitates treatment in an effort to protect the clients and/or others (Hall, Farrell, & Carter, 2014).

Ethical issues that might arise with mandated treatment in scenarios like this include: rights to consent, privacy, and self-determination. Additionally, things like culture and other demographics (e.g. age) must be considered.


Evidence suggests that mandated treatment is as effective, if not more-so, than voluntary treatment. One of the biggest concerns of mandated treatment was how it would impact the therapeutic relationship between patient and therapist. In mandated treatment relationships, the therapist holds more control and the client is in a more submissive position. Research has indicated that in spite of this, mandated relationships are fundamentally affiliative, meaning that the control of the therapist does not come at the loss of warmth (Manchak, Skeem, & Rook, 2014); strong and cooperative relationships are still forged in mandated treatment circumstances.


A primary challenge in assessing the overall effectiveness of mandated treatment would be ensuring that the patient is following through with established therapeutic interventions. However, to combat this issue, I would recommend that the patient keep a chart that tracks things like medication compliance, mood, anxiety, sleep patterns, etc. This would help both patient and professional to see where future issues might arise in terms of reoccurring symptoms and why they are presenting.


In this instance, mandated treatment would only help validate my clinical decisions, in that it would assist me in guaranteeing that the client is getting the help she needs and making certain she is upholding instituted and agreed upon treatment(s). Bipolar disorder is a condition wherein if left untreated, will only progress and worsen with time. It is a condition that requires constant dedication and maintenance of symptoms through therapy and medication.


Factors that may limit potential benefits of treatment if mandated would be non-compliance and a resistance to treatment. Sometimes when bipolar patients are going through manic episodes, they feel as though they have control of their condition and no longer need assistance. This can be extremely detrimental, especially when they start shifting into depressed mood-states after a particularly “high” manic episode. Thus, I think it is important to continue to remind and education patients about their disorder so that they have a clear understanding of what is happening to them when it is happening.

Ethical principles that guided my decision with this patient were primarily the rights dignity and autonomy (though this rights have limitations), do no harm, rights to privacy and informed consent. While every decision will be made to uphold each of these ethical codes, the client will be informed of the limitations that apply to each within her respective case.



Scenario 3:

The client in this scenario is an older, debilitated woman who wishes to be in psychotherapy; however, her adult daughter, who currently lives close by and has control over her mother’s finances and is very aware that her mother cannot leave home unassisted to even buy basic necessitates, reportedly believes that outside care is not necessary and that she can handle her mother on her own.


This situation is rather unique, in that it isn’t a patient trying to refuse treatment, but a patient that wants to voluntarily participate in therapy. However, the patient’s daughter is preventing the patient from seeking treatment because she feels she can take care of the patient all on her own. I don’t feel as though there is enough evidence to advocate for mandated treatment, rather this is a situation that would be best resolved through the justice system. It needs to be determined whether or not the patient truly needs therapy, along with whether or not the adult daughter is the best candidate to make those kinds of decisions regarding her mother’s care and well-being. If mandated treatment is believed to be in the best interest of the patient, factors that might limit or augment the potential benefits of treatment would largely revolve around the daughter and her compliance and adherence to ensuring her mother receives the treatment. It is also unclear why the patient is even requesting psychotherapy; thus, it is difficult to determine the effectiveness and/or non-effectiveness of treatment with and without coercion. Due to the lack of information within this scenario, my clinical decision-making is not so much influenced by mandated treatment, rather it is influenced by the need to gather more data regarding this case before any definitive decisions are made regarding the treatment of the patient.


My decision for this client was primarily guided by the APA’s ethical principles of do no harm and the rights to dignity and autonomy. Until clearly deemed otherwise, the client is considered competent and able to make decisions regarding her own care and well-being.


References:

Hall, W., Farrell, M., & Carter, A. (2014). Compulsory treatment of addiction in the patient's best interests: More rigorous evaluations are essential. Drug & Alcohol Review, 33(3), 268-271. doi:10.1111/dar.12122

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