Measures are considered coercive if they are carried out against the patient’s autonomous wishes or in spite of his/her opposition. In medical practice, coercion can take a wide variety of forms, whose ethical and legal status ranges from «required» to «completely unacceptable».
In recent decades, medical ethics has focused on patient autonomy – an approach that is widely accepted. At the same time, tensions may arise between patients’ decisions, on the one hand, and medically indicated measures, on the other. In an emergency – for example, in cases of acute agitation or postoperative delirium – where the patient (temporarily) lacks capacity, the question of whether to use coercive measures will often arise.
How can patient autonomy be respected in these situations? When is it permissible – or essential – to take urgent medical measures even though the person concerned has not given consent or even offers active resistance?
The guidelines «Coercive measures in medicine» published by the SAMS in 2015 provide a framework for resolving conflicts of this kind. They take into account the requirements of the Swiss child and adult protection legislation which came into force in 2013.
The guidelines are designed to promote and maintain awareness of the fact that coercive measures of any kind represent a serious infringement of personal rights and thus require ethical justification in each case. Compliance with procedural requirements does not in itself provide a justification for the application of such measures. In all cases, careful ethical reflection is just as indispensable as rigorous compliance with legal provisions and applicable guidelines.