Any measure that is performed against a patient’s free will or resistance is considered coercive. In medical practice, coercion can manifest itself in a variety of ways whose ethical and legal standing range from «Necessary» to «Completely unacceptable».
In recent decades, medical ethics have focused on the autonomy of patients – an approach that is widely accepted. At the same time, tension can appear between patients’ decisions and the induced medical measures. In an emergency – for example if a patient is in a state of great agitation or in a post-operative delirium – and if the patient is (temporarily) unable to make decisions, the question of whether to use coercive measures quickly arises.
How can patient autonomy be put into practice in these situations? When is it permitted – and when required – to take urgent medical measures even though the affected person has not agreed to them, or even actively resists them?
SAMS guidelines «Coercive measures in medicine»
The guidelines published by the SAMS in 2015 provide a framework for answering questions about these conflicting priorities. They take into account the legal requirements of the Kindes- und Erwachsenenschutzrecht (Swiss child and adult protection law – KESR) that entered into effect in 2013.
The guidelines are intended to create and maintain awareness of the fact that every coercive measure is a major invasion of the patient’s personal rights, and must therefore have an ethical justification. Simply adhering to procedural specifications does not justify the use of coercive measures. Both careful ethical reflection and precise analysis of the legal provisions and applicable guidelines are essential in each case.