Is forced psychotherapy ethical

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Is forced psychotherapy ethical
Educated Stupid
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Posted Feb 20, 2004 - 10:52 AM:

Is forced psychotherapy ethical? Admittedly, this is more of an issue among the unemancipated, under-18 crowd, but I've known of cases where families have admitted middle-aged adults against their will. From my view, the ethics of any situation are entirely dependant on the relative circumstances. And so it follows that this issue, forced psychotherapy, is ethical in some instances and unethical in others. I'll demonstrate this assertion with an example.

Let's begin with an example of an ethical use of forced psychotherapy. Imagine for a moment you have a young child, let's say 10 years old. He or she is beginning puberty and is experiencing some extreme hormonal releases, resulting in mood swings that they don't understand. Said mood swings are causing serious issues with authority at school and at home. The parents of this child identify him as having a mood disorder, if you will, and feel the correct course of action may lay in medication and a little therapy. Now, why do I feel this course of action is ethical? Reason number one, the child is unaware of his problem, being undeveloped at the young age of 10. Awareness and self-identifying the psychological issue, I argue, is critical if one is to successfully deal with it. If an individual is incapable of identifying an issue, for whatever reasons (in this case, age), forced psychotherapy can sometimes be validated. This "sometimes validation," I feel, rests on a second condition: General organizational stability. If the individual is both ignorant of their condition, and cannot control it to the extent that it has significant negative consequences on the organizations to which the individual belongs, forced psychotherapy becomes more legitimate. However... these two factors still, in my view, cannot typically justify forced psychotherapy. There must be a third condition met: The individual cannot function sufficiently to provide for themselves, both outside and within any organizations where they are causing difficulties. If all these conditions are met, AND an individual's life appears to be at serious risk, I believe forced psychotherapy can often, but not always, be ethical.
dancingphoenix
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Posted Feb 20, 2004 - 11:29 AM:

'Psychotherapy' doesn't have anything to do with being forcably medicated and detained in hospital - it refers to the 'talking' techniques such as cognitive-behavioural therapy. While you could lock someone in a room with a psychologist these sort of techniques don't work unless the person is willing to put some effort into changing their life. So if a person isn't willing to engage in therapy then trying to force them is just a waste of everyone's time.


~ dp
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Posted Feb 20, 2004 - 12:35 PM:

dancingphoenix wrote:
'Psychotherapy' doesn't have anything to do with being forcably medicated and detained in hospital - it refers to the 'talking' techniques such as cognitive-behavioural therapy. While you could lock someone in a room with a psychologist these sort of techniques don't work unless the person is willing to put some effort into changing their life. So if a person isn't willing to engage in therapy then trying to force them is just a waste of everyone's time.


~ dp


Yeah, what I was referring to was the more "gentle" psychotherapy - seeing a therapist and/or getting meds, as opposed to being locked up.
Radrook
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Posted Feb 20, 2004 - 1:07 PM:

The moral justification to use force against a person's will must be based on that person's inability to reason clearly. For example, in cases of terminal disease, extreme psychological duress often affects a patient's judgment and causes some to request active or passive euthanasia. Jacqueline Kennedy was one whose request for passive euthanasia was granted.


In such circumstances it has to be determined to what degree the request really reflects the will of the patient and to what degree it is merely a manifestation of the patient's temporary desperation. Alter all, we all say and desire irrational things when we are under great stress. So forcing the patient to live on by forcing medical treatment on him or respecting his request is a very delicate issue as are all issues relating to the right to freedom of choice.

I don;t think that anyone who understands basics of ethics would ever propose that we rely on deontological reasoning in such a matter. In ethics, reaching the morally justifiable decision requires giving moral priority of one human right over another. Inflexible Rule-based thinking would inevitably lead to injustice as it does in all other areas of human relations.
rabeldin
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Posted Feb 20, 2004 - 1:52 PM:

I know of a case where a son commited his mother because she said things he didn't understand, seemed to be hallucinating, etc. She was given medication and a bed. During the night, she rose from the bed and (probably) confused by the strange location and medication, fell and broke a leg bone.

He now has found a doctor who has certified his father to suffer from Alzheimer's disease and with that certification obliged the bank to accept him as co-owner of the father's (substantial) bank accounts.

The potential for abuse when medicine and law are intertwined is great.
xect
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Posted Feb 20, 2004 - 4:17 PM:

Radrook wrote:
The moral justification to use force against a person's will must be based on that person's inability to reason clearly. For example, in cases of terminal disease, extreme psychological duress often affects a patient's judgment and causes some to request active or passive euthanasia. Jacqueline Kennedy was one whose request for passive euthanasia was granted.

I believe that in the cases where such patients request euthanasia, their request should be considered. When someone asks for such a thing, they feel that their life is not worth it. In such a case, even though the life is on a level where we would call it a good life, their view upon their own life means they do not enjoy it. Often, we will be doing them a favor by doing it the easy way.

This, of cause, is provided they really mean what they say. Within the first few months of that state, their decisions are probably not really valid, since they have had too little time to consider their new situation. The system I'd prefer was one where the patient, after making the request, would be required to confirm it after a month had passed, and then after another month. That way, it can be assured that it's not just a passing thing, or at least a passing thing that takes long enough to pass that the patient's rational decision should be respected.
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