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The Concept of Autonomy in Contemporary Psychiatric Ethics
Introduction: There is no global ethical approach in medicine neither is there any agreement on psychiatric ethics and that is especially problematic when it comes to involuntary psychiatric treatment. According to some authors, human rights is the closest concept to »global ethics« and they form the background of legislations in the field of mental health. However, legislative solutions can contradict clinical and ethical principles. Methods: Using the methods of hermeneutical reading and comparison we will compare the concepts of autonomy in two predominant contemporary ethical approaches in psychiatry, namely the four principle ethics and the relational ethics of care. Results: The above mentioned ethical approaches use different concepts of autonomy – individual versus relational autonomy. This generates tensions, especially when taking decisions for or against involuntary psychiatric treatment. Patients with severe mental disorders are vulnerable due to disease deficits as well as due to potential traumatisation caused by involuntary treatment interventions. Conclusions: There is great need for interdisciplinary research and discourse in the quest for the best model approaches to treatment of the vulnerable psychiatric patients when they cannot decide about treatment in their best interest. Legislations that reflect the contract between society and psychiatry need to be reviewed on a regular basis to be clinically, ethically and legally updated as much as possible.