“Benevolent Coercion’’ in Elderly and Disability Care

Particularly in inpatient facilities, measures can be observed which, due to their coercive character, represent a serious infringement of the fundamental rights of the person concerned. Therefore, it is especially important that such measures are ethically and legally justified. Coercive measures include, among others, the custodial placement of persons in hospitals and other inpatient facilities, the treatment of mental and somatic illnesses without the person’s consent, restraint through medication in cases of challenging behaviour, as well as custodial measures such as the use of bed rails or restraint belts and structural coercion.

The German Ethics Council is currently preparing an Opinion on the following questions: which forms of coercion can be identified; what role coercive measures play in fields such as psychiatry, nursing, social work, child and youth services as well as disability welfare; to what extent these measures are ethically and legally problematic; and what need for change exists for practice and legal regulation. Of particular interest to the Ethics Council are those coercive measures that are carried out based on the justification of ensuring the self-protection of the person concerned (so-called “benevolent coercion”).

The third hearing on the topic is dedicated to coercive measures to which mainly persons with high support and/or care needs are exposed in the field of care and assistance for persons with disabilities. Particularly very elderly and seriously ill persons as well as persons with severe physical or cognitive impairments are affected in this field by measures such as compulsory guardianship, involuntary placement in facilities for the disabled or nursing homes, measures restricting freedom, compulsory diagnostic and therapeutic measures, compulsory care measures (e.g. concerning personal hygiene, food or fluid intake) as well as reward and punishment systems based on behavioural psychology. At the hearing, experts from the fields of rehabilitation education, general medicine and from selected facilities as well as representatives from associations of relatives and affected persons will give their views.

By holding this hearing, the German Ethics Council aims to investigate the different forms of benevolent coercion in care and assistance for people with disabilities and to identify the factors that cause them to occur. Since nursing and support personnel in these fields particularly often invoke structural conditions to legitimise the exercise of coercion, the question will also be addressed how structures can be changed in such a way that certain coercive measures can be avoided.

The first hearing on the various fields in which benevolent coercion plays a particular role covered the field of psychiatry and took place on 23 February 2017. The second hearing on child and youth welfare will take place on 18 May 2017. In addition, the German Ethics Council is conducting an online survey on all three areas, which is open to all interested individuals and institutions.