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Self-determination and freedom can be undermined by internal and external constraints. Internal compulsions can consist in impulses, thoughts or ideas that are so overwhelming that they cause suffering to the person having them. Beyond a certain degree of suffering or impairment of everyday life, psychiatrists speak of obsessive-compulsive disorder. Whether the extent to which a person’s life is determined by certain behaviours or ways of thinking is still considered “normal” or already compulsive in a pathological sense depends on socio-cultural factors, just as with other attributions of psychiatric disease.
External coercion, on the other hand, refers to the overriding of a person’s will by other individuals or institutions. It is a challenging task to specify the constellations in which the exercise of external coercion can be considered ethically or legally acceptable. Cases in which a person has to be prevented from causing significant harm to others are generally less controversial than cases in which the use of coercive measures is justified by the need to protect persons from harming themselves. When assessing coercive measures aiming to protecting persons from themselves, it is important to know whether or not the person whose wellbeing is at stake can be considered fully competent.
Coercive measures used, for example, in nursing homes, child and youth welfare facilities, but also in care for the disabled and psychiatric departments of hospitals, include the liberty-depriving involuntary commitment of persons in clinics and other inpatient facilities, the involuntary treatment of psychological and somatic illnesses, the sedation through medication during challenging behaviour, as well as measures involving the deprivation of liberty such as the use of bed barriers or restraint straps. Even if they are justified on the grounds of the well-being of the persons concerned, each one of these measures constitutes a grave intervention into the fundamental rights of the person concerned, so that they notably require ethical and legal justification.
