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A case against compulsory care for borderline personality disorder

2023-11-30

Borderline personality disorder is characterised by difficulties regulating and containing negative emotions and is associated with dysfunctional coping-mechanisms like self-harm and suicidality. Patients with this disorder are over-represented in compulsory care. But compulsory care sometimes increases suicide risk in patients. A paper recently published in Clinical Ethics explores whether compulsory care is ethically justified for these patients and finds that in most cases – it isn’t. 

“Clinical guidelines on when or when not to subject a patient to compulsory care are unclear. Even as a suicide prevention measure, this raises ethical concerns among clinicians who can feel very alone in making these decisions without enough guidance,” says Niklas Juth, Professor of Clinical Medical Ethics at Uppsala university’s Centre for Research Ethics & Bioethics, and one of the authors of the paper.

In their study, the authors analysed the arguments commonly used in favour of compulsory care for patients with borderline disorder, such as lack of decision competence, lack of authenticity, suicide prevention, safeguarding against litigation, practical solutions in emergencies, and the idea of ‘erring on the safe side’. The goal was to discover in which situations such care is ethically justified. According to the authors, unless the clinician has strong reason to believe that the patient lacks decision-making capacity from another severe mental condition, compulsory care for these patients is not ethically justified.

“Our hope is that these findings can help guide clinicians in making these decisions, and reduce the use of potentially harmful care measures. Easing the burden on clinicians by helping to clear up the uncertainties that currently exists in the available guidelines,” says Niklas Juth.

By Anna Holm Bodin

Lundahl A, Helgesson G, Juth N. Is compulsory care ethically justified for patients with borderline personality disorder? Clinical Ethics. 2023;0(0). DOI:10.1177/14777509231216036

Last modified: 2023-11-16