Swiss guidelines show broad consensus on ethical problems of coercion but note differences in normative goals and responsibility attribution
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Key Takeaway
Note differences in normative goals and responsibility attribution despite broad consensus on ethical problems of coercion.
This narrative review examines five documents from Swiss professionals and stakeholders to explore consensus and controversy surrounding coercive measures in psychiatric disorders. The scope includes involuntary admission, treatment without consent, and mechanical restraint compared with voluntary treatment within the Swiss setting.
The authors synthesize findings indicating broad consensus across all documents regarding the ethical problem of coercion and the necessity of prevention and voluntary treatment. Conversely, significant differences exist regarding normative goals, specifically the reduction versus abolition of coercion. Attribution of responsibility also varies between procedural safeguards, relational practice, and systemic reform.
Interpretation of clinical risk and security logics was not reported in the source documents. The framing of coercion differs, with some viewing it as an exceptional necessity, professional failure, or a systemic symptom. These variations highlight the complexity of implementing coercive measures despite general ethical agreement.
The review notes that future developments may benefit from integrating procedural and legal safeguards with preventive, relational, outcome-oriented, and systemic approaches aimed at reducing coercion. This integration addresses the identified gaps in current practice and policy discussions within Switzerland.
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View Original Abstract ↓
IntroductionCoercive measures, such as involuntary admission, treatment without consent and mechanical restraint, are among the most ethically contentious practices in psychiatry. In Switzerland, several influential position papers and guidelines articulating different professional, ethical and policy perspectives on the use and prevention of coercion have been published in recent years.ObjectiveThis review aims to provide a comparative analysis of five key Swiss documents addressing coercive measures in psychiatry, focusing on their formal characteristics, thematic priorities and underlying normative assumptions.MethodsA narrative review was conducted aiming to synthesize ethical, legal and clinical perspectives on coercive measures in psychiatry, with particular focus on Swiss position papers emphasizing legal and ethical frameworks. The review included documents discussing involuntary admission, forced medication, seclusion, and restraint, as well as broader ethical analyses of coercion. Five documents published between 2014 and 2025 by various professional and stakeholder organizations were analyzed in terms of their formal structure, key recommendations and framing of coercion.ResultsA broad consensus exists across all documents regarding the ethical problem of coercion, the importance of prevention and the prioritization of voluntary treatment. However, significant differences emerged with respect to normative goals (reduction vs. abolition of coercion), attribution of responsibility (procedural safeguards vs. relational practice vs. systemic reform), interpretation of clinical risk and security logics, and framing of coercion as exceptional necessity, professional failure or systemic symptom.ConclusionsThe current Swiss debate among professionals on coercive measures is characterized less by empirical disagreement than by different normative and discursive rationalities. Future developments may benefit from integrating procedural and legal safeguards with preventive, relational, outcome-oriented and systemic approaches aimed at reducing coercion.
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