Abstract：
While principle-based ethics is well known and widely accepted in psychiatry, much less is known about how decisions are made in clinical practice, which case scenarios exist, and which challenges exist for decision-making. Protocols of the central ethics committee responsible for four psychiatric hospitals over 7 years (N=17) were analysed. While four cases concerned suicide risk in the case of intended hospital discharge, the vast majority (N=13) concerned questions of whether the responsible physician should or should not initiate the use of coercion in patients lacking mental capacity. The committee\'s recommendations were non-uniform. Forced feeding and electroconvulsive therapy were endorsed in each one case. In two cases of intermittent loss of capacity due to heavy drinking or intermittent severe suicidal ideation, a self-binding contract was recommended and the use of coercion was considered as justified for a very limited period. In all other cases, most of which involved involuntary treatment, the use of coercion was not endorsed. Without exception, the recommendations were accepted with relief by the physicians and their treatment teams, who feared liability in the event of harm to the patient. Eventually, a model of a decision algorithm was derived from the ethical arguments in the protocols.
摘要：
虽然基于原则的伦理学在精神病学中众所周知并被广泛接受，人们对临床实践中如何做出决定知之甚少，存在哪种情况，以及决策存在哪些挑战。分析了负责四家精神病医院7年（N=17）的中央伦理委员会的协议。虽然四宗个案涉及有意出院的自杀风险，绝大多数（N=13）涉及的问题是，负责任的医生是否应该或不应该在缺乏心理能力的患者中开始使用胁迫。委员会的建议是不统一的。在每种情况下，都认可了强迫进食和电惊厥治疗。在两种由于大量饮酒或间歇性严重自杀意念而间歇性丧失能力的情况下，有人建议订立一个自具约束力的合同，并认为在非常有限的时间内使用胁迫是合理的。在所有其他情况下,其中大部分涉及非自愿治疗，使用胁迫没有得到认可。无一例外,医生及其治疗小组松了一口气，接受了这些建议，他们担心在对病人造成伤害的情况下承担责任。最终,从协议中的道德论点得出决策算法的模型。
