Consent in Intensive Care Teams in the Community: From Coercion to the Personification of Care

Abstract

The historical context of mental health care in Quebec, which in recent years has given way to greater client participation in the decision-making process for which they are concerned, has reversed the previous medical conception of psychiatry. From a vision of internment, care is now adapted to the individual needs of the clientele served, even including the provision of care in the home. However, work with people weakened by mental illness is often fraught with questions and sometimes contradictory ethical issues. Intensive follow-up teams in the community are a case in point. Working with a very vulnerable clientele, health workers must know how to be open and flexible in order to establish a therapeutic relationship with a clientele that is often involuntary and refractory to any form of treatment. To achieve this, they often have to get past refusals to follow-up by using various strategies derived from libertarian paternalism in order to maintain contacts that will become meaningful and allow these individuals to regain control over their lives. This sometimes-intrusive approach obviously raises its share of ethical issues, particularly regarding consent to care, and can be perceived as an infringement of fundamental rights by infringing rights to self-determination and decision-making autonomy. However, it is possible to reverse this position through a benevolent approach supported by an ethics of care that favours respect for the uniqueness of each individual by placing them at the heart of the therapeutic relationship. It is through dialogue, the place given to the other, respect for their choices, uniqueness and self-determination that it will then be possible to seek implicit consent and active participation of the user in the recovery process, even if sometimes there are binding legal measures.