Methods of Influencing the Decisions of Psychiatric Patients: An Ethical Analysis

INTRODUCTION Psychiatry has given considerable attention to the ethics of coercive methods, such as involuntary commitment and forced medications. This attention is warranted because patients with major mental disorders are vulnerable to impediments in decision making and also to coercion and excessive paternalism.What has not received adequate attention, however, is the ethics of subtle and routine forms of influence such as framing information, using rewards, and employing social norms. These forms of influence can powerfully shape patients’ thoughts, decisions, actions, and compliance. As such, they should be carefully considered. In an effort to find a middle ground between excessive paternalism and protecting patients from imprudent decisions, reflective psychiatrists and mental health professionals will often struggle with when, how, and how much to influence patients’ decisions. In that context, our goals here are to develop a typology of influence on psychiatric patient’s decision making and to describe the ethically relevant factors that should be considered. This framework should contribute to the ethical practice of psychiatry.