Use of coercive measures in the intensive care unit

Coercive treatment in medicine includes measures taken against a current or previous expression of the will of the person concerned. It can include overcoming manifested resistance, especially in patients who no longer have the capacity to consent. Even though coercive measurements are common in psychiatry, they are also used in intensive care units (ICU). Use of coercive measurements in the ICU has always been a conflict between providing best medical care and restriction of free will/patient will. Medical staff is generally only partially aware of the moral conflict of these measures. However, patients have described coercion as an active loss of free will which they experience to be dehumanizing, stressful and traumatizing. The challenge in the ICU is to focus on the individual needs of the patients and involve them as much as possible while providing high-quality, highly specialized medical care. In order to avoid coersion in the ICU and to do justice to the individual patient, the focus must shift to building awareness. Models that have been shown to improve awareness such as the ethical reflection within the team, supervision and psychological support for patients and internal hospital standards have also been shown to reduce coercive measurements taken. The aim of this paper is to describe causes, different methods and frequencies of coercive measures used in the ICU. Legal aspects are also taken into account. This paper attempts to identify which procedures undertaken in the ICU can be associated with coercive measurements and how coercion is experienced by patients and the team.