Ethical reflections of healthcare staff on 'consentless measures' in somatic care: A qualitative study.

Abstract

BackgroundMany patients in medical wards lack decision-making capacity and cannot provide valid consent. As a result, nurses and other healthcare professionals often face a dilemma: whether to neglect the medical needs of such patients, or provide healthcare interventions without obtaining valid consent. Previous studies have indicated that many interventions are provided without consent; however, there is insufficient knowledge about how staff in this context reason about the ethical dilemmas they encounter.AimTo explore the ethical reasons provided by nurses and other healthcare professionals in medical wards for and against providing healthcare interventions without patients' consent.Research designThe study employed a qualitative explorative design. Eight focus group interviews were held with 37 staff across five different professions, mainly nurses, at two Swedish hospitals. The material was subjected to qualitative analysis, following a Reflective Thematic Analysis framework.Ethical considerationsEthical approval for this study was obtained from the Swedish Ethical Review Authority. All participants were informed orally and in writing about the study's aims and its voluntary nature. No sensitive personal information was registered. Participants provided their oral consent to participate before the interviews took place.Findings/ResultsThematic analysis resulted in four main themes: Coercion is a bad word; Reasons to accept coercion; Coercion is part of ward culture, and Unacceptable coercion.ConclusionsParticipants overwhelmingly supported the current use of 'consentless measures' at the investigated wards. Most situations described either needed no justification, according to participants, or could be easily justified by reference to the benefit of the patient, the patient's poor decision-making capacity, or the benefit of others. A range of implicit, contextual, and institutional justifications were also given. Suboptimal ward culture was considered a prime driver of consentless measures and a force that compromises nurses' agency in the patient encounter.