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Ethical reflections of healthcare staff on ‘consentless measures’ in somatic care: A qualitative study

Year: 2025

Type: article

Abstract: Background Many 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. Aim To explore the ethical reasons provided by nurses and other healthcare professionals in medical wards for and against providing healthcare interventions without patients’ consent. Research design The 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 considerations Ethical 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/Results Thematic analysis resulted in four main themes: Coercion is a bad word ; Reasons to accept coercion ; Coercion is part of ward culture, and Unacceptable coercion. Conclusions Participants 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.

Source: Nursing Ethics

DOI: 10.1177/09697330251328649

Authors: Joar Björk, Niklas Juth, Tove Godskesen

Institutions: Linköping University, Uppsala University, Karolinska Institutet, Nord University

Language: English

Topic: Healthcare Decision-Making and Restraints

Subfield: Clinical Psychology

Field: Psychology

Domain: Social Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,900