Criteria for involuntary hospitalisation

Objective: The aim of this paper is to provide an overview of the ethical bases of compulsory commitment legislation. Method: The ethical principles of beneficence and autonomy are examined and used to identify criteria for the commitment of mentally ill patients. Results: Two aspects of beneficence, medical paternalism and social paternalism, are discussed. It is argued that social paternalism is insufficient ethically to warrant involuntary admission, and that the basis for compulsory hospitalisation is medical paternalism. Conclusion: The central role of autonomy in medical ethics suggests a patient should have a diminished capacity for autonomous decision-making and a potential to benefit from hospitalisation, as well as a risk of harm to self (including self-neglect) to warrant committal. In specific circumstances, the risk of harm to others may also justify committal. These ethical principles may be at odds with public attitudes.