Reweighing the Ethical Tradeoffs in the Involuntary Hospitalization of Suicidal Patients

Am J Bioeth. 2019 Oct;19(10):71-83. doi: 10.1080/15265161.2019.1654557.


Suicide is the 10th leading cause of death in the United States and the second cause of death among those ages 15-24 years. The current standard of care for suicidality management often involves an involuntary hospitalization deemed necessary by the attending psychiatrist. The purpose of this article is to reexamine the ethical tradeoffs inherent in the current practice of involuntary psychiatric hospitalization for suicidal patients, calling attention to the often-neglected harms inherent in this practice and proposing a path for future research. With accumulating evidence of the harms inherent in civil commitment, we propose that the relative value of this intervention needs to be reevaluated and more efficacious alternatives researched. Three arguments are presented: (1) that inadequate attention has been given to the harms resulting from the use of coercion and the loss of autonomy, (2) that inadequate evidence exists that involuntary hospitalization is an effective method to reduce deaths by suicide, and (3) that some suicidal patients may benefit more from therapeutic interventions that maximize and support autonomy and personal responsibility. Considering this evidence, we argue for a policy that limits the coercive hospitalization of suicidal individuals to those who lack decision-making capacity.

Keywords: decision making; health policy; informed consent; mental health; professional–patient relationship; psychiatry/psychology.

MeSH terms

  • Adolescent
  • Adult
  • Coercion*
  • Female
  • Humans
  • Inpatients / psychology*
  • Involuntary Treatment / ethics*
  • Involuntary Treatment / trends*
  • Male
  • Mentally Ill Persons
  • Personal Autonomy*
  • Standard of Care / ethics
  • Standard of Care / legislation & jurisprudence
  • Suicidal Ideation*
  • Suicide / statistics & numerical data
  • United States / epidemiology