‘Prescribing’ coercive healthcare: documentary accounts of coercive healthcare decisions regarding persons with intellectual disabilities

Abstract

There is limited knowledge of how health professionals document decisions to provide coercive medical and dental healthcare for persons with intellectual disabilities. Drawing on sociological perspectives, we analysed 28 Norwegian decision documents to explore how professionals account for coercive healthcare decisions. The professionals presented clear-cut medicalized and morally neutral ‘coercive healthcare cases’ in favour of coercion. They typically emphasized the medical necessity of healthcare provision to prevent damage to the patient’s health. However, professional and ethical judgments of the necessity of coercion in individual cases were largely obscured. Professionals’ case presentation was facilitated by a standardized decision form. We suggest that professionals’ documentary accounts constitute a routinized ‘prescriptive’ practice that expresses the ‘voice of medicine’. We question whether the current practice promotes the rule of law or in the worst case may serve to legitimize unlawful use of coercion in healthcare.

Keywords:

• Intellectual disabilities
• medicalization
• coercion
• documentation
• standardization