Community treatment orders: Bioethical basis

Abstract

Background and Objectives: Numerous opinions and medico-legal controversies have arisen up to the date from community treatment orders in Western countries, but underlying bioethical questions have not been specifically studied. The aim of this work is to contribute to further clarify the bioethical conflicts arising from community treatment orders. Methods: The bioethical deliberation of the author is principally based on what can be considered the deontologist-principlist dominant paradigm. These principles, as first described by Beauchamp and Childress in 1979, will be applied in this work to the actual situation of involuntary outpatient treatment. Results: The author's deliberation considers that community treatment orders are consistent first with the deontologist-principlist dominant paradigm of practical reason, respecting its four general categories of basic principles. It also respects the principles of the medical ethics of virtue, subsumed in the personalism of ontological matrix, in the same way as its ethos affects the intrinsic purpose which is the dignity of the person; and with the consequentialist utilitarianism because it seeks the proportionality of the common good. A community treatment order prescription must ultimately be based on a bioethical exercise of responsibility by the clinician, judiciously weighing up the classic principal prima facie duties which must necessarily be translated into a real duty referring to a specific patient and context. Conclusions: Community treatment orders are seen as a method of therapeutic intervention with a bioethical basis resistant to criticism.