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

## TL;DR

This study explores how healthcare staff in Sweden justify providing medical care without patient consent when patients lack decision-making capacity.

## Contribution

The study provides new qualitative insights into healthcare professionals' ethical reasoning around consentless measures in somatic care.

## Key findings

- Participants generally supported consentless measures, often justifying them by patient benefit or lack of decision-making capacity.
- Suboptimal ward culture was identified as a key driver of consentless measures and a barrier to nurses' ethical agency.
- Four main themes emerged: coercion perceptions, acceptance reasons, cultural normalization, and unacceptable coercion.

## Abstract

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.

To explore the ethical reasons provided by nurses and other healthcare professionals in medical wards for and against providing healthcare interventions without patients’ consent.

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 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.

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.

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.