Development of guidelines regarding ethical dilemmas in mental health care for asylum seekers
Dit project gaat over de ontwikkeling van richtlijnen voor behandelaren die in de Geestelijke Gezondheids Zorg (GGZ) voor asielzoekers te maken krijgen met ethische dilemma’s. Ethische dilemma’s kunnen ontstaan als de behandeling van een asielzoeker in conflict lijkt of dreigt te komen met de professionele standaarden van behandelaars in de GGZ. Bij dergelijke conflicten maken behandelaars ethische afwegingen afgeleid van vier typen principes met als één van de meest relevante: ‘do no harm’.
Behandelaren in de praktijk geven aan behoefte te hebben aan de ontwikkeling van een referentiekader. Op basis van internationale wetenschappelijke literatuur, interviews en focusgroepen met behandelaars in de GGZ zullen de richtlijnen ontwikkeld worden. Deze richtlijnen worden getoetst aan bruikbaarheid in de praktijk en ter bekrachtiging voorgelegd aan beroepsverenigingen van behandelaren in de GGZ. De richtlijnen worden ook met een focusgroep bestaande uit asielzoekers besproken.
Samenvatting van de aanvraag
Formulation of the problem In asylum policies biomedical ethics, human rights and health converge. Due to the sequence of stressful experiences before, during and/or after their migration, a relatively large percentage of asylum seekers present mental health (MH) problems. These MH problems may emerge or increase because of e.g. a too lengthy, stressful life situation in a reception centre; and/or because of an imminent rejection of the asylum request or deportation. Some of the rejected asylum seekers with health problems receive a permission to stay for the length of their treatment. In literature, attention has been given to ethical dilemmas in mental health care (MHC), and the application of the four principles of biomedical ethics is discussed. E.g. in literature, advocacy is seen as complying with the principle of justice. However, in Dutch health care it is not common that care providers act as advocates for their patients. With the increasing restrictions in asylum policies the confrontation of MHC providers with ethical dilemmas has augmented. MHC providers ask themselves how to comply with the ‘duty to treat’ when it may contravene with ‘do no harm’, in case that successful treatment leads to deportation. And how to act when mental health problems are mostly situational? Own norms and values of MHC providers may influence their actions, that might not meet professional standards. Relevance Practical, professionally accepted guidelines as a support to Dutch MHC workers in their decision making how to act when confronted with medical ethical dilemmas in their care for asylum seekers have not been developed yet. It is observed that in daily practice different norms and values among MHC workers and their institutions lead to divergent decisions and actions in MHC for asylum seekers. This divergence not only creates uncertainty at individual level about the acceptability of certain actions, but also incomprehension between institutes, and between MHC and the medical advisors of the Immigration Service (BMA). A professionally accepted tool is needed that not only supports MHC providers and their institutions in their policies and individual decision making concerning ethical cases, but also creates more consistency in actions. Implementation As closure of the project a conference will be organised for representatives of all professional target groups in which the results of the qualitative study and the guidelines will be presented. Besides, since representatives of MHC and professional associations will be involved in this project, a widespread distribution of the guidelines, e.g. through their websites, can be realized. Also, later, articles will be written about the results of the project and submitted to relevant professional newsletters and journals. Aim of the project The aim of the project is the development of practical, professionally accepted guidelines as a supportive tool for Dutch MHC workers in their decision making how to act when confronted with medical ethical dilemmas in their care for asylum seekers. Globally, two moral cases has been identified that lead to divergent decisions and actions in MHC for asylum seekers. Possible solutions for these moral cases, and the arguments that lead to these possible solutions should be explored, first by a literature study, and second in dialogue with individual and groups of different MHC professionals involved in MHC for asylum seekers. The results of the dialogues should be analysed, and turned into guidelines. Consensus should be found among the relevant professional associations whether those guidelines are morally and professionally acceptable. Approach The methodology of the project consists of nine phases. First the structure for support and feedback by the project advisors and the feedback group, including representatives of professional associations, will be established. Next, a literature study will be performed. Based on the results, topics will be determined for interviews with six individual MHC providers. The outcome of the interviews will be analysed , and moral cases will be constructed that will be used for discussions in six focus group meetings of different MHC professionals. The results of the individual and focus group interviews will be analysed with using a reflective equilibrium approach for reaching a maximally coherent view. Next, on basis of the analysis guidelines will be drafted. The results of the qualitative study and the drafted guidelines will be discussed with the feedback group. Also, the drafted guidelines will be tested on their applicability in daily practice of MHC. If needed, the drafted guidelines will be adjusted and presented to the professional association for their endorsement. Also, the guidelines will be discussed with a focus group of (former) asylum seekers. A conference, in which the results of the qualitative study and the guidelines will be presented, closes the project.