Ethical use of long-acting medications in the treatment of severe and persistent mental illnesses☆

Abstract 

Mental illnesses are prevalent, cause great suffering, and are burdensome to society. Traditional “depot” antipsychotic agents are used to treat the most severely and persistently mentally ill individuals. They will soon be joined by new atypical antipsychotic medications in long-acting formulations. These long-acting medications pose special ethical issues, but may greatly benefit some people who suffer from severe and persistent mental illnesses. The objective of the current report is to highlight ethical considerations related to the use of long-acting antipsychotic medications. An analysis centering on the ethical concepts of voluntarism, beneficence, and justice is performed, integrating relevant empirical evidence and bioethics principles. Two main conceptual issues related to constraints upon voluntarism and coercion exist. Careful examination of ethically important empirical evidence suggests that voluntarism may not be perceived as an issue for some persons receiving depot antipsychotic medications. A favorable balance of benefits and risks has been documented for some individuals with severe and persistent mental illnesses. Access to care, innovative treatments, and long-acting antipsychotic medications may arise as an issue of justice and nondiscrimination in the care of mental illness. Considerations of justice indicate that long-acting medications may need to be used more frequently and earlier in the course of severe and persistent mental illness for select patients. We conclude that great care should be given to ethically important issues surrounding voluntarism, beneficent care, and equitable access to innovative psychiatric treatments, especially for persons who carry the burden of stigma as well as severe and persistent mental illness.