The negotiating process.
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Dutch health care is developing in the direction of posttraditional medicine: a dynamic system of demand and supply, in which the media, information technology and a more active attitude of the patient play a part. The nature of the complaint/diagnosis combination affects the degree to which therapy is or is not evidence-based and can be medically justified. Randomized studies and guidelines in itself do not lead to a more purposeful application of treatment. Patients persistently request interventions that are not medically justified, but rather have various non-medical aims. Physicians can regard demands of this nature as an encroachment on their authenticity and find it difficult to decide whether or not to comply with them.
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Psychiatric nursing practice can be likened to an ethical minefield. Nurses are often in the middle of the minefield and are pushed and pulled by forces, which are sometimes beyond their control. This paper signposts some of the more problematic areas of practice so that nurses may be equipped with at least a broad over-view of the ethical terrain.
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