Compulsory care for alcohol use disorder A historical & ethical analysis

Abstract: Introduction: Compulsory care as an intervention to treat alcohol-use disorder has been acontroversial practice, and the law on care of misusers in certain cases (LVM) often comesunder criticism from different areas of Swedish society.  Aim: The purpose of this paper was to conduct a historical and ethical analysis pertaining tothe use of compulsory care for alcohol-use in Sweden. Method: Text was analysed using a hermeneutical approach. Historical information wasgathered through 3 different types of sources: academical dissertation, laws, andgovernmental investigations. Empirical data regarding LVM was gathered through asystematic search in psycinfo, Cochrane, and pubmed Results: Compulsory care against alcohol-use disorder started in 1913, The initial iteration ofthis was utilitarian. There has always been a heavy class-element to Swedish alcohol politics,especially before the 1950s. The legislation surrounding compulsory care has not drasticallychanged, nor has the characteristics of the individuals sanctioned under the laws. The mainethical conflicts are between individual autonomy and integrity, and the states responsibilitytowards its populace. Conclusions: The process of LVM is still reminiscent of earlier iterations of the law, and thediscussions surrounding compulsory care on a legislative level has not changed drasticallyduring the last 50 years. The efficacy of the intervention is not apparent, the process ofdefining who needs the intervention is not transparent, and it is not apparent that the socialwelfare board is equipped to make these decisions. This adds to the already dubious ethicaldilemmas regarding autonomy and integrity inherent to compulsory care.