Ethical Considerations in Granting Leave to Psychiatric Patients
Name Susanne Noteboom
Student number 547576
Word count 3625
, Introduction
On January 2nd of this year, a 76-year-old severely injured woman was found on the street in
Den Dolder by passersby (Crawford, 2025). Emergency services were called, but help came
too late: the woman had already died from her injuries. A 27-year-old suspect was arrested
by the police. The man was a patient in a closed ward at the psychiatric clinic Fivoor, also
located in the village. He was on leave. This incident is not the first of its kind; in 2017, Anne
Faber was also murdered by a patient on leave from the same clinic (Crawford, 2025). The
murder on Anne Faber caused a lot of media attention. With this incident repeating itself,
concerns have arisen again among local residents. Some are questioning the safety of the
system allowing trial leave, while others want the clinic to be shut down altogether. The case
of the 76 year old woman is again receiving a lot of media attention, highlighting the societal
relevance of the ethical dilemmas surrounding the leave of psychiatric patients.
Involuntary care and policy in The Netherlands
According to the Dutch Wet zorg en dwang (Wzd), individuals with a severe psychiatric
disorder can be involuntarily hospitalized without having committed any criminal offenses.
This may apply, for example, to individuals experiencing a psychosis but who have not
committed any crimes. The moral responsibility of healthcare institutions and treating
physicians becomes evident in the decision of whether granting leave is justified, considering
both the patient's care needs and the potential risks to society.
The law does not automatically grant involuntarily hospitalized patients the right to leave. The
right to leave is only granted based on the patient's stability and the prognosis for further
treatment. This decision is made by the treatment team, which must carefully weigh the risk
of relapse or harm to others (Erasmus MC, n.d.). If the patient has not committed any crimes
and does not pose a danger to others, leave may be part of the recovery process.
Moral dilemma
In the ethical dilemma about whether psychiatric patients in closed wards who have not
committed a criminal offense should be allowed unaccompanied leave, multiple principles
conflict. Beauchamp and Childress (2019) describe several principles used as guidelines in
ethical dilemmas: beneficence, non-maleficence, autonomy and justice. Allowing these
patients unaccompanied leave aligns with the principle of beneficence. Beauchamp and
Childress (2019) define beneficence as promoting the well-being of others and acting in the
best way possible for patients. Allowing unaccompanied leave supports recovery, which
aligns with this principle.
An observational study by Ziltener et al. (2021) showed why leave is beneficial for patient
recovery. Firstly, it offers the opportunity to test the effectiveness of treatment in real-life
situations, allowing caregivers to assess the treatment process and potential discharge. It
also enhances treatment effectiveness as patients can practice skills learned in the clinic in
real-world settings. Additionally, it reduces stress for patients by providing a break from the
hospital environment and allows for tailored care, as behavior during leave can be re-
evaluated. All these benefits lead to a reduced chance of readmission after discharge.
Allowing psychiatric patients who have not committed a criminal offense to go on
unaccompanied leave also aligns with the principle of autonomy. Beauchamp and Childress
(2019) describe autonomy as respecting an individual's right to make their own decisions
about their life and care. It acknowledges the inherent dignity of individuals and their capacity
Name Susanne Noteboom
Student number 547576
Word count 3625
, Introduction
On January 2nd of this year, a 76-year-old severely injured woman was found on the street in
Den Dolder by passersby (Crawford, 2025). Emergency services were called, but help came
too late: the woman had already died from her injuries. A 27-year-old suspect was arrested
by the police. The man was a patient in a closed ward at the psychiatric clinic Fivoor, also
located in the village. He was on leave. This incident is not the first of its kind; in 2017, Anne
Faber was also murdered by a patient on leave from the same clinic (Crawford, 2025). The
murder on Anne Faber caused a lot of media attention. With this incident repeating itself,
concerns have arisen again among local residents. Some are questioning the safety of the
system allowing trial leave, while others want the clinic to be shut down altogether. The case
of the 76 year old woman is again receiving a lot of media attention, highlighting the societal
relevance of the ethical dilemmas surrounding the leave of psychiatric patients.
Involuntary care and policy in The Netherlands
According to the Dutch Wet zorg en dwang (Wzd), individuals with a severe psychiatric
disorder can be involuntarily hospitalized without having committed any criminal offenses.
This may apply, for example, to individuals experiencing a psychosis but who have not
committed any crimes. The moral responsibility of healthcare institutions and treating
physicians becomes evident in the decision of whether granting leave is justified, considering
both the patient's care needs and the potential risks to society.
The law does not automatically grant involuntarily hospitalized patients the right to leave. The
right to leave is only granted based on the patient's stability and the prognosis for further
treatment. This decision is made by the treatment team, which must carefully weigh the risk
of relapse or harm to others (Erasmus MC, n.d.). If the patient has not committed any crimes
and does not pose a danger to others, leave may be part of the recovery process.
Moral dilemma
In the ethical dilemma about whether psychiatric patients in closed wards who have not
committed a criminal offense should be allowed unaccompanied leave, multiple principles
conflict. Beauchamp and Childress (2019) describe several principles used as guidelines in
ethical dilemmas: beneficence, non-maleficence, autonomy and justice. Allowing these
patients unaccompanied leave aligns with the principle of beneficence. Beauchamp and
Childress (2019) define beneficence as promoting the well-being of others and acting in the
best way possible for patients. Allowing unaccompanied leave supports recovery, which
aligns with this principle.
An observational study by Ziltener et al. (2021) showed why leave is beneficial for patient
recovery. Firstly, it offers the opportunity to test the effectiveness of treatment in real-life
situations, allowing caregivers to assess the treatment process and potential discharge. It
also enhances treatment effectiveness as patients can practice skills learned in the clinic in
real-world settings. Additionally, it reduces stress for patients by providing a break from the
hospital environment and allows for tailored care, as behavior during leave can be re-
evaluated. All these benefits lead to a reduced chance of readmission after discharge.
Allowing psychiatric patients who have not committed a criminal offense to go on
unaccompanied leave also aligns with the principle of autonomy. Beauchamp and Childress
(2019) describe autonomy as respecting an individual's right to make their own decisions
about their life and care. It acknowledges the inherent dignity of individuals and their capacity
