| Summary: | Community treatment orders (CTOs) are a legal mechanism to extend powers of compulsion into outpatient mental health settings in certain circumstances. Previous ethical analyses of these powers have explored a perceived tension between a duty to respect personal freedoms and autonomy and a duty to ensure that patients with the most complex needs are able to receive beneficial care and support that maximises their welfare in the longerterm. This empirical ethics paper presents an analysis of 75 interviews with psychiatrists, patients and family carers to show how these ethical considerations map onto the different ways that CTOs are used and experienced in practice. A complex and nuanced account of how the requirements to respect patients’ autonomy, to respect patients’ liberty, and to act beneficently should be interpreted in order to make judgements about the ethics of CTOs is presented. The paper argues that, due to such complexity, no general ethical justification for CTOs can be provided, but that a justification on the basis of the promotion of patients’ autonomy could provide an ethical reason for community mental health practitioners to make use of a CTO in some limited circumstances.
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