in the rate of psychiatric commitment between countries, with the median rate being 74 per hundred thousand people. It is estimated that 38% of people who are involuntarily committed experience another form of compulsion such as seclusion or forced medication. Effects A 2014 Cochrane systematic review found that compulsory outpatient treatment of those with severe mental health disorders "results in no significant difference in service use, social functioning or quality of life compared with standard voluntary care." A 2006 review found that as many as 48% of respondents did not agree with their treatment, though a majority of people retrospectively agreed that involuntary medication had been in their best interest. A review in 2011 looked at people's experience of coercion in mental health care. It found common themes of feeling violated, disrespected, and not being heard, commonly conceptualized as being dehumanized through isolation. A minority of narratives from people who had been treated involuntarily talked about the necessity of treatment in retrospect. Studies suggest that coercion in mental health care has a long-lasting psychological effect on individuals leading to reduced engagement and poorer social outcomes, but that this may be reduced by clinicians' knowledge of the effects of coercion. A systematic review and meta synthesis from 2020, that combined the experiences of stakeholders (service-users, informal carers such as family members, and mental health professionals), identified experiences of power imbalances among the stakeholders. The review found that these power imbalances hindered the respect for the service users' rights, will, and preferences. Ethics In medical ethics, involuntary treatment is conceptualized as a form of parens patriae whereby the state takes on the responsibilities of incompetent adults on the basis of the duty to protect and the duty of beneficence (the duty of the state to repair the random harms of nature). The duty to protect is reflected in utilitarianism and communitarianism philosophy, though psychiatrist Paul Chodoff asserted a responsibility to "chasten" this responsibility in light of the political abuse of psychiatry in the Soviet Union. This duty to protect has been criticized on the grounds that psychiatrists are not effective at predicting violence, and tend to overestimate the risk. The obligatory dangerousness criterion is a principle that has been applied to some mental health law that holds that parens patriae should only be applied if an individual is a danger to themselves or others. Paul Ricœur distinguishes two forms of self, the