Within debates on mental health ethics, it is typically taken for granted that coercive interventions can be warranted when individuals with psychiatric conditions pose a risk to themselves or to others. Such actions are usually defended only when specific moral requirements—such as the proportionality of the intervention to the anticipated harm—are met. In this article, we argue that this widely accepted evaluative approach is insufficient in contexts where individuals with mental illness are exposed to structural racism. Using a clinical vignette from mental healthcare, we illustrate how judgments about proportionality can be distorted, including through inflated assessments of dangerousness shaped by racialized assumptions. We further contend that even when a proportionality judgment appears accurate and the intervention would be considered ethically legitimate within the conventional framework, the use of coercion can remain morally troubling. This is because the prevailing model does not interrogate the broader social and institutional conditions that give rise to coercive encounters. When structural racism plays a causal role in creating the circumstances in which coercion is enacted, such interventions risk reinforcing and intensifying pre-existing racial injustices. We therefore argue that ethical evaluations of coercion in psychiatric settings must attend to the potential for discriminatory bias and must explicitly integrate the ways structural inequities shape both clinical reasoning and the situations in which coercion occurs.
