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We have studied the ethical challenges that mental health care professionals reflected upon during 86 ethics reflection groups focusing on the use of coercion. Our main finding is that the professionals experience many different and demanding ethical challenges. These challenges are divided into four main categories: informal coercion, formal coercion, uncertainty about the legislation, and professionalism. The most important value trade-off is whether patient’s autonomy ought to give way to other considerations. This study shows that Norwegian health law does not answer all questions related to what should be considered as legitimate use of coercion in mental health care. Sometimes mental health care professionals may even experience that health law causes ethical challenges. Dealing openly with ethical challenges in a systematic way is important in order to define coercion and to acknowledge the various associated value conflicts. Furthermore, a joint reflection process can help determine when coercion should be regarded as the lesser evil and how coercive measures can be used in the least restrictive and offensive manner.

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