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The use of coercion in complex situations, such as intensive care therapy, requires special attention, as patients are in a situation of dependency and often limited self-determination. Coercion can also arise in intensive care situations, including situations where a person's natural will is overcome.Coercion as freedom-restricting, -limiting measures and forced treatment in ICUs exists in the form of formal and informal coercion and is perceived by the patient. Formal coercion includes measures such as restraints, sedation and environment. Informal coercion arises from influence, such as manipulation, inadequate or false information, lack of communication and threat.Longer-term, i. e. > 30 minutes, measures restricting or withdrawing freedom, as well as compulsory treatment, are subject to authorization.The central conflict in the use of coercion is the tension between self-determination of the patient and care, the protection of the patient from harm.In intensive care, phases of agitation, delirium, but also dementia or depressive phases, hypoactivity are commonplace in patients. The use of coercive measures in emergency situations is only possible if it has been examined according to legal and medical-ethical criteria and there are no alternatives (ultima ratio) for the use of coercion.The use of coercion as "ultima ratio" includes the verification of decision-making capacity and the assessment/examination of the critical situation. Only in exceptional cases of incapacity to consent and in the event of "imminent significant damage to health" may measures restricting or withdrawing freedom be used.Treatment in the intensive care unit is based on a current indication with medical evidence, as well as the standards and process structures. To avoid formal and informal coercion, it is crucial to establish an image of humanity in the interprofessional team that respects the patient and his autonomy and implements this in everyday life and training concepts.Concepts to be recognized and name the use of coercion and to avoid coercion include: Recognition of risk situations for coercion, standards to avoid coercion in ICUs, education and training in communication.