Sexual rights of people with serious and persistent mental illness: Gathering evidence for decision making

1999 ◽  
Vol 5 (5) ◽  
pp. 150-161 ◽  
Author(s):  
D TORKELSON
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Sexual Rights ◽  
Persistent Mental Illness

scholarly journals Perceived Burdensomeness and the Wish for Hastened Death in Persons With Severe and Persistent Mental Illness

2021 ◽  
Vol 11 ◽  
Author(s):  
Julia Stoll ◽  
Christopher James Ryan ◽  
Manuel Trachsel
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Worth Living ◽  
Perceived Burdensomeness ◽  
Medical Assistance In Dying ◽  
Persistent Mental Illness ◽  
Decision Making Capacity ◽  
Capacity Uncertainty ◽  
Hastened Death ◽  
The Individual

Background: In several European countries, medical assistance in dying (MAID) is no longer confined to persons with a terminal prognosis but is also available to those suffering from persistent and unbearable mental illness. To date, scholarly discourse on MAID in this population has been dominated by issues such as decision-making capacity, uncertainty as to when a disease is incurable, stigmatization, isolation, and loneliness. However, the issue of perceived burdensomeness has received little attention.Objective: The study explores the possible impact of perceived burdensomeness on requests for MAID among persons with severe and persistent mental illness (SPMI).Method: Using the method of ethical argumentation, we discuss the issue of access to MAID for persons with SPMI and perceived burdensomeness.Conclusion: Perceived burdensomeness may be a contributing factor in the wish for hastened death among persons with SPMI. MAID is ethically unsupportable if SPMI causes the individual to make an unrealistic assessment of burdensomeness, indicating a lack of decision-making capacity in the context of that request. However, the possibility that some individuals with SPMI may perceive burdensomeness does not mean that they should be routinely excluded from MAID. For SPMI patients with intact decision-making capacity who feel their life is not worth living, perceived burdensomeness as a component of this intolerable suffering is not a sufficient reason to deny access to MAID.

scholarly journals Compulsory Interventions in Severe and Persistent Mental Illness: A Survey on Attitudes Among Psychiatrists in Switzerland

2021 ◽  
Vol 12 ◽  
Author(s):  
Julia Stoll ◽  
Martina A. Hodel ◽  
Florian Riese ◽  
Scott A. Irwin ◽  
Paul Hoff ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Mental Illness ◽  
Anorexia Nervosa ◽  
Cross Sectional Survey ◽  
Persistent Mental Illness ◽  
Decision Making Capacity ◽  
Case Vignettes ◽  
Persistent Depression

Background: Some psychiatric patients develop severe and persistent mental illness (SPMI), which, for a variety of reasons, can be therapy-refractory. Sometimes, treatment is not considered helpful by the patients themselves and does not improve their subjective quality of life. Furthermore, many SPMI patients experience compulsory interventions such as seclusion, restraint, or treatment against their will, which can cause harm.Methods: In a cross-sectional survey of 1,311 German-speaking psychiatrists in Switzerland, participants were asked about the care of SPMI patients in general, and about their attitudes with regard to compulsory interventions in particular, using three case vignettes of patients with severe and persistent anorexia nervosa, schizophrenia and depression.Results: Out of 1,311 contacted psychiatrists, 457 (34.9%) returned the completed survey. In general, 91.0% found it important or very important to respect SPMI patients' autonomy in decision making. However, based on three different clinical case vignettes, 36.8% of psychiatrists would act against the wishes of the patient with severe and persistent schizophrenia, 34.1% against the wishes of the patient with severe and persistent depression, and 21.1% against the wishes of the patient with severe and persistent anorexia nervosa, although all patients were stated to have preserved decision-making capacity. With regard to the case vignettes, 41.1% considered compulsory interventions leading to a temporary reduction of quality of life acceptable in the patient with severe and persistent schizophrenia, 39.4% in the patient with severe and persistent depression, and 25.6% in the patient with severe and persistent anorexia nervosa, although it was stated in all three case vignettes that two independent experts ascribed the patients decision-making capacity regarding their illness and further treatment.Conclusions: Many psychiatrists in our sample found themselves in an ethical dilemma between autonomy and the provision of medical care. While most respondents respect the autonomy of SPMI patients, many saw the need to perform compulsory interventions even though it was clearly and prominently stated that two independent psychiatrists had ascribed the patients in the case vignettes decision-making capacity. Further examination of these conflicting views is warranted, perhaps along with the development of guidelines for such situations.

Acceptability of Assisted Suicide in Patients With Severe and Persistent Mental Illness

GeroPsych ◽  
2020 ◽  
pp. 1-8
Author(s):  
Sophie Gloeckler ◽  
Manuel Trachsel
Keyword(s):  
Mental Illness ◽  
Pilot Study ◽  
Psychiatric Diagnosis ◽  
Assisted Suicide ◽  
Shared Values ◽  
Psychiatric Nurses ◽  
Attitudes And Beliefs ◽  
Future Studies ◽  
Persistent Mental Illness ◽  
Moral Attitudes

Abstract. In Switzerland, assisted suicide (AS) may be granted on the basis of a psychiatric diagnosis. This pilot study explored the moral attitudes and beliefs of nurses regarding these practices through a quantitative survey of 38 psychiatric nurses. The pilot study, which serves to inform hypothesis development and future studies, showed that participating nurses supported AS and valued the reduction of suffering in patients with severe persistent mental illness. Findings were compared with those from a previously published study presenting the same questions to psychiatrists. The key differences between nurses’ responses and psychiatrists’ may reflect differences in the burden of responsibility, while similarities might capture shared values worth considering when determining treatment efforts. More information is needed to determine whether these initial findings represent nurses’ views more broadly.

Crisis Occurrence and Resolution in Patients with Severe and Persistent Mental Illness

Crisis ◽  
2005 ◽  
Vol 26 (4) ◽  
pp. 160-169 ◽  
Author(s):  
Paul S. Links ◽  
Rahel Eynan ◽  
Jeffrey S. Ball ◽  
Aiala Barr ◽  
Sean Rourke
Keyword(s):  
Mental Illness ◽  
Suicide Ideation ◽  
Rating Scale ◽  
Psychiatric Symptoms ◽  
Self Report ◽  
Community Treatment ◽  
Persistent Mental Illness ◽  
Crisis Events ◽  
Symptom Distress Scale ◽  
Distress Scale

Abstract. Assertive community treatment appears to have limited impact on the risk of suicide in persons with severe and persistent mental illness (SPMI). This exploratory prospective study attempts to understand this observation by studying the contribution of suicidality to the occurrence of crisis events in patients with SPMI. Specifically, an observer-rated measure of the need for hospitalization, the Crisis Triage Rating Scale, was completed at baseline, crisis occurrence, and resolution to determine how much the level of suicidality contributed to the deemed level of crisis. Second, observer-ratings of suicidal ideation, the Modified Scale for Suicide Ideation, and psychopathology and suicidality, Brief Psychiatric Rating Scale, were measured at baseline, crisis occurrence, and resolution. A self-report measure of distress, the Symptom Distress Scale, was completed at baseline, crisis occurrence, and resolution. Finally, the patients' crisis experiences were recorded qualitatively to compare with quantitative measures of suicidality. Almost 40% of the subjects experienced crisis events and more than a quarter of these events were judged to be severe enough to warrant the need for hospitalization. Our findings suggest that elevation of psychiatric symptoms is a major contributor to the crisis occurrences of individuals with SPMI; although the risk of suicide may have to be conceived as somewhat separate from crisis occurrence.

What Patients With Severe Mental Illness Transitioning From Hospital to Community Have to Say About Care and Shared Decision-Making

2016 ◽  
Vol 37 (6) ◽  
pp. 400-405 ◽  
Author(s):  
Dawn I. Velligan ◽  
David L. Roberts ◽  
Cynthia Sierra ◽  
Megan M. Fredrick ◽  
Mary Jo Roach
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Shared Decision Making ◽  
Shared Decision

The capacity to designate a surrogate is distinct from decisional capacity: normative and empirical considerations

2021 ◽  
pp. medethics-2020-107078
Author(s):  
Mark Navin ◽  
Jason Adam Wasserman ◽  
Devan Stahl ◽  
Tom Tomlinson
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Decisional Capacity ◽  
Risks And Benefits ◽  
Relative Risks ◽  
Decision Making Capacity ◽  
Cognitive Diseases ◽  
Surrogate Selection

The capacity to designate a surrogate (CDS) is not simply another kind of medical decision-making capacity (DMC). A patient with DMC can express a preference, understand information relevant to that choice, appreciate the significance of that information for their clinical condition, and reason about their choice in light of their goals and values. In contrast, a patient can possess the CDS even if they cannot appreciate their condition or reason about the relative risks and benefits of their options. Patients who lack DMC for many or most kinds of medical choices may nonetheless possess the CDS, particularly since the complex means-ends reasoning required by DMC is one of the first capacities to be lost in progressive cognitive diseases (eg, Alzheimer’s disease). That is, patients with significant cognitive decline or mental illness may still understand what a surrogate does, express a preference about a potential surrogate, and be able to provide some kind of justification for that selection. Moreover, there are many legitimate and relevant rationales for surrogate selection that are inconsistent with the reasoning criterion of DMC. Unfortunately, many patients are prevented from designating a surrogate if they are judged to lack DMC. When such patients possess the CDS, this practice is ethically wrong, legally dubious and imposes avoidable burdens on healthcare institutions.

Sign in / Sign up

Export Citation Format

Share Document