Psychiatry of the elderly

2021 ◽  
pp. 499-528
Author(s):  
Catherine Oppenheimer ◽  
Julian C. Hughes
Keyword(s):  
Decision Making ◽  
Old Age ◽  
Ethical Issues ◽  
The Elderly ◽  
Predictive Diagnosis ◽  
Truth Telling ◽  
Persons With Disabilities ◽  
Decision Making Capacity ◽  
The Face ◽  
Mental Capacity Act

This chapter describes the ethical issues that arise in the setting of mental illness, and particularly dementia, in old age. It affirms the importance of understanding each older person as an individual, embedded in a unique history and in relationships which sustain their identity even in the face of cognitive decline. Autonomy and paternalism are discussed, and the alternative concept of ‘parentalism’ introduced. Decision-making capacity and competence are extensively analysed from both philosophical and practical viewpoints, with particular reference to the Mental Capacity Act 2005, and to mechanisms for decision-making for noncompetent patients. Topics briefly treated include predictive diagnosis and mild cognitive impairment, end-of-life care, truth telling, sexuality, and the UN Convention on the Rights of Persons with Disabilities. The text is aimed at old age psychiatrists and other practitioners in the field, as well as at those with an interest in ethical issues in old age.

The early experience of Old Age Psychiatrists in the application of the Mental Capacity Act 2005: a pilot study

2009 ◽  
Vol 22 (1) ◽  
pp. 147-157 ◽  
Author(s):  
Ajit Shah ◽  
Natalie Banner ◽  
Chris Heginbotham ◽  
Bill Fulford
Keyword(s):  
Decision Making ◽  
Old Age ◽  
Social Care ◽  
Mental Capacity ◽  
Best Interests ◽  
Decision Making Capacity ◽  
Mental Capacity Act 2005 ◽  
Old Age Psychiatry ◽  
Mental Capacity Act

ABSTRACTBackground: The Mental Capacity Act 2005 (MCA) was fully implemented in October 2007 in England and Wales.Methods: A pilot questionnaire study examined the experience of consultants in Old Age Psychiatry in the early implementation of the MCA pertaining to local policy and training in the application of the MCA, the assessment of decision-making capacity, the determination of best interests, and the use of the least restrictive option and restraint.Results: Fifty-two (27%) of the 196 consultants in Old Age Psychiatry returned useable questionnaires. Seventy-five percent of them reported that local training on the application of the MCA was available, but less than 50% reported that training was mandatory. The vast majority of assessments of decision-making capacity were conducted by consultants in Old Age Psychiatry. Almost all of them reported using the four-fold specific test of decision-making capacity (DMC) described in the MCA. Restraint was reported to be rarely used.Conclusions: Consultants in Old Age Psychiatry generally reported using the criteria for the assessment of DMC, the determination of best interests and restraint described in the MCA. The findings highlight concern about the workload of clinicians in implementing the MCA and this requires careful monitoring. Consideration should be given to statutory provision of training in the application of the MCA by all healthcare and social care providers for all their healthcare and social care staff.

scholarly journals Młodość wobec starości: szacunek czy deprecjacja? „Namir!” Lubka Deresza

2017 ◽  
Vol 163 ◽  
pp. 401-414
Author(s):  
Albert Nowacki
Keyword(s):  
Old Age ◽  
Mass Culture ◽  
The Elderly ◽  
The Novel ◽  
Research Task ◽  
The Face

Youth to old age: respect or depreciation? Namir! by Lubko DereshThis article deals the problem of old age in the novel Namir! by Ukrainian writer Lubko Deresh. To accomplish this research task, at the beginning of the presentation problem of how the elderly was presented in culture and literature over the centuries was analyzed, and then was analyzed the novel itself. Studies have shown that in his book the author raised the question of a confrontation of youth with an old age. Our analyzes of Namir! by Deresh turned out that it repeats the patterns of mass culture, showing atendency to devaluation the elderly. During the study revealed, however, achange in approach to the problems of old age, which is visible attitude of respect for the elderly linked to equality in the face of inevitable death.Молодість перед старістю: пошана чи зневага? Намір! Любка ДерешаМетою цієї статті є спроба показати проблему старості в романі українського пись­менника Любка Дереша Намір! Щоб успішно висвітлити так окреслене завдання, на по­чатку було звернено особливу вагу на те, як питання старості представлялося культурою та літературою протягом століть, і тільки тоді було звернено увагу на саму повість. Дослі­дження показали, що в своїй книзі автор використав питання конфронтації молодого віку із старістю. Під час аналізу нами було встановлено, що Намір! повторює схеми масової куль­тури та показує виразну схильність автора до девальвації літніх людей. Наше дослідження показало, однак, певну зміну в підході до проблеми старості, а саме, що зміна зневаги на ставлення з повагою до літніх людей пов’язана із рівністю всіх людей перед обличчям не­минучої смерті.

A Conceptual Framework for the Ethical Evaluation of Supported Decision-Making

2021 ◽  
Vol 66 (Special Issue) ◽  
pp. 159-160
Author(s):  
Matthé Scholten ◽  
◽  
Jakov Gather ◽  
Jochen Vollmann ◽  
◽  
...  
Keyword(s):  
Decision Making ◽  
Conceptual Framework ◽  
Ethical Issues ◽  
Plain Language ◽  
Undue Influence ◽  
Persons With Disabilities ◽  
Ethical Evaluation ◽  
Process Support ◽  
Wide Range ◽  
Outsourcing Decision

"Background: Supported decision-making (SDM) refers to all types of interventions support persons with impaired decision-making capacity (DMC) in making informed treatment decisions. It encompasses a wide range of interventions, such as enhanced consent procedures, elaborated plain language and involvement of family, friends or peers in the informed consent process. Empirical research showed that SDM can enhance DMC. The UN Convention on the Rights of Persons with Disabilities, which has been ratified by 180 states parties to date, pronounces in article 12(3) that “states parties shall take appropriate measures to provide access by persons with disabilities to the support they may require in exercising their legal capacity.” At the same time, medical ethicists and legal scholars have raised the concern that persons with impaired DMC are more likely to become subject to undue influence under SDM arrangements. Objectives: The aim of this presentation is to provide a conceptual framework to facilitate an ethical evaluation of various forms of supported decision-making. Methods: Empirically informed conceptual analysis. Various SDM interventions are analyzed. Findings: It is necessary to distinguish between input, process and output support. Input support involves influencing factors that are negatively correlated with DMC; process support involves interpreting a person’s preferences and carrying out intellectual processing; and output support involves enabling a person to communicate decisions to others. Conclusion: Most forms of input and output support are promising, but ethical issues in relation to framing and interpersonal leverage must be addressed. Forms of process support that involve “outsourcing” decision-making capacities are ethically problematic. "

The hierarchy of values in Jewish bioethics

2011 ◽  
Vol 18 (4) ◽  
pp. 537-547 ◽  
Author(s):  
Chaya Greenberger
Keyword(s):  
Decision Making ◽  
Patient Autonomy ◽  
Ethical Issues ◽  
Ethical Code ◽  
Allocation Of Resources ◽  
Health Providers ◽  
Truth Telling ◽  
Red Flag

This article describes how ethical issues in health are approached and resolved within the framework of Jewish bioethics. Its main purpose is to explore the range of sources and methodologies used to determine the appropriate hierarchy of values for various ethical scenarios. Its major thrust is to illustrate how a divinely based but humanly negotiated ethical code stands firm upon ‘red flag’ principles, while at the same time, allowing for ‘shades of gray’ flexibility informed by given contexts. It provides significant insights and practical tools that can be instrumental in decision making for nurses and other health providers of all faiths. The following ethical domains are addressed: respect for patient autonomy, truth-telling and allocation of resources.

scholarly journals Unwell in hospital but not incapable: cross-sectional study on the dissociation of decision-making capacity for treatment and research in in-patients with schizophrenia and related psychoses

2018 ◽  
Vol 213 (2) ◽  
pp. 484-489 ◽  
Author(s):  
Benjamin Walter Jack Spencer ◽  
Tania Gergel ◽  
Matthew Hotopf ◽  
Gareth S. Owen
Keyword(s):  
Decision Making ◽  
Odds Ratio ◽  
Assessment Tool ◽  
Legal Framework ◽  
Cross Sectional Study ◽  
Competence Assessment ◽  
Sectional Study ◽  
Cross Sectional ◽  
Decision Making Capacity ◽  
Mental Capacity Act

BackgroundConsent to research with decision-making capacity for research (DMC-R) is normally a requirement for study participation. Although the symptoms of schizophrenia and related psychoses are known to affect decision-making capacity for treatment (DMC-T), we know little about their effect on DMC-R.AimsWe aimed to determine if DMC-R differs from DMC-T in proportion and associated symptoms in an in-patient sample of people with schizophrenia and related psychoses.MethodCross-sectional study of psychiatric in-patients admitted for assessment and/or treatment of schizophrenia and related psychoses. We measured DMC-R and DMC-T using ‘expert judgement’ clinical assessment guided by the MacArthur Competence Assessment Tool for Clinical Research, the MacArthur Competence Assessment Tool for Treatment and the legal framework of the Mental Capacity Act (2005), in addition to symptoms of psychosis.ResultsThere were 84 participants in the study. Half the participants had DMC-R (51%, 95% CI 40–62%) and a third had DMC-T (31%, 95% CI 21–43%) and this difference was statistically significant (P < 0.01). Thought disorder was most associated with lacking DMC-R (odds ratio 5.72, 95% CI 2.01–16.31, P = 0.001), whereas lack of insight was most associated with lacking DMC-T (odds ratio 26.34, 95% CI 3.60–192.66, P = 0.001). With the exception of improved education status and better DMC-R, there was no effect of sociodemographic variables on either DMC-R or DMC-T.ConclusionsWe have shown that even when severely unwell, people with schizophrenia and related psychoses in in-patient settings commonly retain DMC-R despite lacking DMC-T. Furthermore, different symptoms have different effects on decision-making abilities for different decisions. We should not view in-patient psychiatric settings as a research ‘no-go area’ and, where appropriate, should recruit in these settings.Declaration of interestNone.

Decision-Making in Old Age: Cautiousness and Rigidity

1981 ◽  
Vol 13 (2) ◽  
pp. 89-98 ◽  
Author(s):  
Richard E. Calhoun ◽  
Sam L. Hutchison
Keyword(s):  
Decision Making ◽  
Old Age ◽  
The Elderly ◽  
Elderly Individual ◽  
Elderly Individuals ◽  
Two Factors ◽  
Behavioral Rigidity ◽  
Elderly Participant ◽  
Risky Decisions

The purpose of the present study was to test the findings of Botwinick's work on cautiousness and decision-making in old age [1, 2], along with an examination of two factors not previously studied: rigidity and certainty of decision outcome. Sixty-four elderly participants of both sexes participated in filling out the Choice Dilemmas Questionnaire (CDQ) after having been classified as high or low on Schaie's Test of Behavioral Rigidity [3]. In general, Botwinick's conclusions were supported: 1. when given the opportunity to avoid making decisions on the CDQ, the elderly did so, even under conditions of no risk at all concerning the outcome of the decision; 2. elderly individuals appeared to become more conservative and cautious in their decisions when the outcome was directed at the lives of young individuals than when older individual's lifestyles were of concern. This latter phenomenon, however, was not seen when the elderly participant was required to make a decision and could not elect to abstain. In addition, rigidity was found to be related to risky decisions made by the elderly individual.

Ethics

Oncology ◽  
2017 ◽  
pp. 728-738
Author(s):  
Natalia S. Ivascu ◽  
Sheida Tabaie ◽  
Ellen C. Meltzer
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Informed Consent ◽  
Ethical Issues ◽  
Surrogate Decision Making ◽  
Ethical Problems ◽  
Decision Making Capacity ◽  
Surgical Critical Care ◽  
Surrogate Decision ◽  
Special Circumstances

In all areas of medicine physicians are confronted with a myriad ethical problems. It is important that intensivists are well versed on ethical issues that commonly arise in the critical care setting. This chapter will serve to provide a review of common topics, including informed consent, decision-making capacity, and surrogate decision-making. It will also highlight special circumstances related to cardiac surgical critical care, including ethical concerns associated with emerging technologies in cardiac care.

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