A Puzzling Anomaly

2020 ◽  
Author(s):  
Louis C. Charland
Keyword(s):  
Decision Making ◽  
Ethical Issues ◽  
Double Standard ◽  
Mental Capacity ◽  
Ethical Concern ◽  
Decision Making Capacity ◽  
Ethical Inquiry ◽  
Psychometric Instruments ◽  
History Of ◽  
Ethical Controversy

Any ethical inquiry into addiction research is faced with the preliminary challenge that the term “addiction” is itself a matter of scientific and ethical controversy. Accordingly, the chapter begins with a brief history of the term “addiction.” The chapter then turns to ethical issues surrounding consent and decision-making capacity viewed from the perspective of the current opioid epidemic. One concern is the neglect of the cyclical nature of addiction and the implications of this for the validity of current psychometric instruments used to evaluate decision-making capacity in addiction. Another is the apparent discrepancy—possibly an ethical double standard—in the manner in which society and addiction researchers view the mental capacity and vulnerability of individuals who suffer from severe addiction. On the whole, the main ethical concern of the chapter is the puzzling lack of clinical research on decision-making capacity in research on addiction.

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.

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.

Is childhood a disability? Using Mental Capacity Tribunals and the Deprivation of Liberty Safeguards to shield children's capacity to consent to and refuse medical treatment

2014 ◽  
Vol 19 (2) ◽  
pp. 96-106 ◽  
Author(s):  
Robin Mackenzie ◽  
John Watts
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Medical Treatment ◽  
Mental Health Treatment ◽  
Mental Capacity ◽  
Best Interests ◽  
Legal Analysis ◽  
Content Type ◽  
Decision Making Capacity ◽  
The Law

Purpose – The purpose of this paper is to demonstrate that the common and statutory law governing children's capacity or competence to consent to and to refuse medical treatment is unsatisfactory and to suggest solutions. Design/methodology/approach – Critical legal analysis of the law on assessing minors’ decision-making capacity in relation to legal recognition of their consent to and refusal of medical treatment. Findings – Without legal mechanisms which protect both children and their rights, all children and young people are effectively disabled from exercising age and capacity-related autonomy and participation in decisions affecting their lives. Yet in English law, inconsistencies between legal and clinical measures of decision-making capacity, situations where compulsory medical or mental health treatment is lawful, and tensions between rights and duties associated with human rights, autonomy, best interests and protections for the vulnerable create difficulties for clinicians, lawyers and patients. Research limitations/implications – As the paper acknowledges in its recommendations, the views of stakeholders are needed to enrich and inform legal reforms in this area. Originality/value – The paper makes suggestions to amend the law and clinical practice which are original and far reaching. The paper suggests that in order to observe children's rights while protecting them appropriately, the Mental Capacity Act 2005 and Deprivations of Liberty Safeguards should be applied to minors. The paper recommends the establishment of Mental Capacity Tribunals, similar in nature and purpose to Mental Health Tribunals, to provide legal safeguards and mechanisms to foster the supported decision-making envisaged in recent United Nations Conventions.

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.

Mental Health and Social Care Regulation in Ireland: New Ethical Perspectives

2017 ◽  
Vol 41 (S1) ◽  
pp. S21-S21
Author(s):  
P. Dodd
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Social Care ◽  
Mental Health Problems ◽  
Ethical Issues ◽  
Regulatory System ◽  
Decision Making Capacity ◽  
Health And Social Care ◽  
Competing Interest ◽  
Care Regulation

This talk will outline the regulatory framework (both mental health and social care) currently in place in Ireland for people with intellectual disability (I.D.) and mental health problems, in the context of the varied nature of available mental health services. As not all aspects of service are currently under the regulatory system, potential ethical issues arise, and will be discussed.In addition new legislation regarding the support of people with vulnerable decision making capacity will be outlined (Assisted Decision Making (Capacity) Act, 2015); potential ethical issues that are currently arising from this legislation will be explored and discussed.Disclosure of interestThe author has not supplied his declaration of competing interest.

Ethics

2017 ◽  
pp. 1-11
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.

Ethics

2015 ◽  
pp. 124-134
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.

Ongoing Consent in Situations of Cognitive Vulnerability

2019 ◽  
pp. 3-14 ◽  
Author(s):  
Lauren R. Sankary ◽  
Paul J. Ford
Keyword(s):  
Clinical Trial ◽  
Decision Making ◽  
Ethical Issues ◽  
Cognitive Vulnerability ◽  
Research Participation ◽  
Proxy Consent ◽  
Decision Making Capacity ◽  
Research Oversight ◽  
Vulnerable Patient ◽  
Study Participants

This chapter explores ethical issues in obtaining ongoing consent for clinical research involving cognitively vulnerable patient populations. Stakeholders in these challenges include researchers, sponsors, study participants, caregivers and other legally authorized representatives, and research oversight boards. First, this chapter examines existing conceptual frameworks and proposed safeguards for the protection of cognitively vulnerable research participants, including double consent, proxy consent with participant assent, advance consent, and process consent. This chapter then proposes an inclusionary approach to obtaining ongoing consent to research participation when cognition could fluctuate over the course of research participation. Proposed safeguards and modifications to the consent process should address duration of research participation, the nature and timing of research-related risks, expected and unexpected fluctuations in decision-making capacity, and the process of exiting a clinical trial. The proposed framework is then applied to the specific context of implanted neural device trials, with special attention to considerations for device explant.

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