The Vexed Question of the Voluntary Patient

2019 ◽  
Vol 26 (3) ◽  
pp. 205-220
Author(s):  
Hope Davidson
Keyword(s):  
Mental Health ◽  
Medical Treatment ◽  
Mental Health Treatment ◽  
Health Treatment ◽  
Recent Developments ◽  
The Law ◽  
Vexed Question ◽  
The Right

Abstract The current statutory framework in Ireland provides certain key safeguards for people who are admitted involuntarily for mental health treatment and care; the same legislation makes scant reference to the person who seeks treatment and care on a voluntary basis. This has led to concerns in relation to deprivation of liberty and to non-consensual medical treatment for these patients. This article seeks to examine the development of the law in relation to voluntary patients in Ireland and to assess in light of recent developments where Ireland now stands in terms of protecting the right of the voluntary patient to liberty.

Dr. Szasz or Dr. Seuss: Whose Right to Refuse Mental Health Treatment?

1981 ◽  
Vol 9 (3) ◽  
pp. 283-303
Author(s):  
Grant H. Morris
Keyword(s):  
Mental Health ◽  
Medical Treatment ◽  
Mental Health Treatment ◽  
Psychiatric Treatment ◽  
Decision Makers ◽  
Willingness To Accept ◽  
Health Treatment ◽  
Mental Patients ◽  
Substitute Decision Makers ◽  
The Right

In this article, the author asserts that the right of involuntarily confined mental patients to refuse psychiatric treatment is both legally sound and medically desirable. This right is viewed as one example of the broader right of any patient to deny his consent to proposed medical treatment. The author critiques two devices that are utilized to subvert the right of mental patients to refuse psychiatric treatment: (1) a competency test that equates the patient's competence with his willingness to accept the psychiatrist's proposed therapy, and (2) the appointment of guardians to act as substitute decision-makers for civil and criminal patients who have not been declared incompetent to make treatment decisions.

scholarly journals Reduction in mental health treatment utilization among transgender individuals after gender-affirming surgeries: A total population study

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
R Bränström ◽  
J E Pachankis
Keyword(s):  
Mental Health ◽  
Anxiety Disorder ◽  
Medical Treatment ◽  
Population Study ◽  
Mental Health Treatment ◽  
Gender Dysphoria ◽  
Total Population ◽  
Swedish Population ◽  
Health Treatment ◽  
Drug Register

Abstract Background Despite professional recommendations to consider gender-affirming hormonal and surgical interventions for transgender individuals with gender dysphoria, the long-term effect of such interventions on mental health is largely unknown. This study aims to ascertain the prevalence of mood and anxiety disorder healthcare visits and antidepressant and anxiolytic prescriptions in 2015 as a function of gender dysphoria diagnosis and gender-affirming medical treatment in the entire Swedish population. Methods This study used the Swedish Total Population Register (n = 9,747,324), linked to the National Patient Register and Prescribed Drug Register. Among those who received a gender dysphoria diagnosis between 2005 and 2015 (n = 2,679), mental health treatment in 2015 was examined as a function of length of time since gender-affirming medical treatment. The main outcome measure was mood and anxiety disorder healthcare visits and antidepressant and anxiolytic prescriptions. Results Compared to the general population, individuals diagnosed with gender dysphoria were about six times as likely to have had a mood and anxiety disorder healthcare visit and more than three times as likely to have been prescribed antidepressants and anxiolytics. Years since initiating hormones was not significantly related to likelihood of mental health treatment (AOR: 1.01; 95% CI: 0.98, 1.03). However, increased time since last gender-affirming surgery was associated with reduced mental health treatment (AOR: 0.92; 95% CI: 0.87, 0.98). Conclusions In this first total population study of transgender individuals diagnosed with gender dysphoria, the longitudinal association between gender-affirming surgery and reduced likelihood of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them. Main messages: This study lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them.

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.

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