scholarly journals “I would prefer not to”: Assessing competence to consent in a case of refusal of cancer treatment

2019 ◽  
Vol 14 (1) ◽  
pp. 42-45
Author(s):  
Gustavo B Castellana ◽  
Lilia B Schraiber ◽  
Talita R de Oliveira ◽  
Daniel M de Barros
Keyword(s):  
Decision Making ◽  
Forensic Psychiatry ◽  
Patient Relationship ◽  
Ethical Conflict ◽  
Actual Case ◽  
Clinical Issue ◽  
Case Presentation ◽  
Decision Making Capacity ◽  
Forensic Psychiatric

Background Based on an actual case in which a psychiatrist was called in to assess a patient’s capacity to refuse treatment, the aim of this study is to discuss how to manage this ethical and clinical issue and the dilemmas faced by the medical team. Case presentation: The case involved a 45-year-old female patient diagnosed with breast cancer who refused treatment. Since the mastology team had doubts about the patient’s mental state and given that she refused to consent to surgery, a forensic psychiatric consult was requested. Conclusion The forensic psychiatry team concluded that the patient’s decision-making capacity was preserved. The team suggested some actions to help the specialists deal with the ethical conflict. A reflection is proposed about the role of psychiatrists when an ethical dilemma involving decision-making capacity emerges in clinical situations, elucidating their work not only as physicians who determine diagnoses and conducts, but also as agents of transformation in the doctor–patient relationship.

Overview of Legal Issues in Psychiatry

2017 ◽  
Author(s):  
Tracy D. Gunter
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Forensic Psychiatry ◽  
Medical Decision Making ◽  
Third Parties ◽  
Legal Issues ◽  
Medical Decision ◽  
Patient Relationship ◽  
Treatment Provider ◽  
Regulatory Issues

Psychiatrists routinely encounter legal and regulatory issues in the practice of psychiatry. This review provides an overview of the psychiatrist’s duties and responsibilities in the doctor-patient relationship and common legal issues arising in clinical practice, with reference to US statutory and regulatory practices. The field of forensic psychiatry is described, and the roles of the forensic evaluator and the treatment provider are compared. This review contains 2 figures, 5 tables, and 64 references. Key words: civil commitment, confidentiality, duty to third parties, forensic psychiatry, guardianship, gun ownership, medical decision making, medical marijuana, risk assessment 

scholarly journals Neuropsychological assessment at forensic psychological assessment of decision making capacity

2018 ◽  
Vol 8 (4) ◽  
pp. 115-127
Author(s):  
F.S. Safuanov ◽  
Y. Perepravina ◽  
A.D. Chernenkov
Keyword(s):  
Decision Making ◽  
Neuropsychological Assessment ◽  
Psychological Assessment ◽  
Psychiatric Examination ◽  
Forensic Examination ◽  
Decision Making Capacity ◽  
Forensic Psychiatric ◽  
And Control ◽  
Neuropsychological Methods

Relevance of the research consists in consideration the forensic neuropsychological assessment in Russia. The new problem of use of neuropsychological methods in complex forensic psychological and psychiatric examination and forensic psychiatric examination is studied. The article presents the results of neuropsychological assessment of the persons, who could not understand the meaning of their actions, regulate and control them at the time of the transaction. The persons, who could not understand the meaning of their actions, regulate and control them at the time of the transaction, characterized by the presence of a decrease of the ability to control one's actions and the of spatial functions, the neuropsychological syndrome of memory and consciousness. The persons who were able to make decisions at the time of the transaction, such features were less. The importance of the use of neuropsychological methods in forensic examination was established.

Overview of Legal Issues in Psychiatry

2017 ◽  
Author(s):  
Tracy D. Gunter
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Forensic Psychiatry ◽  
Medical Decision Making ◽  
Third Parties ◽  
Legal Issues ◽  
Medical Decision ◽  
Patient Relationship ◽  
Treatment Provider ◽  
Regulatory Issues

Psychiatrists routinely encounter legal and regulatory issues in the practice of psychiatry. This review provides an overview of the psychiatrist’s duties and responsibilities in the doctor-patient relationship and common legal issues arising in clinical practice, with reference to US statutory and regulatory practices. The field of forensic psychiatry is described, and the roles of the forensic evaluator and the treatment provider are compared. This review contains 2 figures, 5 tables, and 64 references. Key words: civil commitment, confidentiality, duty to third parties, forensic psychiatry, guardianship, gun ownership, medical decision making, medical marijuana, risk assessment 

Examples in ethics

2018 ◽  
Author(s):  
Robert B. Louden
Keyword(s):  
Decision Making ◽  
Case Studies ◽  
Moral Education ◽  
Real Life ◽  
Moral Dilemmas ◽  
Moral Experience ◽  
Moral Obligations ◽  
Actual Case ◽  
Philosophical Questions

Philosophers often employ examples to illustrate how their favoured principles are to be applied to concrete cases, and sometimes even to show that principles are of no help in decision-making. Examples are also used to convince readers of the existence of moral dilemmas – unresolvable conflicts between moral obligations. But a variety of different philosophical questions concerning the role, status, and nature of examples used in ethics have also been raised. One such question concerns the role that examples should play in our moral experience: should this be a rhetorical, pedagogic role of persuading us to do what is right, as determined by pre-existing principle; or a stronger, logical role of helping to determine what is morally right? Another query relates to moral teaching: is exposure to and reflection on stories, tales, narratives and exemplars sufficient for moral education, or is there a further need for exposure to principles and theories of ethics? Third, in terms of the kinds of examples employed in moral philosophy and reflection, should such examples be culled from great literature or sacred texts? Alternatively, should they be actual case studies drawn from real life, or hypothetical but realistic examples constructed by theorists? Or should they be imaginary, highly improbable cases designed to test our intuitions? A fourth question asks how examples are best identified and described, and to what extent the examples used in ethics are themselves theory-laden or even theory-constituted.

Mental Disorders and Decision-Making Capacity: What Is the Role of Law?

2015 ◽  
Vol 22 (1) ◽  
pp. 75-82 ◽  
Author(s):  
Claire Rommelaere
Keyword(s):  
Decision Making ◽  
Capacity Assessment ◽  
Complex Task ◽  
Decision Making Capacity ◽  
Patient’S Rights ◽  
Surrogate Decision ◽  
Definition Of ◽  
Point Of Departure ◽  
Legal Consequences

AbstractWhen a patient appears to have a mental disorder, doubts may arise about his or her decision-making capacity. Health professionals must then assess the patient’s capacity in order to make sure of the validity of his or her consent or refusal. Incapacity has indeed legal consequences, as law provides for the appointment of a surrogate decision-maker in case of incapacity. With Belgian law as a point of departure, this contribution is aiming at identifying the role of law in capacity assessment itself, prior to the decision about (in)capacity. In order to protect the patient’s rights and to support the task of those carrying out the assessment, law should provide for a global definition of decision-making capacity and for a frame-procedure guiding this assessment. In my opinion, it is possible for law to contribute to the complex task of capacity assessment without interfering embarrassingly with healthcare practice.

Dealing with advance directives for critically ill adolescents

1992 ◽  
Vol 12 (5) ◽  
pp. 31-37 ◽  
Author(s):  
CH Rushton ◽  
ME Lynch
Keyword(s):  
Public Policy ◽  
Decision Making ◽  
Critical Care ◽  
Advance Directives ◽  
Nursing Practice ◽  
Critical Care Nurses ◽  
Essential Dimension ◽  
Decision Making Capacity ◽  
Improved Methods

Respecting the values and preferences of adolescents regarding treatment is an essential dimension of nursing practice. As public policy and societal thinking about the role of minors in healthcare decisions evolves, critical care nurses are in a pivotal position to provide leadership and guidance. Critical care nurses who care for adolescents should embrace the opportunity created by the PSDA to implement creative strategies for involving minors in decision making, seek improved methods of assessing decision-making capacity, and document the values and preferences of minors.

scholarly journals A ‘second youth’ for the EU Speakers’ Conference? A critical appraisal of its ‘quasi-constitutional’ role

2018 ◽  
Vol 10 (3) ◽  
pp. 83-106
Author(s):  
Cristina Fasone
Keyword(s):  
Decision Making ◽  
Critical Appraisal ◽  
Ex Post ◽  
Decision Making Capacity ◽  
Rules Of Procedure ◽  
Constitutional Constraints ◽  
The Many ◽  
Rule Making ◽  
The Eu

Abstract The EU Speakers’ Conference has experienced a ‘second youth’ after the entry into force of the Treaty of Lisbon by playing a ‘quasi-constitutional’ role in inter-parliamentary cooperation, and in particular by trying to exercise a rule-making function over the many inter-parliamentary venues of the EU’s system of government. The fulfilment of such a function has certainly not been made any easier as a consequence of the constitutional constraints surrounding the positions of the Speakers and Presidents of the European and Member States’ (MS) Parliaments, with a considerable variety in terms of powers and decision-making capacity among the MS and the EU. Despite these limitations, the ‘quasi-constitutional’ role of the EU Speakers’ Conference has mainly consisted of approving guidelines, if not directly rules of procedure, for other inter-parliamentary venues. It has also been argued that the coordinating function of the EU Speakers’ Conference can be much more effective when looking at its ‘quasi-constitutional’ role, and also in its function of joint parliamentary scrutiny in the EU, if it is aimed at enhancing the rational organisation of inter-parliamentary activities in terms of timing, agendas and ex-post supervision of the results, in the absence of any other possible alternative to the Speakers’ leadership.

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