Undisclosed probing into decision-making capacity: a dilemma in secondary care

Abstract Background The assessment of patients’ decision-making capacity is ubiquitous in contemporary healthcare. This paper examines the ethics of undisclosed probing of capacity by psychiatrists. The discussion will refer to the law in England and Wales, though the highlighted issues are likely to be relevant in similar jurisdictions. Main text Decision-making capacity is a private attribute, and patients may not necessarily be aware that one of their personal abilities is being explored. Routine exploration of capacity has not historically been a part of psychiatric examination, but it is now difficult to avoid during psychiatric interview.Ethical practice and shared decision-making require patients to be aware that their decision-making may be evaluated by the doctor at some point, and the potential implications of an objective professional conclusion of incapacity. Case law directs that patients should be informed about any assessment of their decision-making ability, though the extent to which this has translated into practice is unclear. However, explanation about the assessment may cause a patient to react negatively, which may impede therapeutic engagement and constitute an ethical dilemma. It is argued that in the absence of systemic measures, professionals should retain the discretion to decide whether a particular patient should be informed about the impending probe into their decision-making ability, or not. In the latter instance, concealment of information about the assessment or its purpose should be subject to the caveats and safeguards associated with any recourse to therapeutic exception. Conclusion The necessity to mandatorily inform patients about assessment of their capacity introduces a novel ethical dilemma for psychiatrists. The negotiation of this dilemma should not be the prerogative of the clinician, and requires systemic initiatives to ensure universal awareness of patients about the possibility of their capacity being assessed during their journeys through healthcare systems.

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Neuropsychological assessment at forensic psychological assessment of decision making capacity

Psychology and Law ◽

10.17759/psylaw.2018080411 ◽

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.

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An Inevitable “Marriage March”? A Survey of the “Arbiter of Religious Dogma” in Canadian Case Law

Studies in Religion/Sciences Religieuses ◽

10.1177/0008429816636089 ◽

2016 ◽

Vol 45 (2) ◽

pp. 127-145

Author(s):

Dia Dabby

Keyword(s):

Decision Making ◽

Discourse Analysis ◽

Case Law ◽

Supreme Court Of Canada ◽

Religious Doctrine ◽

Decision Making Capacity ◽

The Supreme Court ◽

Canadian Context ◽

Religious Dogma ◽

Religion In Canada

“Arbiter of religious dogma,” first expressed by the Supreme Court of Canada in Syndicat Northcrest v. Amselem ([2004] 2 SCR 551), has had a lasting and pervasive effect on the Canadian lawscape. Developed in an effort to remove the State (and therefore Court apparatus) from a decision-making capacity in questions related to religious doctrine, this expression has become an inevitable mantra when discussing issues related to religion in Canada. This article argues, however, that the presence of this expression should not be understood as the end of a conversation, but rather, the beginning of a novel one on the legitimacy of religion in law. Through discourse analysis, this article will endeavor to suggest that this “marriage march” between law and religion is inevitable in the Canadian context.

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Psychometric properties of the Arabic version of the 9-item Shared Decision-Making Questionnaire: the entire process from translation to validation

BMJ Open ◽

10.1136/bmjopen-2018-026672 ◽

2019 ◽

Vol 9 (4) ◽

pp. e026672 ◽

Cited By ~ 1

Author(s):

Hamzah Alzubaidi ◽

Amal Hussein ◽

Kevin Mc Namara ◽

Isabelle Scholl

Keyword(s):

Decision Making ◽

Factor Analysis ◽

Psychometric Properties ◽

Shared Decision Making ◽

United Arab Emirates ◽

Internal Consistency ◽

Secondary Care ◽

Outpatient Clinics ◽

Shared Decision ◽

Arabic Version

ObjectiveTo translate the German 9-item Shared Decision-Making Questionnaire (SDM-Q-9) to Arabic and assess its psychometric properties for measuring Arabic-speaking patients' perceptions of the shared decision-making (SDM) process.DesignMulticentre cross-sectional study.SettingSecondary healthcare settings; outpatient clinics of 10 major hospitals were selected in four emirates in the United Arab Emirates (Abu Dhabi, Dubai, Sharjah and Umm Al Quwain).ParticipantsPatients with chronic diseases who attended outpatient clinics of participating hospitals.MeasurementsThe original German SDM-Q-9 was translated to Arabic. International multiphase translation guidelines and the process of cross-cultural adaptation of self-reported measures were used. Various psychometric properties were assessed, including reliability (internal consistency), and construct validity (exploratory factor analysis [EFA] and confirmatory factor analysis [CFA]).ResultsThe final Arabic version of the SDM-Q-9 was tested among 516 secondary care patients. Internal consistency yielded a Cronbach’s alpha of 0.929 for the whole scale. EFA showed a one-factorial solution, Kaiser-Meyer-Olkin measure of sampling adequacy was 0.907 and Bartlett’s test of sphericity was significant (χ2=3413.69, df=36, p<0.0005). For the CFA, two different models were tested; Model 1 included the nine items and Model 2 was monofactorial that included items 2–9 and thus excluded item 1. Both models were adequate as they produced similar indices.ConclusionsThe Arabic version of SDM-Q-9 showed excellent reliability and acceptable validity parameters among secondary care patients. The newly translated Arabic questionnaire is the first psychometrically tested tool that can be used in the 22 member states of the Arab league to assess patients’ perspectives on the SDM process.

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Shared decision-making in psychiatry: a study of patient attitudes

Australasian Psychiatry ◽

10.1177/1039856218758562 ◽

2018 ◽

Vol 26 (5) ◽

pp. 478-481 ◽

Cited By ~ 9

Author(s):

Josie Nott ◽

Aspen Mcintosh ◽

Clare Taube ◽

Mark Taylor

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Mini Mental State Examination ◽

Mental Healthcare ◽

Shared Decision ◽

Positive Attitudes ◽

Decision Making Capacity ◽

State Examination ◽

Patients Perspective ◽

Hospital Sample

Objectives: Shared decision-making (SDM) is promoted as beneficial in mental healthcare, despite a dearth of supportive evidence. We aimed to obtain patients’ perspective on SDM in a ‘real world’ hospital sample. Methods: Structured validated questionnaires were used to examine SDM with regard to treatment choices, and whether SDM influences attitudes towards treatment. The Mini-Mental State Examination was used to assess decision-making capacity. Results: A total of 109 individuals participated, with 60% reporting experiencing SDM. SDM positively correlated with positive attitudes to medication. Those detained under the Mental Health Act had lower levels of SDM. Conclusions: SDM leads to more positive attitudes towards medication and may improve adherence with treatment. SDM may particularly benefit those subject to involuntary treatment and is not onerous to practice.

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Advance Care Planning and Shared Decision-Making: Paving the Way

Studia Universitatis Babeş-Bolyai Bioethica ◽

10.24193/subbbioethica.2021.spiss.17 ◽

2021 ◽

Vol 66 (Special Issue) ◽

pp. 39-39

Author(s):

Francesca Bosisio ◽

◽

Daniela Ritzenthaler ◽

Eve Rubli Truchard ◽

Ralf J. Jox ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Advance Care Planning ◽

Care Quality ◽

University Hospital ◽

Care Planning ◽

Shared Decision ◽

Goals Of Care ◽

Decision Making Capacity ◽

Advance Care

"Advance care planning (ACP) has become widely used in medical care in order to plan ahead of a loss of decision-making capacity. Since ACP aim is to promote anticipatory and substitute autonomy by engaging people ‒ and possibly their relatives ‒ in deciding about future goals of care and treatments, scientific literature in this field often posits that ACP involve shared decision-making. This assumption however is rarely backed up by an in-depth reflection on how shared decision-making might operate within ACP and which shared decision-making template is more likely to foster ACP. Our ACP tool, based on a model created at the Zurich University Hospital (Krones et al, 2019), engages patients in a structured communicational process about their values and preferences for care. In this tool, ACP facilitators help patients set goals of care and document treatments decisions in three paradigmatic situations of loss of decision-making capacity. Because our ACP tool entails discussions about goals of care, quality of life, and options in terms of disease- or symptom-management, we turned to Elwyn and al.’s three talk’s model (2012) and Vermunt et al.’s three level goal model (2018) in order to incorporate elements of shared decision-making in our ACP tool. In this presentation we discuss how these models might be combined in order to foster shared decision-making within our ACP tool and, by then, broaden its scope and eventually improve its effectiveness, strengthen its theoretical foundations and uphold the ethics of care in the event of a loss of decision-making capacity. "

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Capacity, Informed Consent, and Guardianship

10.1093/med/9780199374656.003.0009 ◽

2017 ◽

Author(s):

Stephen L. Read ◽

James E. Spar

Keyword(s):

Decision Making ◽

Informed Consent ◽

Medical Decision Making ◽

Case Law ◽

Fundamental Principle ◽

Medical Decision ◽

Decisional Capacity ◽

Decision Making Capacity ◽

Management Capacity

Medical decision-making based on informed consent is a fundamental principle of ethical medical practice. When a patient lacks medical decisional capacity and is unable to give truly informed consent, an agent must be sought to act on the behalf of the person. This chapter reviews the principles underlying determination of the capacity to give informed consent regarding healthcare decisions in a clinical setting. Cognitive loss, emotional distress, or disengagement or the perception that the patient is choosing unwisely or as a result of influence may be concerns that lead to consultation. In contrast to the clear standards for medical decision-making capacity, statutory guidance and case law are essentially nonexistent regarding what standard applies to the capacity to create or to change an advance health directive (AHCD) or to change or designate a healthcare agent. In addition to current decision-making capacity, the consultant must address broader issues of functional or management capacity when the patient’s ongoing capacity to manage personal care and health is at issue, as is relevant to the petition for guardianship. A comprehensive forensic geriatric psychiatry consultation will assist with the care of the patient.

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Informed Consent Obtainment, Malpractice Litigation, and the Potential Role of Shared Decision-making Approaches

European Journal of Health Law ◽

10.1163/15718093-12341410 ◽

2017 ◽

Vol 24 (3) ◽

pp. 264-284 ◽

Cited By ~ 3

Author(s):

Søren Fryd Birkeland

Keyword(s):

Decision Making ◽

Informed Consent ◽

Shared Decision Making ◽

Potential Role ◽

Case Law ◽

National Sample ◽

Shared Decision ◽

Contributing Factors ◽

Inadequate Information

AbstractMalpractice lawsuits are a substantial concern in health systems with miscommunication, inadequate information, and unsuccessful patient involvement in decision-making seeming to be contributing factors. This paper draws attention to the explicit role of informed consent (IC) obtainment in actualized complaint cases and to what extent novel methods to exercise IC through means of shared decision-making (SDM) and supporting tools might be applicable. A national sample of cases from the Health Professionals Disciplinary Board in Denmark is reviewed and discussed together with international legal instruments and case law. It is confirmed that patients claim their right to participate in decision-making about healthcare options. In many situations SDM and accompanying tools would apply and possibly they could sometimes prevent IC duty breaches, assist documenting IC procedures, and help avert the need for litigation.

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Integrating patient perspectives in medical decision-making: a qualitative interview study examining potentials within the rare disease information exchange process in practice

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-019-0911-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Ana Babac ◽

Verena von Friedrichs ◽

Svenja Litzkendorf ◽

Jan Zeidler ◽

Kathrin Damm ◽

...

Keyword(s):

Decision Making ◽

Rare Disease ◽

Shared Decision Making ◽

Health Professionals ◽

Qualitative Interview ◽

Healthcare Systems ◽

Interview Study ◽

Medical Decision ◽

Shared Decision ◽

Qualitative Interview Study

Abstract Background Many European countries have recently implemented national rare disease plans. Although the network is strengthening, especially on the macro and meso levels, patients still go a long way through healthcare systems, with many health professionals involved and scarce evidence to gather. Specifically, patient involvement in the form of shared decision-making can offer further potential to increase healthcare systems’ efficiency on a micro level. Therefore, we examine the implementation of the shared decision-making concept thus far, and explore whether efficiency potentials exist—which are particularly relevant within the rare disease field—and how they can be triggered. Methods Our empirical evidence comes from 101 interviews conducted from March to September 2014 in Germany; 55 patients, 13 family members, and 33 health professionals participated in a qualitative interview study. Transcripts were analyzed using a directed qualitative content analysis. Results The interviews indicate that the decision-making process is increasingly relevant in practice. In comparison, however, the shared decision-making agreement itself was rarely reported. A majority of interactions are dominated by individual, informed decision-making, followed by paternalistic approaches. The patient-physician relationship was characterized by a distorted trust-building process, which is affected by not only dependencies due to the diseases’ severity and chronic course, but an often-reported stigmatization of patients as stimulants. Moreover, participation was high due to a pronounced engagement of those affected, diminishing as patients’ strength vanish during their odyssey through health care systems. The particular roles of “expert patients” or “lay experts” in the rare disease field were revealed, with further potential in integrating the gathered information. Conclusions The study reveals the named efficiency potentials, which are unique for rare diseases and make the further integration of shared decision-making very attractive, facilitating diagnostics and disease management. It is noteworthy that integrating shared decision-making in the rare disease field does not only require strengthening the position of patients but also that of physicians. Efforts can be made to further integrate the concept within political frameworks to trigger the identified potential and assess the health-economic impact.

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