Biomedical subjects
Publications and source records attributed to L H Roth.
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The views of patients on the degree of confidentiality that is necessary for effective psychiatric care have not been empirically investigated, despite their potential importance to the debate. This study examines the views of 30 psychiatric inpatients on issues related to confidentiality. Patients were found to value confidentiality highly and to be concerned about the possibility of unauthorized disclosures but to have little knowledge of their legal rights or recourses should breaches of confidentiality occur. The data support contentions about the importance of confidentiality and suggest the need for further patient education.
Over the past decade the subject of informed consent has become increasingly important for general and forensic psychiatry. Viewed by many as the preeminent means by which psychiatric and other medical patients can secure their rights to full participation in treatment decision-making in therapeutic settings, informed consent has also gained general acceptance as an ethical and legal requirement for enrolling patients in human experimentation. The authors explore the many facets of this controversial issue.
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The requirement that a subject be competent as a condition of valid consent to participate in research has been accepted by most students of legal and ethical problems of human experimentation. "Competency," however, has lacked a clear and generally agreed on standard. There are four commonly used standards for competency: evidencing a choice in regard to research participation, factual understanding of the issues, rational manipulation of information, and appreciation of the nature of the situation. These standards can be arranged hierarchically such that each represents a stricter test of competency. The decision as to how rigorous a standard for competency is desirable cannot be made on psychiatric grounds. It requires consideration of the policy goals on hopes to attain. Empirical research helps demonstrate the consequences of choosing a particular standard but cannot replace the need for achieving consensus on policy goals.
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To illustrate the dilemma in evaluating and treating patients who deny their illness, the authors present the case of a woman with paranoia who denied she was ill and refused medication. They focus specifically on the issue of whether a patient who denies his or her illness is truly legally competent to refuse or consent to treatment. They conclude that the assessment of such competency requires a consideration of the accuracy of the patient's "appreciation of the nature of his or her situation" and that safeguards have to be built into a system for evaluating competency along these lines to prevent abuse.
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The evaluation of a patient's competency to consent to treatment, regardless of the test of competency used, can be substantially affected by a number of clinical factors. The authors point out that, in assessing competency, the clinician must consider 1) psychodynamic elements of the patient's personality, 2) the accuracy of the historical information conveyed by the patient, 3) the accuracy and completeness of the information disclosed to the patient, 4) the stability of the patient's mental status over time, and 5) the effect of the setting in which consent is obtained. Inattention to these factors can lead to errors in assessment of competency that can have important implications for patient care.
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Explore the source record for details and available documents.