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PubMed1998

'It begins with the goose and ends with the goose': medical, legal, and lay understandings of imbecility in Ingram v Wyatt, 1824-1832.

A number of historians have recently suggested that we need to get out of the asylum if we are to fully understand attitudes to insanity in the nineteenth century. Arguing that accounts of the medicalization of madness have ignored the importance of non-medical attitudes to lunacy and idiocy, recent studies have stressed the need to explore family attitudes and responses in more detail. Unfortunately, efforts to escape the asylum have to some extent been hampered by a persistent reliance on institutional records. This institutional dependence is understandable: certificates of insanity, reception orders, case-books, and asylum registers, together with published documents, constitute the major record of historical constructions of the lunatic and idiotic mind. However, there may be more resourceful ways of exploring both medical and non-medical attitudes to idiocy. In this paper, I want to use the records from a contested will case, Ingram v Wyatt, to demonstrate that records from the ecclesiastical courts can provide access to a domain where the definitions and meanings of idiocy and imbecility were routinely considered by lawyers, lay witnesses, judges, and doctors. I shall argue that such cases constitute a fruitful site for excavating lay, professional legal, and medical attitudes to imbecility, for exploring the complex relationship between medical and non-medical understandings of capacity, and for situating those understandings within the context of professional developments in law and medicine and contemporary concerns about inheritance.

History, 19th Century↗
PubMed1996

'Religious fanaticism' and wrongful confinement in Victorian England: the affair of Louisa Nottidge.

Louisa Nottidge was kidnapped and committed to a private asylum in 1846 by her family because she had joined a millenarian sect of which they disapproved. After eighteen months the Commissioners in Lunacy were pressurised into ordering her release. Subsequently, she successfully sued her brother and brother-in-law for wrongful imprisonment. The judge's criticisms of the medical profession led to an acrimonious public debate about the nature of mental illness and its treatment, a debate that involved some of the leading 'mad doctors' of the day including Dr. John Conolly. The complex history of this case, frequently referred to in recent scholarly work, but never discussed in detail, is examined together with its implications for our understanding of Victorian psychiatry, and its attitude to mental illnesses involving religious matters.

Government Agencies↗
PubMed1996

Beneficence re-examined: protective intervention in mental health.

Social workers have long reacted negatively to the idea of limiting client freedoms, seeing such activity as directly contrary to such central social work values as autonomy and self-determination. Nevertheless, practitioners often find themselves required to actively intervene in a protective manner when clients are unable to fend for themselves. Such interventions are increasingly a part of everyday practice as social workers respond to new mandates to provide services to disabled and vulnerable individuals. Because of these changing circumstances, the concept of beneficence and the process of protective treatment are currently being re-examined, especially in mental health. This article develops a conceptual model of protective intervention that can be used by clinical decision makers in a variety of situations. Case examples drawn from work with chronically mentally ill patients are used to illustrate the discussion.

Aged↗
PubMedDate not supplied

End-of-life challenges: honoring autonomy.

Patients' end-of-life decisions challenge nurses to improve palliative care, symptom management, and patient advocacy, and examine ethical issues. When terminally ill patients take charge of the last stages of life, they may challenge nurses to reexamine attitudes about lifesaving technology and autonomy and values about preserving life. Staff members can become benevolent and believe that they know what is best despite the patient's independent decisions. When patients unsuccessfully decline continued aggressive, life prolonging strategies, they may decide to hasten dying rather than accept a natural death. Researchers (Breitbart WS et al. JAMA. 2000;284:2907-2911) defined desire for hastened death as a unifying construct underlying requests for assisted suicide, euthanasia, and withdrawal of food and fluids. When a terminally ill patient considers a hastened death, the nurse needs to examine the patient's mental health, symptom management, advance directives, and decision making. Medical and psychological symptoms and spiritual distress often trigger thoughts of hastening death even when pain and symptoms have been treated (Breitbart WS et al. JAMA. 2000;284:2907-2911). Ethical issues and guidelines for management of patients and evaluation of rationality are presented.

Advance Directives↗
PubMed1996

Conducting research with children: legal and ethical issues.

Research with children and mentally disabled individuals raises difficult legal and ethical issues. It is the obligation of researchers and those who review research to protect both the rights and welfare of research subjects. Ethicists, legal scholars, and national commissions have examined the circumstances under which it is acceptable to use incompetent people as research subjects, since they are unable to provide consent for participation. Furthermore, there is an extensive set of federal rules that govern the use of children as research subjects. Children may be used as research subjects after a careful weighing of risks and benefits, and as long as they participate in the decision to the extent they are able to do so. However, research projects that will not provide children with direct benefit, such as some placebo-controlled trials, raise particularly difficult issues concerning the protection of these subjects. While biomedical research is an important and socially desirable undertaking, it must proceed only when the rights and welfare of the subjects are scrupulously protected.

Adolescent↗
PubMedDate not supplied

Older widows' experience of home care.

BACKGROUND: Scholars and practitioners have defined home care as a set of services that older persons receive at home. There have been few empirical studies of the essence of the experience. OBJECTIVES: To describe the experience of home care for older widows living alone in their own homes. Findings are reported from one aim of the study, which was to discern the phenomena that were descriptive of the experience of the sample as a whole. METHOD: A descriptive phenomenological method was used. Participants met inclusion criteria for duration of widowhood, continuing residence in their own homes since the husband's death, number of adult children, self-rated health, and study-specific mental competence. Over a 3-year period, seven tape-recorded interviews were conducted in the homes of 25 widows over the age of 80. Foci of interest were the women's perceptions, actions, and intentions relative to their helpers and the help they had while living alone. The structures of the experience and its context were discerned and detailed in the form of taxonomies of phenomena and contextual features. RESULTS: The common phenomena were sorting out who can best do what needs to be done, protecting my standby, mobilizing my standby to help with this job too, and working together to get the job done. A new definition of home care was proposed, incorporating those phenomena. DISCUSSION: These older widows were not merely receiving home-care services. They were negotiating reliance on their standby helpers in specific ways. As home-care nurses plan care with widows and their other helpers, they should set aside standard definitions of home care that pertain to providing services and focus on the intentions of the older widows whom they serve.

Aged↗
PubMedDate not supplied

Computerized neuropsychiatric assessment of geriatric subjects by content analysis of brief samples of their speech.

The life expectancy of people living in the United States is increasing. Are very elderly individuals compromised mentally and physically in comparison to much younger persons? The purpose of this study was to test the efficacy of a computerized program applicable to the content analysis of 5-minute speech samples obtained from a group of individuals 90 years of age and older and to compare the results with those previously obtained in younger people with respect to their mental capacities in terms of a set of diverse neuropsychiatric dimensions. After obtaining informed consent from 26 elderly people, recorded verbal samples were elicited from each individual in response to purposely ambiguous instructions to talk for 5 minutes about any interesting or dramatic personal life experiences. The transcripts of their speech samples were digitized on a computer diskette and processed on the computer program. The computer program compared the scores obtained on each verbal sample with norms obtained on 15 previously validated content-analysis scales from individuals ranging in age from 5 to 80. The norms on these content-analysis scales are different for children (aged 5-10) and adults (aged 11-80). The computerized content-analysis scores obtained from this elderly cohort reveal plausible deviations from the norms for younger people.

Adolescent↗
PubMed2004

Assessment and management of patients with psychiatric disorders.

OBJECTIVE: To review key issues in the preoperative assessment of patients with psychiatric disorders: assessment of cognitive capacity, psychiatric history, capacity to give informed consent, and the impact of psychotropic medications or substances of abuse. We also outline a general approach to the psychiatric patient. Our review focuses on those psychiatric conditions and medications most likely to complicate perioperative care. DATA SOURCE: Critical studies and expert reviews in the field, as well as the authors' clinical experience in general hospital psychiatry. CONCLUSIONS: Psychiatric disorders need not unduly complicate perioperative care, but they present certain challenges; a systematic approach as described here will simplify perioperative care of these patients.

Humans↗
PubMed2005

Latin American aspects of refusal to undergo court-ordered forensic psychiatric examination.

PURPOSE OF REVIEW: Forensic psychiatric examinations have gained increasing importance in many areas of the law. When individuals refuse to undergo court-ordered examinations of this kind, experts have to solve the tension between ethical and technical problems and judicial requirements. The purpose of this review is to obtain research information and standards related to refusal to undergo court-ordered forensic psychiatric examinations. RECENT FINDINGS: In Latin American countries, the literature on this subject is limited. The dominant position is that court-ordered examinations should be conducted even when the individual refuses to undergo examination, following technical and ethical considerations. SUMMARY: Experts should consider the mental competency of individuals and whether they pose a danger to themselves or others. In cases when the defendant refuses to undergo a court-ordered psychiatric examination, the expert, in collaboration with the judge, should decide upon an appropriate and reasonable means to conduct such an evaluation.

Journal Article↗
PubMed2006

Ethical issues in the evaluation and treatment of death row inmates.

PURPOSE OF REVIEW: To summarize recent ethical analyses of psychiatrists' participation in the evaluation and treatment of death row inmates. RECENT FINDINGS: Psychiatric participation in death penalty cases remains highly controversial in the United States, whereas there appears to be a more worldwide consensus that it is ethically inappropriate. SUMMARY: Psychiatrists working in death penalty settings are functioning in a complex ethical arena, and must consider the implications of their decisions to participate and/or abstain from various activities with great care and attention to the circumstances of the individual cases at hand.

Capital Punishment↗