Ethical Considerations Regarding End-of-Life Planning and Palliative Care Needs in Patients With Chronic Psychiatric Disorders

Bauer, Rebecca L.

doi:10.1176/appi.ajp-rj.2016.110503

Cited by 5 publications

(4 citation statements)

References 17 publications

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“…Psychiatric services should integrate palliative care into programs when caring for patients with serious mental illness, especially during this time when the ongoing pandemic and climate change poses significant threats to the well-being of older people. This will ensure that the right to dignity, autonomy, and self-determination will be respected and individualized care will be provided in keeping with the values of even the most vulnerable person ( 36 – 40 ).…”

Section: Discussionmentioning

confidence: 99%

Ageism, human rights and ethical aspects of end-of-life care for older people with serious mental illness

Kotzé

Roos

2022

Front. Psychiatry

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There are many complex concepts to consider during end-of-life discussions and advance care planning, especially when vulnerable populations such as older individuals with serious mental illness are involved. This article aims to summarize some of these important concepts, such as the effects of ageism, preservation of human rights and dignity, supported or shared decision making and palliative approaches. It emerged from a study that found two thirds of 100 participants 60 years of age and older with serious mental illness had end-of-life decision-making capacity. This finding highlighted the individual and contextual nature of decision-making capacity, the importance of consideration of individual values and protection of human dignity during end-of-life care. Healthcare providers have a duty to initiate end-of-life and advance care discussions, to optimize decision-making capacity, and to protect autonomous decision-making. Chronological age or diagnostic categories should never be used as reasons for discrimination and all patients should receive end-of-life care in keeping with their preferences and values.

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Section: Discussionmentioning

confidence: 99%

Ageism, human rights and ethical aspects of end-of-life care for older people with serious mental illness

Kotzé

Roos

2022

Front. Psychiatry

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“…Important aspects of palliative care include the clear communication of a diagnosis and prognosis, optimal symptom management, and support for advance care planning and for caregivers. Integration of psychiatric care and palliative care should be a priority for all facilities where long-term care for those with SMI is provided, and is an urgent consideration during the COVID-19 pandemic while these older people with SMI are considered especially at risk (53)(54)(55)(56).…”

Section: Discussionmentioning

confidence: 99%

End-of-Life Decision-Making Capacity in Older People With Serious Mental Illness

2021

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Background: The study's main aim was to assess the end-of-life decision-making capacity and health-related values of older people with serious mental illness.Methods: A cross-sectional, observational study, was done at Weskoppies Psychiatric Hospital, Gauteng Province, South Africa that included 100 adults older than 60 years of age and diagnosed with serious mental illness. The Mini-Cog and a semi-structured clinical assessment of end-of-life decision-making capacity was done before a standardized interview, Assessment of Capacity to Consent to Treatment, was administered. This standardized instrument uses a hypothetical vignette to assess decision-making capacity and explores healthcare-related values.Results: The Assessment of Capacity to Consent to Treatment scores correlated (p < 0.001) with the outcomes of the semi-structured decision-making capacity evaluation. Significant correlations with impaired decision-making capacity included: lower scores on the Mini-Cog (p < 0.001); a duration of serious mental illness of 30–39 years (p = 0025); having a diagnosis of schizophrenia spectrum disorders (p = 0.0007); and being admitted involuntarily (p < 0.0001). A main finding was that 65% of participants had decision-making capacity for end-of-life decisions, were able to express their values and engage in advance care discussions.Discussion and Conclusion: Healthcare providers have a duty to initiate advance care discussions, optimize decision-making capacity, and protect autonomous decision-making. Many older patients with serious mental illness can engage in end-of-life discussions and can make autonomous decisions about preferred end-of-life care. Chronological age or diagnostic categories should never be used as reasons for discrimination, and older people with serious mental illness should receive end-of-life care in keeping with their preferences and values.

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“…This population is often not engaged with the medical system, may not be adherent to physician recommendations, and may intermittently lack capacity to make decisions. 46 In general, it is difficult for patients in active substance use to think long-term, partly due to their disease and partly because they are more focused on obtaining a substance to avoid withdrawal. Other common barriers raised include time and difficulty prioritizing ACP in the setting of multiple uncontrolled comorbidities.…”

Section: M: Map Out What's Important To the Patient: (A)mentioning

confidence: 99%

Would You Be Surprised If This Patient Died This Year? Advance Care Planning in Substance Use Disorders

et al. 2019

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Primary care physicians are increasingly incorporating screening tools for substance use disorders (SUDs) and referral to treatment into their practice. Despite efforts to provide access to treatment, patients with SUDs remain at an increased risk of mortality, both from overdose and from general medical conditions. Advance care planning (ACP) is recommended for patients with chronic, progressive medical conditions such as malignancies or heart failure. Though SUDs are widely acknowledged to be chronic diseases associated with an increased risk of mortality, there has been little discussion on ACP in this population. ACP is a discussion regarding future care, often including selection of a surrogate decision-maker and completion of an advanced directive. ACP has been associated with better quality of end-of-life and care more consistent with patient preferences. Studies in other vulnerable populations have shown that marginalized and high-risk individuals may be less likely to receive ACP. Similarly, patients with SUDs may employ different decision-makers than that defined by law (i.e., friend vs. family member), increasing the importance of discussing patient values and social structure. Physicians should routinely conduct ACP conversations with patients with SUDs, especially those with chronic, progressive medical conditions and/or severe, uncontrolled substance use disorders.

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Ethical Considerations Regarding End-of-Life Planning and Palliative Care Needs in Patients With Chronic Psychiatric Disorders

Cited by 5 publications

References 17 publications

Ageism, human rights and ethical aspects of end-of-life care for older people with serious mental illness

Ageism, human rights and ethical aspects of end-of-life care for older people with serious mental illness

End-of-Life Decision-Making Capacity in Older People With Serious Mental Illness

Would You Be Surprised If This Patient Died This Year? Advance Care Planning in Substance Use Disorders

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