Harmful Choices, the Case of C, and Decision-Making Competence

Pickering, Neil; Newton‐Howes, Giles; Young, Greg

doi:10.1080/15265161.2021.1941422

Cited by 22 publications

(5 citation statements)

References 22 publications

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“…The other perspective takes into account the broader external factors (such as outcome and risk) and influences the standards required to achieve capacity (the externalist approach). 6 The legally mandated requirement for psychiatry-led competence assessments, where competence is in doubt, raises questions of resourcing in an already overstretched mental health service. Private psychiatrists may find greater incentive to participate, however, they make up a small portion of the NZ workforce.…”

Section: Discussionmentioning

confidence: 99%

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Psychiatrists’ views on the New Zealand End of Life Choice Act

Cassidy

Sims

Every‐Palmer

2022

Australas Psychiatry

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Objective This cross-sectional survey aimed to establish the views and intentions of New Zealand (NZ) psychiatrists regarding their role as competence assessors in the NZ End of Life Choice Act (‘Act’). Some questions were replicated from a pre-existing Ministry of Health workforce survey regarding the Act, for comparative analysis between psychiatrists and other health professionals. Methods The survey was disseminated via email to all NZ psychiatrists registered with the Royal Australia and NZ College of Psychiatry and promoted by snowballing methods to reach non-members. Results There were similar (moderate) levels of understanding of the Act, compared to other health professionals. Psychiatrists show similar levels of support for assisted dying as other health professionals (55% and 47%, respectively), however psychiatrists are significantly less likely to be willing to provide assisted dying services than other health professionals. Concerns were raised regarding the challenges faced by psychiatrists and need for more clarity around the psychiatrist’s role. Conclusions Few NZ psychiatrists were willing to be involved with the Act. There was a perceived lack of information around a psychiatrist’s role, responsibilities and legal protections. Further guidance is needed regarding the concept of capacity in assisted dying and the factors that challenge these assessments.

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Section: Discussionmentioning

confidence: 99%

“…The other perspective takes into account the broader external factors (such as outcome and risk) and influences the standards required to achieve capacity (the externalist approach). 6…”

Section: Discussionmentioning

confidence: 99%

Psychiatrists’ views on the New Zealand End of Life Choice Act

Cassidy

Sims

Every‐Palmer

2022

Australas Psychiatry

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“…Such decisions to postpone capacity assessment, deploying therapeutic skills to support the patient in the interim, can be seen as fitting with the 'support principle' of the Mental Capacity Act. But these examples also highlight clinical complexity and add nuance to debates about outcome concerns threatening the neutrality of capacity assessment (30)(31)(32). Clinicians, familiar with therapeutic goals and relationships, may be best placed to consider the role of the capacity assessment in the overall therapeutic landscape and negotiate these complexities.…”

Section: Clinical Skillsmentioning

confidence: 99%

Difficult Capacity Cases—The Experience of Liaison Psychiatrists. An Interview Study Across Three Jurisdictions

et al. 2022

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BackgroundAssessment of capacity for treatment and discharge decisions is common in the general hospital. Liaison psychiatrists are often asked to support the treating medical or surgical team in difficult capacity assessments. However, empirical research on identification and resolution of difficult capacity cases is limited. Some studies have identified certain patient, decisional, and interpersonal factors which cause difficulty, but no study has explored how these issues are resolved in practice. Our study therefore aimed to describe how experienced liaison psychiatrists identify and resolve difficult capacity cases in a general hospital setting.MethodsWe carried out semi-structured interviews with 26 liaison psychiatrists from England, Scotland, and New Zealand, on their most difficult capacity cases. Thematic analysis was used to examine types of difficulty and how these were resolved in practice. Summaries were prepared and example quotes extracted to illustrate phenomena described.ResultsWe identified four types of difficulty in capacity assessment, spanning both clinical and ethical domains: 1) Difficulty determining whether the decision is the patient's own or driven by illness, 2) Difficulty in applying ethical principles, 3) Difficulty in avoiding personal bias, and 4) Procedural difficulties. The liaison psychiatrists presented as self-reflective and aware of challenges and pitfalls in hard cases. We summarized their creative strategies to resolve difficulty in assessment.ConclusionPractitioners approaching difficult capacity cases require both clinical skills, e.g., to uncover subtle illness impairing decision-making and to consider interpersonal dynamics, and ethical skills, e.g., to negotiate the role of values and risks in capacity assessment. Education and training programmes should incorporate both aspects and could include the resolution strategies identified in our study. Practitioners, supported by health and social care systems, should work to develop self-aware and reflective capacity assessment practice.

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“…We will focus on one paper as an example. When we searched the database using the above keywords, we found four categories of papers: (1) written mainly from the perspective of ethicists or philosophers [ 1 , 2 , 3 ]; (2) written mainly from a clinical perspective [ 4 , 5 , 6 , 7 , 8 ]; (3) written mainly from the perspectives of other fields such as law [ 9 , 10 , 11 ]; (4) written mainly by interdisciplinary expert authors such as clinicians and ethicists [ 12 , 13 , 14 , 15 , 16 ]. All categories have merits and demerits.…”

Section: Introductionmentioning

confidence: 99%

Decision-Making Capacity to Refuse Treatment at the End of Life: The Need for Recognizing Real-World Practices

Akabayashi

Nakazawa

Ino

2022

Clinics and Practice

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End-of-life decision making is a troublesome ethical dilemma. These decisions should be made in trustful patient–doctor relationships. We aimed to propose a balanced approach when discussing this complex issue. We categorized the research into four approaches and suggest that a multidisciplinary approach may be appropriate. We also analyzed the pitfalls of the multidisciplinary approach. Our conclusion is two-fold. First, discussions in this field should be based on real-world practice. If this is not the case, the proposal may be armchair theory, which is not effective in a clinical setting. Second, interdisciplinary researchers should not stick to their position too firmly and should listen to others. Otherwise, proposals made will be paternalistic or philosophically biased. Therefore, when philosophical collaboration is applied to the topic of clinical bioethics, it is necessary to thoroughly examine different positions and carry out careful discussions with consideration for medical care settings. Researchers must also understand what is needed for a trustful patient–doctor relationship. By making such efforts, clinical bioethics will contribute to the wellbeing of patients.

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Harmful Choices, the Case of C, and Decision-Making Competence

Cited by 22 publications

References 22 publications

Psychiatrists’ views on the New Zealand End of Life Choice Act

Psychiatrists’ views on the New Zealand End of Life Choice Act

Difficult Capacity Cases—The Experience of Liaison Psychiatrists. An Interview Study Across Three Jurisdictions

Decision-Making Capacity to Refuse Treatment at the End of Life: The Need for Recognizing Real-World Practices

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