Protecting Patients from their Bad Decisions: Rebalancing Rights, Relationships, and Risk

Cave, Emma

doi:10.1093/medlaw/fww046

Cited by 9 publications

(17 citation statements)

References 4 publications

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“…Laws on involuntary psychiatric treatment focus on the presence of severe mental illness, need of treatment or danger to self or others but not on the patient's ability to make autonomous decisions (Sjöstrand et al, ). Certain critics of the implementation of AHDs in mental health uphold that users may cause themselves harm if their legal right to make a “bad decision” were honoured (Cave, ).…”

Section: Introductionmentioning

confidence: 99%

Advance healthcare directives in mental health: A qualitative analysis from a Spanish healthcare professional's viewpoint

Juliá‐Sanchis

García-Sanjuán

Martí

et al. 2019

Psychiatric Ment Health Nurs

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Accessible summary What is known on the subject? Advance care planning (ACP) in mental health is a useful tool to avoid human rights violations in mental health settings. However, ACP is not yet a reality in the Spanish context. The advance healthcare directive (AHD) is a document reflecting healthcare preferences, drafted within the framework of the ACP process, to be applied in situations in which an individual's legal capacity may be questionable. No study has explored the viewpoint of Spanish mental healthcare professionals towards AHDs in the mental health field. Considering their extensive use, further study of providers’ knowledge and attitudes is warranted. What does the paper add to existing knowledge? The study adds knowledge about the viewpoint of Spanish mental healthcare professionals towards the implementation of AHDs in their clinical practices. This study illuminates the prevailing paternalistic provider–user relationship as the main barrier surrounding AHD management in terms of decision‐making. Our findings support the need for broader awareness, staff training regarding the documentation, the conversation process and communication skills, and personalized assistance in the mental health services to implement AHDs in everyday practice. What are the implications for practice? Advance healthcare directives are a recovery tool that offers major information regarding mental health user preferences. Although they pose challenges for clinical practice, AHDs should be incorporated into interventional mental health care. Obtaining up‐to‐date perspectives held by mental healthcare professionals regarding AHDs allows the administration to determine the aspects requiring reinforcement. The implementation of AHDs in the Spanish mental health system requires macro‐ and micro‐changes, both ethically and structurally, so that mental healthcare professionals relinquish their paternalistic approach and embrace new ways of relating to users. AbstractIntroductionAn advance healthcare directive (AHD) is a written document that contains a patient‐in‐care's will and preferences concerning the treatment options available to them, should they lack decision‐making capacity. AHDs are completed within a broader framework known as advance care planning. No study has explored the viewpoint of Spanish mental healthcare professionals towards AHDs.AimTo explore the viewpoint of mental health professionals towards the implementation of AHDs in mental health.MethodA qualitative study was conducted using semi‐structured interviews that were thematically analysed.FindingsThree main themes were identified: care planning culture; barriers for the practical management of AHDs; and reasons to not honour patient‐in‐care AHDs.DiscussionProfessionals find it pragmatically difficult to stop applying traditional paternalistic practices. To implement AHDs, improving the knowledge and awareness of AHDs and management of non‐technical skills through training is required. Such training should include users and families and allow fo...

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Section: Introductionmentioning

confidence: 99%

Advance healthcare directives in mental health: A qualitative analysis from a Spanish healthcare professional's viewpoint

Juliá‐Sanchis

García-Sanjuán

Martí

et al. 2019

Psychiatric Ment Health Nurs

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“…One is to recognize that, in the specific context of information disclosure, the TE is necessary because the MCA does not adequately protect those who are unable to make an autonomous decision. This would continue a trend established in the recent development of the inherent jurisdiction to protect those who have capacity but lack the ability to make a voluntary decision (Cave, 2017). Conversely, this article has suggested that the MCA’s protective scheme extends to such patients, in which case a principled justification for the TE is lacking.…”

Section: Resultsmentioning

confidence: 99%

“…If so, this marks a divergent approach from the MCA 2005 which utilizes incapacity as the benchmark for best interests decision-making. Admittedly, such divergence is evident in recent developments of the inherent jurisdiction of the High Court to protect people from harmful involuntary decisions (Cave, 2017). 110 But the application of the inherent jurisdiction is judicial rather than clinical; it would be more difficult in the case of the TE to ensure that its application is facilitative of autonomy rights so as to enhance (rather than limit) commitment to Article 8 of the European Convention on Human Rights.…”

Section: Introduction: Montgomery V Lanarkshire Health Boardmentioning

confidence: 99%

The ill-informed

Cave

2017

Common Law World Review

Self Cite

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Affirming the doctrine of informed consent, the UK Supreme Court in Montgomery v Lanarkshire HB belatedly followed the Australian decision of Rogers v Whitaker, decoupling the duty to inform patients about the material risks of medical treatment from Bolam. The underlying commitment to patient autonomy coincides with a wider body of medical law that protects the right of capacitous adult patients to make treatment decisions, even if others consider those decisions bizarre and even if they will cause the patient serious harm. It is seemingly anomalous, therefore, that the Supreme Court in Montgomery referred to a 'therapeutic exception' (TE), as this suggests an underlying paternalistic approach. Contrary to this view, international examples suggest that a TE does not necessarily conflict with commitment to patient autonomy. In some countries, the exception mitigates the effects of a broadly objective test of materiality by enabling clinicians in exceptional circumstances to protect the autonomy interests of the particular patient. In others, it protects those incapable of an autonomous decision from harm. In England and Wales, however, alternative mechanisms can be interpreted to protect such patients from harm. On this basis, it is argued that the TE is obfuscatory, unnecessary and unjustified.

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“…The resolution of identity undertaken through engaging with treatment, working to reconcile a spoiled identity, is described by Camlin and colleagues (Camlin et al 2017) in Kenya and Uganda. Nobuhle's story extends the concept of therapeutic citizenship, showing how this may be threatened by refusing or delaying ART initiation, which she described being positioned as "breaking the law."…”

Section: Sifiso: Taking Time To Reconcile a Sense Of Self With Hivmentioning

confidence: 99%

Dissonance of Choice: Biomedical and Lived Perspectives on HIV Treatment-Taking

Horter

Seeley

Bernays

et al. 2020

Medical Anthropology

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Treat-all recommends prompt treatment initiation for those diagnosed HIV positive, requiring adaptations to individuals' behavior and practice. Drawing on data from a longitudinal qualitative study in Eswatini, we examine the choice to initiate treatment when asymptomatic, the dissonance between the biomedical logic surrounding Treat-all and individuals' conceptions of treatment necessity, and the navigation over time of ongoing engagement with care. We reflect on the perspectives of healthcare workers, responsible for implementing Treat-all and holding a duty of care for their patients. We explore how the potentially differing needs and priorities of individuals and the public health agenda are navigated and reconciled. Rationalities regarding treatment-taking extend beyond the biomedical realm, requiring adjustments to sense of self and identity, and decision-making that is situated and socially embedded. Sense of choice and ownership for this process is important for individuals' engagement with treatment and care.

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Protecting Patients from their Bad Decisions: Rebalancing Rights, Relationships, and Risk

Cited by 9 publications

References 4 publications

Advance healthcare directives in mental health: A qualitative analysis from a Spanish healthcare professional's viewpoint

Advance healthcare directives in mental health: A qualitative analysis from a Spanish healthcare professional's viewpoint

The ill-informed

Dissonance of Choice: Biomedical and Lived Perspectives on HIV Treatment-Taking

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