Informed Consent and Capacity to Give Consent in Mental Disorders

Abstract

Among four basic principles (respect for autonomy, beneficence, non-malfeasance, and justice) which determine ethical behaviors in healthcare, informed consent is mostly related to 'respect for autonomy'. Also, it reflects patient/client's right for decision and the value given for the client and his/her autonomy. Informed consent is an information sharing process including both rational decision-making about the most appropriate method among many different options and the interaction between the clinician and the client. This concept sheds light on criteria regarding the limits of confidentiality, competency, appropriate and sufficient information sharing and voluntariness. In this theoretical review, the definitions and the content of informed consent were shared, and then a section regarding the required content of informed consent for psychotherapy process was provided. Then, the components of informed consent were discussed and the relationship between capacity to consent and mental disorders in terms of aforementioned diagnostic groups was examined.

Keywords

• Informed consent, capacity to consent, mental disorders

Ruhsal Bozukluklarda Bilgilendirilmiş Onam ve Onam Verme Kapasitesi

Abstract

Sağlık alanında etik davranışları belirleyen dört temel ilke (özerkliğe saygı, faydalı olma, zarar vermeme ve adalet) içinde en çok 'özerkliğe saygı' prensibiyle ilişkili olan bilgilendirilmiş onam aynı zamanda danışanın karar verme hakkı ve hastaya/danışana ve özerkliğine verilen değeri de yansıtır. Bilgilendirilmiş onam, bireyin pek çok farklı seçenek içinden kendisi için en uygun yöntemi seçmek üzere mantıklı bir karar almasını ve klinisyen ile etkileşimi de kapsayan bilgi paylaşım sürecidir. Bu kavram gizliliğin sınırlarına, yetkinliğe, uygun ve yeterli bilgi paylaşımına, gönüllülüğe dair ölçütlerin neler olduğuna ilişkin klinisyenlere ışık tutmaktadır. Bir kuramsal derleme olan bu çalışmada bilgilendirilmiş onam kavramının tanımları ve içeriği paylaşıldıktan sonra, psikoterapistlerin psikoterapi sürecinde kullanacakları onam formunun neleri kapsaması, bilgilendirilmiş onam bileşenleri irdelenmiştir. Ardından yukarıda belirtilen tanı grupları kapsamında ruhsal bozukluklar ve onam verme kapasitesi ilişkisi incelenmiştir

Keywords

• Bilgilendirilmiş onam, etik ikilem, onam verme kapasitesi, ruhsal bozukluklar

References

1. Beauchamp TL, Childress JF. Principles of Biomedical Ethics, 4th ed. New York, Oxford University Press, 1994.
2. Youngren J. Psychotherapy: ethical issues. In International Encyclopedia of the Social & Behavioral Sciences (Eds NJ Smelser, PB Baltes):12480-12484. Oxford, Pergamon Press, 2001.
3. Gümüş AE, Gümüş MA. Bilgilendirilmiş onay: psikolojik danışma sürecinin yasal ve etik yükümlülüğü, Türk Psikolojik Danışma ve Rehberlik Dergisi 2009; 4:69-79.
4. Beahrs JO, Gutheil TG. Informed consent in psychotherapy. Am J Psychiatry 2001; 158:4-10.
5. Pope KS, Vasquez MJT. Ethics in Psychotherapy and Counseling: A Practical Guide, 2nd ed. San Francisco, Jossey-Bass Publishers, 2001.
6. Dsubanko-Obermayr K, Baumann U. Informed consent in psychotherapy: demands and reality, Psychother Res 1998; 8:231-247.
7. Roberts LW, Roberts B. Psychiatric research ethics: An overview of evolving guidelines and current ethical dilemmas in the study of mental illness. Biol Psychiatry 1999; 46:1025-1038.
8. Bray JH, Shepherd JN, Hays JR. Legal and ethical issues in informed consent to psychotherapy. Am J Fam Ther 1985;13:50

9. Faden RR, Beauchamp TL. A history and context and theory of informed consent. New York, Oxford University Press, 1986. Türk Psikologlar Derneği. Türk Psikologlar Derneği Etik Yönetmeliği 2004. http://www.psikolog.org.tr/turkey-code-tr.pdf (002013’te ulaşıldı).
10. Tribbensee NE, Claiborn CD. Confidentiality in psychotherapy and related contexts. In Handbook of Professional Ethics for Psychologists (Eds W O’Donohue, K Ferguson):287-300. USA, Sage Publications, 2003.
11. Duffy M. Informed consent. In The Ethical and Professional Practice of Counseling and Psychotherapy (Ed. L Sperry0.) Boston, Pearson/Ally and Bacon, 2007.
12. Simon RI. Clinical-legal issues in psychotherapy. In Oxford Textbook of Psychotherapy (Eds GO Gabbard, J Beck, J Holmes,):487-495. New York, Oxford University Press, 2005.
13. Roberts L. Psychiatry: informed consent and care. In International Encyclopedia of the Social & Behavioral Sciences (Eds NJ Smelser, PB Baltes):12296-12302. Oxford, Pergamon Press, 2001.
14. Richards DF. The central role of informed consent in ethical treatment and research with children. In Handbook of Professional Ethics for Psychologists (Eds. W O’Donohue, K Ferguson):377-389. USA: Sage Publications, 2003.
15. Pierce-Dennis B. The origin and nature of informed consent: experiences among vulnerable groups. J Prof Nurs 1999; 15:281-287.
16. Berg JW, Appelbaum PS, Lidz CW, Parker LS. Informed Consent: Legal Theory and Clinical Practice , 2nd ed. New York, Oxford University Press, 2001
17. Silva MC, Sorrell JM. Enhancing comprehension of information for informed consent: a review of empirical research. IRB 1998; 10:1-5.
18. Sturman ED. The capacity to give consent to treatment and research: a review of standardized assessment tools. Clin Psychol Rev 2005; 25:954-974.
19. Handelsman MM, Galvin MD.Facilitating informed consent for outpatient psychotherapy: a suggested written format. Prof Psychol Res Pr 1988; 19:223-225.
20. Handelsman MM, Kemper MB, Kesson-Craig P, McLain J, Johnsrud C. Use, content and readability of written informed consent forms for treatment. Prof Psychol Res Pr 1986; 21:451-454.
21. Young DR, Hooker DT, Freeberg FE. Informed consent documents: Increasing comprehension by reducing reading level. IRB 1990; 12:1-5.
22. Rudnick A, Roe D. Normal variants of competence to consent to treatment. HEC Forum 2004; 16:129-137.
23. Hotopf M, Raymont V. Mental capacity and valid consent. Psychiatry 2004; 3:8-10.
24. Roberts LW. Informed consent and the capacity for voluntarism. Am J Psychiatry 2003; 159:705-712.
25. Egg R. Zwangstherapie. Zur bedeutung der freiwilligkeit bei der durchführung therapeutischer maßnahmen. Verhaltensthrepaie und Psychosoziale Praxis 1986; 18:35-41.
26. Benson PR, Roth LH, Appelbaum PS, Lidz C W, Winslade WJ. Information disclosure, subject understanding and informed consent in psychiatric research. Law Human Behav 1988; 12:455-475.
27. Appelbaum PS, Berg JW, Lidz CW. Informed consent: Legal theory and clinical practice 2nd edition. USA, Oxford University Press, 2001.
28. Candillis PJ, Fletcher KE, Geppert CMA, Lidz CW, Appelbaum P S. A direct comparison of research decision-making capacity: schizophrenia/schizoaffective, medically ill and non-ill subjects. Schizophr Res 2008; 99:350-358.
29. Misra S, Socherman R, Hauser P, Ganzini L. Appreciation of research information in patients with bipolar disorder. Bipolar Disord 2008; 10:635-646.
30. Appelbaum PS, Grisso T. The MacArthur Competence Assessment Tool-Clinical Research. Sarasota, Fla, Professional Resource Press, 1995.
31. Schachter D, Kleinman I, Prendergast P, Remington G, Schertzer S. The effect of psychopathology on the ability of schizophrenic patients to give consent. J Nerv Ment Dis 1994; 182:360-362.
32. Howe V, Foister K, Jenkins K, Skene L, Copolov D, Keks N. Competence to give informed consent in acute psyhosis is associated with symptoms rather than diagnosis. Schizophr Res 2005; 77:211-214.
33. Appelbaum PS, Roth LH. Competency to give consent to research: a psychiatric review. Arch Gen Psychiatry 1982; 39:9519
34. Carpenter WT Jr., Gold JM, Lahti AC, Queern CA, Conley RR, Bartko JJ et al. Decisional capacity for informed consent in schizophrenia research. Arch Gen Psychiatry 2000; 57:533-538.
35. Carpenter WT, Conley R R. Sense and nonsense: an essay on schizophrenia research ethics. Schizophr Res 1999; 35:2192
36. Stroup S, Appelbaum P, Swartz M, Patel M, Davis S, Jeste D et al. Decision-making capacity for research participation among individuals in the CATIE schizophrenia trial. Schizophr Res 2005; 80:1-8.
37. Moser DJ, Schultz S K, Arndt S, Benjamin ML, Fleming FW, Brems CS et al. Capacity to provide informed consent for participation in schizophrenia and HIV research. Am J Psychiatry 2002; 159:1201-1207.
38. Ghormley C, Basso M, Candlis P, Combs D. Neuropsychological impairment corresponds with poor understanding of informed consent disclosures in persons diagnosed with major depression. Psychiatry Res 2011; 187:106-112.
39. Raffard S, Bayard S, Gely-Nargeot MC, Capdevielle D, Maggi M, Barbotte E et al. Insight and executive functioning in schizophrenia: A multidimensional approach. Psychiatry Res 2009; 167:239-250.
40. Mandarelli G, Parmigiani G, Tarsitani L, Frati P, Biondi M, Ferracuti S. The relationship between executive functions and capacity to consent to treatment in acute psychiatric hospitalization. J Empir Res Hum Res Ethics. 2012; 7:63-70.
41. Stroup S, Appelbaum PS, Gu H, Hays S, Swartz MS, Keefe RS et al. Longitudinal consent-related abilities among research participants with schizophrenia: results from the CATIE study. Schizophr Res 2011; 130:47-52.
42. Wirshing DA, Wirshing WC, Marder SR, Liberman RP, Mintz J. Informed consent: assessment of comprehension. Am J Psychiatry 1998; 155:1508-1511.
43. Stiles PG, Poythress NG, Hall A, Falkenbach D, Williams R. Improving understanding of research consent disclosures among persons with mental illness. Psychiatr Serv 2001; 52:780-785.
44. Dunn LB, Lindamer LA, Palmer BW, Golshan S, Schneiderman LJ, Jeste DV. Improved understanding of research consent in middle-aged and elderly patients with psychotic disorders. Am J Geriatr Psychiatry 2002; 10:42-150.
45. Eyler LT, Mirzakhanian H, Jeste DV. A preliminary study of interactive questioning methods to assess and improve understanding of informed consent among patients with schizophrenia. Schizophr Res 2005; 75:193-198.
46. Simon V, De Hert M, Wampers M, Peuskens J, van Winkel R. The relation between neurocognitive dysfunction and impaired insight in patients with schizophrenia. Eur Psychiatry 2009; 24:239–243.
47. Owen GS, David AS, Richardson G, Szmukler G, Hayward P, Hotopf M. Mental capacity, diagnosis and insight in psychiatric in-patients: a cross-sectional study. Psychol Med 2009; 39:1389-1398.
48. Adida M, Clark L, Pomietto P, Kaladjian A, Besnier N, Azorin JM et al. Lack of insight may predict impaired decision-making in manic patients. Bipolar Disord 2008; 10:829-837.
49. Capdeville D, Raffard S, Bayard S, Garcia F, Baciu O, Bouzigues I et al. Competence to consent and insight in schizophrenia: Is there an association? a pilot study. Schizophr Res 2013; 108:272-279.
50. Raffard S, Fond G, Brittner M, Bortolon C, Macgregor A. Cognitive insight as an indicator of competence to consent to treatment in schizophrenia. Schizophr Res 2013; 144:118-121.
51. Palmer BW, Jeste DV. Relationship of individual cognitive abilities to specific components of decisional capacity among middle-aged and older patients with schizophrenia. Schizophr Bull 2006; 32:98-106.
52. Croarkin P, Berg J, Spira J. Informed consent for psychotherapy: a look at therapists’ understanding, opinions and practices. Am J Psychother 2003; 57:384- 401.
53. Kerby SE. Informed consent as a predictor of working alliance and perception of counselor/psychotherapist (Unpublished doctoral thesis). Michigan, Western Michigan University, 2009.
54. Schultz AL, Pardee GP, Ensinck JW. Are research subjects really informed? West J Med 1975; 123:76-80
55. Martin L. Ethics and negative effects of psychotherapies. In Oxford Textbook of Psychotherapy (Ed. GO Gabbard) 30-42. USA, Oxford University Press, 1988.
56. Jeste DV, Dunn LB, Palmer BW, Saks E, Halpain M, Cook A et al. A collaborative model for research on decisional capacity and informed consent in older patients with schizophrenia: bioethics unit of a geriatric psychiatry intervention research center. Psychopharmacology 2003; 171:68-74.
57. Grisso T, Appelbaum PS, Hill-Fotouchi C. The MacCAT-T: A clinical tool to assess patient’s capacities to make treatment decisions. Psychiatr Serv 1997; 48:1415-1419.
58. Gupta UC, Kharawala S. Informed consent in psychiatry clinical research: a conceptual review of issues, challenges and recommendations. Perspect Clin Res 2012; 3:8-15.
59. Hughes JC. Psychiatric ethics. Medicine 2004; 32:1-3 Zeynep Maçkalı, Yrd.Doç.Dr., Yeni Yüzyıl Üniversitesi, Psikoloji Bölümü,İstanbul. Yazışma Adresi/Correspondence: Zeynep Maçkalı, Yeni Yüzyıl Üniv., Psikoloji Bölümü, İstanbul, Turkey. E-mail: [e-mail] Yazarlar bu makale ile ilgili herhangi bir çıkar çatışması bildirmemiştir. The author reported no conflict of interest related to this article. Çevrimiçi adresi / Available online at: www.cappsy.org/archives/vol6/no3/ Çevrimiçi yayım / Published online 03 Kasım/November 03, 2013; doi: 10.5455/cap.20131103093205