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Does Depression Invalidate Competence? Consultants' Ethical, Psychiatric, and Legal Considerations

Published online by Cambridge University Press:  29 July 2009

Ernlè W. D. Young ,
James C. Corby  and
Rodney Johnson
Ernlè W. D. Young
Affiliation:
University School of Medicine, Co-director of the Stanford University Center for Biomedical Ethics, and Ethics Consultant to and Chair of the Stanford University Hospital Ethics Committee
James C. Corby
Affiliation:
University School of Medicine and a psychiatrist in private practice in Santa Cruz, California
Rodney Johnson
Affiliation:
University Medical Center and serves on the Stanford University Hospital Ethics Committee
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Extract

The ethical principle of respect for autonomy has come into its own In American medicine since World War II as equal in importance to the traditional medicomoral principles of nonmaleficence and beneficence. Respect for autonomy provides the ethical underpinning for the patient's right to exercise an informed choice – whether to consent to or to refuse recommended medical treatment. However, an informed choice demands a certain level of competence. Typical criteria for patient competence to accept or to refuse medical treatments Include ability to make a choice and ability to comprehend the nature of the treatment, as well as the risks and benefits of accepting or refusing the treatment.

Type
Special Section: Ethics Consultants and Ethics Consultations
Information
Cambridge Quarterly of Healthcare Ethics , Volume 2 , Issue 4 , Fall 1993 , pp. 505 - 515
Copyright
Copyright © Cambridge University Press 1993

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References

1. See Rothman, DJ. Strangers at the Bedside. New York: Basic Books, 1991;Google ScholarYoung, EWD. Alpha and Omega: Ethics at the Frontiers of Life and Death. Reading, Massachusetts:Addison-Wesley, 1989.Google Scholar

2. See Faden, RR, Beauchamp, TL. A History and Theory of Informed Consent. New York: Oxford University Press, 1986.Google Scholar

3. For the purpose of this paper, “competence” is used in the legal sense of “capacity for consenting or refusing medical treatment” and not in the legal sense of competence to continue to manage one's affairs, as in a conservatorship proceeding. In California, capacity for treatment decisions is generally defined as the ability to understand the nature and consequences of treatment to which one is asked to consent or the refusal of that treatment. California Association of Hospitals and Health Systems. Consent Manual. 19th ed.Sacramento: California Association of Hospitals and Health Systems. 1992:15Google Scholar.

4. California Welfare and Institutions Code, Section 5326.7.

5. An individual can be held involuntarily if the individual is a danger to self or others or gravely disabled as a result of a mental disorder and can be treated for that mental disorder. The procedure to justify such involuntary treatment increases as the length of stay, i.e., 72 hours, 14 days, 14 more days. California Welfare and Institutions Code, Section 5150 et seq.

6. Macklin, R. Mortal Choices: Ethical Dilemmas in Modern Medicine. Boston: Mifflin Co., 1987:91–3.Google Scholar This approach was suggested earlier by Drane, JRCompetency to give an informed consent. Journal of the American Medical Association 1984;252:925–7.CrossRefGoogle ScholarPubMed

7. Roth, LH, Meisel, A, Lidz, CW. Tests of competency to consent to treatment. American Journal of Psychiatry 1977;134:279–84.Google Scholar

8. Kentsmith, DK, Salladay, SA, Kiya, PA, eds. Ethics in Mental Health Practice. Orlando, Florida: Grune & Stratton. 1986:83–108.Google Scholar

9. For example, in California an individual may retain the right to make medical decisions even when a conservator has been appointed to make financial and other decisions for the individual. California Probate Code, Section 2354.

10. See note 3. California Association of Hospitals and Health Systems. 1992:Chapter 5.3.

11. 179 Cal. App. 3d 1127 (1986).

12. Conservator of Drabick, 200 Cal. App. 3d 185 (1988) – affirming the authority of the conservator to withdraw life-sustaining treatments.

13. Kolb, LC, Brodie, HK. Modern Clinical Psychiatry. Philadelphia: WB Saunders Co. 1982:752–3 (countertransf erence).Google Scholar

14. Sandler, J, Dare, C, Holder, A. The Patient and the Analyst. New York: International Universities Press, 1973:61–70 (countertransference).Google Scholar

15. See note 3. California Association of Hospitals and Health Systems. 1992:Chapter 5.3.

16. Lawyers have often helped mental rights advocates, but mental rights advocates are not necessarily lawyers.

17. An initiative on the November 1992 ballot in California that would have allowed physician-assisted death was defeated. The Hemlock Society has stated that it intends to pursue another such ballot measure in California.