Influence of Psychiatric Symptoms on Decisional Capacity in Treatment Refusal

Abstract

How psychiatric symptoms affect patients' decision making in practice can inform how we think-theoretically and conceptually-about what it means for those patients to have decision-making capacity. Assessment of a patient's decisional capacity allows those with adequate capacity to make choices regarding treatment and protects those who lack capacity from potential harm caused by impaired decision making. In analyzing a case in which a patient with stage II breast cancer refuses further treatment, we review the conceptual model of informed consent and approaches to assessing decision-making capacity that are in accordance with the American Medical Association Code of Medical Ethics as well as tools to assess decisional capacity.

Navigating the Minefield: Managing Refusal of Medical Care in Older Adults with Chronic Symptoms of Mental Illness

“…Furthermore, restriction of autonomy should be as brief as possible and, where feasible, efforts should be made to assist a person to regain capacity. 31 , 77 Notably in Australia, guardianship and administration orders are time-limited with compulsory review embedded within the legislation. 25 This is particularly relevant for mental illnesses such as depression or bipolar disorder which may have a relapsing remitting course, where capacity may be regained on treatment of the mental illness.…”

“…25 This is particularly relevant for mental illnesses such as depression or bipolar disorder which may have a relapsing remitting course, where capacity may be regained on treatment of the mental illness. 31 , 78 Capacity may also be regained with diminution of acuity of symptoms in chronic schizophrenia.…”

“…Rubin et al (2018) proposed a 7-question algorithm to provide clinicians with an ethical framework for managing treatment refusal in patients lacking capacity. 30 Case reports of medical treatment-refusal have been described in the literature, highlighting issues which may arise including impaired decision-making capacity, stigma and competing ethical principles 9 , 23 , 31–37 although older adults, particularly those with mental illness, are underrepresented. Similarly, none of the aforementioned studies consider the specific ethical and human rights challenges pertinent to older adults, nor do they consider the combined interplay of medical and mental illness, and practical issues facing clinicians in the setting of treatment-refusal.…”

Approaching differential diagnosis and decisional capacity assessment in the context of COVID-19 conspiracy beliefs: A narrative review and clinical discussion

“…While the 2019 ACLP guidelines and several other publications address strategies to optimize a patient's decisional capacity, the novelty of COVID-19 conspiracy theories present a unique challenge. Common methods of decisional capacity optimization include educational efforts, modifying reversible causes of capacity impairment, and adapting the interview to accommodate for language barriers and cognitive deficits, among others [ 23 , 52 , 82 ]. While these approaches remain valuable in the context of assessing irrational beliefs about COVID-19, additional strategies also need to be considered.…”

Nurse roles in the advance directive system in Korea

“…Here, mental capacity refers to the competence (Beauchamp & Childress 2019) of the writer to perform decision-making for any future LST. Certain mental illnesses can temporarily or permanently damage one's ability to make such decisions (Baruth & Lapid 2017;Sullivan & Youngner 1994). Given that most such writers are elderly (Ministry of Health & Welfare 2018), counselors should be aware of possible circumstances in which a writer's mental capacity may be temporarily or permanently diminished.…”