Potentially incapable patients objecting to treatment: doctors' powers and duties

Eagle, Kerri; Ryan, Christopher James

doi:10.5694/mja12.11814

Cited by 8 publications

(9 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…25 Common law establishes that an adult is presumed to have the capacity to consent to or refuse medical treatment unless that presumption is rebutted. 26 However, capacity may be affected by symptoms of mental and physical illness, emotional state and cognition, which may fluctuate over time and resolve with treatment and support. 27 , 28 With psychosis, for example, there may be symptoms such as delusional beliefs leading to mistrust of clinicians or denial of illness.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

O'Cionnaith¹,

Wand²,

Peisah³

2021

CIA

View full text Add to dashboard Cite

The purpose of this case series is to illustrate the complexity of considerations across health (physical and mental), ethical, human rights and practical domains when an older adult with chronic symptoms of mental illness refuses treatment for a serious medical comorbidity. A broad understanding of these considerations may assist health care professionals in navigating this challenging but common aspect of clinical practice. Case Presentation: Three detailed case reports are described. Participants were older adults with an acute presentation of a chronic mental illness, admitted to a specialized older persons mental health inpatient unit (OPMHU) in an Australian metropolitan hospital. Significant comorbid medical issues were detected or arose during the admission and the patient refused the recommended medical intervention. Data extracted from patients' medical records were analyzed and synthesized into detailed case reports using descriptive techniques. Each patient was assessed as lacking capacity for healthcare and treatment consent and did not have relatives or friends to assist with supported decision-making. Multifaceted aspects of decision-making and management are highlighted. Conclusion:There are multiple complex issues to consider when an older adult with chronic symptoms of mental illness refuses treatment for serious comorbid medical conditions. In addition to optimizing management of the underlying mental illness (which may be impairing capacity to make healthcare decisions), clinicians should adopt a role of advocacy for their patients in considering the potential impact of ageism and stigma on management plans and inequities in physical healthcare. Consultation with specialist medical teams should incorporate multifaceted considerations such as potentially inappropriate treatment and optimum setting of care. Equally important is reflective practice; considering whether treatment decisions may infringe upon human rights or cause trauma.

show abstract

Section: Introductionmentioning

confidence: 99%

“…This may fuel ageist behaviors and attitudes such as lack of therapeutic zeal, demonstrated in clinician responses to medical illness amongst older adults. 29 Thus, a person lacking capacity may be deprived of important medical care for a variety of reasons, 23 , 26 adversely affecting his/her health and, potentially, lifespan.…”

Section: Introductionmentioning

confidence: 99%

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

O'Cionnaith¹,

Wand²,

Peisah³

2021

CIA

View full text Add to dashboard Cite

show abstract

“…The current Mental Health Act () is worded in such a way as to emphasize the serious risk of harm to self or others as the decision rule, rather than the loss of mental (decision‐making) capacity (Ryan ). Eagle and Ryan () argue that losing decision‐making capacity is a loss of autonomy, and this is the point where the MHA should be invoked by carers and case workers. As the law is currently interpreted, carers, case workers, and doctors must stand by, watching and waiting for the person to become a serious risk of harm to self or others before they can legally intervene.…”

Section: Discussionmentioning

confidence: 99%

Lived experience of involuntary transport under mental health legislation

Bradbury

Hutchinson

Hurley

et al. 2016

Int J Mental Health Nurs

View full text Add to dashboard Cite

Police have historically been responsible for transporting people during a mental health crisis in Australia. A major change to the New South Wales (NSW) Mental Health Act (MHA) in 2007 expanded the range of coercive transportation agencies to include NSW Ambulance (paramedics) and NSW Health (mental health nurses). Anecdotal reports, however, describe a lack of clarity around how these changes should be implemented in practice. This research aims to explore this lack of clarity through qualitative analysis of interviews with people with the lived experience of involuntary transport under the MHA. Sixteen interviews were conducted; most (n = 14) interviews in northern NSW regions: six with people who had been transported (consumers), four with carers, and six with service providers (two police, one paramedic, and three mental health nurses). For consumers and carers, the police response was often perceived as too intense, particularly if the person was not violent. Carers were often conflicted by having to call for emergency intervention. Service providers were frustrated by a lack of a coordinated interagency response, resourcing issues, delays at emergency departments, and lack of adequate training. A central theme across all groups was the importance of communication styles. As one participant (consumer) said: 'Everybody needs a lesson in kindness'. All groups agreed that high-risk situations necessitate police involvement. However, invocation of the MHA during a high-risk situation is fraught with stress and difficulties, leaving little room for empathetic communications. Effective and diverse, evidence-based, early intervention strategies - both consensual and non-consensual - are necessary to reduce the requirement for police involvement in mental health transports.

show abstract

“…14 If a suicidal patient demands discharge before any sort of assessment can be completed, the law allows temporary detention to allow assessment of his or her capacity to request discharge. 15 Before any suicidal patient is discharged against medical advice, the case should be discussed with a consultant psychiatrist.…”

Section: Assessmentmentioning

confidence: 99%

Assessing and managing suicidal patients in the emergency department

Ryan¹,

Gribble

Macfarlane

et al. 2015

Australas Psychiatry

View full text Add to dashboard Cite

Objective: The objective of this article is to set out consensus guidelines for the assessment and management of “suicidal patients” in the emergency department. Conclusions: Clinicians should be respectful and reassuring. They should review old notes, conduct a full history and examination, and talk to friends, family and any practitioners already involved in the patient’s care. Management should be guided, where possible, by the patient’s preferences, not by notions of risk. Every negotiated management plan and its rationale should be carefully documented.

show abstract

Potentially incapable patients objecting to treatment: doctors' powers and duties

Cited by 8 publications

References 1 publication

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

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

Lived experience of involuntary transport under mental health legislation

Assessing and managing suicidal patients in the emergency department

Contact Info

Product

Resources

About