Staden, C. W., & Krüger, C. (2003). Incapacity to give informed consent owing to mental disorder. Journal of Medical Ethics vol. 29 , 41–43.
Incapacity to give informed consent owing to mental disorder written by C W Van Staden and C Krüger (2003) argues that a patient’s clinical mental health should be clinically assessed, for all interventions, and at the time when the intervention is to take place. The authors work on the basis of the axiom that a patient’s consent is required for any medical treatment unless he or she is incapable of consenting or the law requires the doctor to intervene without the patient’s consent.
The article states that most of the medical interventions requiring informed consent are required from patients who understand the nature and requirement for such treatment. But the authors argue that the problem that mostly arises in case of consent from mentally ill patients is their clinical condition preventing them from accepting that they need medical help. Thus, their understanding of the treatment is intact but their medical condition makes them feel that they do not require treatment. The authors argue that the patient’s acceptance of the fact that they require medical intervention or not should not be prevented by their medical disorder.
This should be a condition for informed consent. The author further clarifies that these mental disorders prevent patients from consenting to a particular intervention due to a mental delusion that they harbor, but it does not indicate that they will not give consent for all medical interventions. Further, a mentally ill person has provided consent to participate in medical research but he does not understand the nature, method, and the purpose of the research, such consent should be rendered null and void.
Thus the authors conclude that to assess if a person with a mental disorder is fit for giving informed consent clinical examination of the person is insufficient. It must be assessed if the person fits into all the conditions required to give informed consent. The authors agree that such assessment of the conditions to give informed consent may prove a difficult task clinically but strengthens ethical medical practice.
The article has been helpful in understanding the conditions that need to be considered while assessing a mentally ill person to be fit or unfit to give informed consent. Further, this article also provides a thumb rule for understanding a person’s capability to give consent. So as a nurse one may use these rules to estimate if the mentally ill person is fit to provide consent. Though the article is strong in making its arguments it does not provide a scope to understand the method to be employed to assess if a person fits the conditions to provide consent.
The authors are associated with the Department of Psychiatry at the University of Pretoria and Weskoppies Hospital in South Africa. They are consistent in their argument and this article proves to be an important reference for the topic. The article clearly states that people with mental disorders may or may not be capable of providing informed consent, but it all depends on the assessments of a person if he/she fits the conditions for providing informed consent.
Wirshing, D. A., Sergi, M. J., & Mintz, J. (2005). A Videotape Intervention to Enhance the Informed Consent Process for Medical and Psychiatric Treatment Research. American Journal of Psychiatry vol. 162 , 186–188.
The article now under study is A Videotape Intervention to Enhance the Informed Consent Process for Medical and Psychiatric Treatment Research by Donna A. Wirshing, Mark J. Sergi, and Jim Mintz (2005). This is a brief report on experimental research they had undertaken to understand the effectiveness of using a videotape to provide structured information to all normal undergraduate medical students as well as individuals with chronic mental ailment.
The research was designed in an experimental setting where individuals with schizophrenia, individuals without any self reported psychiatric problem and undergraduate medical students were randomly chosen and shown either a highly structured educational video about the consent process or a control video that presented only general information about ethical issue in medical research. The result showed that viewing the structures videotape about informed consent increased.thus the authors conclude that the videotape with informed consent information was an effective means to provide information to even mentally ill patients to make them gain information regarding the informed consent process.
This article provided a different approach to educate patients with severe mental illness to be informed about the informed consent process. Thus, as a nurse we may use such visual medium to inform patients with mental illness like schizophrenia to understand what consent is and how it will help them.
The article is biased to the idea that because schizophrenic patients were able to gain information regarding informed consent from the video all mentally ill patients will be able to do so. But this is a skewed estimation, as not all mental ailments are same. Further as Staden and Krüger (2003) argues that mentally ill patients are often able to understand the process and the requirement of a treatment and the process of informed consent but they are unwilling to go through the treatment. Hence the article is useful in providing information to mentally ill regarding informed consent but it does not state that if they are capable or incapable to do so or if this ensures that they clear all conditions to be fit to provide consent.
The authors presented this paper at the 154th annual meeting of the American Psychiatric Association. Their article is aimed at all medical research groups and shows that mentally ill people are also able to understand the informed consent process and give their view regarding the same.