Introduction to the Ethical Dilemma
The case of Scott Starson provides an interesting example of the ethical controversy surrounding obtaining informed consent. Such consent is necessary if the treatment and interaction between the patient and the doctor are based on the principles of autonomy of the individual and respect for their privacy. In standard practice, physicians do not have significant problems obtaining consent to treatment from a patient, as it is assumed that the patient is capable and aware of the consequences of their actions and decisions.
Principles and Challenges of Informed Consent
In obtaining informed consent, the receiver must ensure that the consent-giver has received complete and comprehensive information about his condition and available treatment options, and establish how much he understood and assimilated the information received. Consent-givers, having received and considered reliable information, weigh all the benefits and consequences based on their own beliefs and interests (Dougherty, 2020). In case of refusal, the consent receiver must not pressure, intimidate, or try to force the consent-giver to change his point of view. The situation becomes more complicated when obtaining consent from a potentially incompetent person is required. The Starson case illustrates a situation in which a fundamental disagreement about patient competence arose between physicians and the Supreme Court of Canada (Collier & Haliburton, 2021).
The Supreme Court’s Ruling
The court, in this case, took the patient’s side and allowed him to determine the need for treatment, regardless of his particular mental state. In this decision, the court relied on several arguments regarding the vagueness of the criteria for incompetence for consent givers. Starson did not accept the diagnosis made by the specialists; however, he was aware of his symptoms and acknowledged their presence. He was also able to comprehend information about the proposed treatment and the consequences of refusing it. In the court’s view, this was sufficient to accept an informed waiver from the patient.
Personal Ethical Reflection
My opinion on this matter is the same as that of the Supreme Court of Canada. I do not believe that all patients with psychiatric diagnoses are competent enough to make serious decisions regarding their health. However, denying one’s diagnosis is not a sufficient reason to refuse the patient to accept his position (Joint Statement on Resuscitative Interventions, n.d.). One of the main criteria for the presence of a severe mental illness is the lack of criticism of one’s condition and the denial of symptoms. In such cases, it is not so important whether the patient admits the presence of a particular disease – his inability to assess the reality of his condition is a confirmation of incapacity in decision-making, at least temporarily (Pietrzykowski & Smilowska, 2021).
Reevaluating Competence and Risk
When a critical attitude towards his condition is restored, and a person begins to realize what is happening to him, it is no longer possible to call him completely incompetent. The task of the doctors was to establish how Scott Starson is oriented in his disease and is aware of the symptoms, and not pass a verdict of incapacity just because he denies the formulation of the diagnosis and does not believe that the treatment will be beneficial enough for him. It is also impossible to ignore the patient’s current level of danger to society and himself in the context of the Harm Principle. If there were cases that threatened the safety of the patient and others, then the situation would need to be considered from the standpoint of this principle.
Conclusion: Autonomy Amid Mental Illness
This court case is complicated from the point of view of medical ethics since it was necessary to evaluate many points and circumstances relating to the patient’s legal capacity. Nevertheless, despite the particularities of patients with mental illness, the principle of informed consent should apply to them, as well as to other patients. A pathological state of the psyche does not deprive a person of autonomy. Still, it only requires a more thorough evaluation of his state and caution in making decisions.
References
Collier, C., & Haliburton, R. (2021). Bioethics in Canada: A philosophical introduction (2nd ed.). Canadian Scholars, an imprint of CSP Books Inc.
Dougherty, T. (2020). Informed consent, Disclosure, and understanding. Philosophy & Public Affairs, 48(2), 119–150. Web.
Joint statement on Resuscitative Interventions . Canadian Medical Association. (n.d.). Web.
Pietrzykowski, T., & Smilowska, K. (2021). The reality of informed consent: Empirical studies on patient comprehension—systematic review. Trials, 22(1). Web.