Consenting not to be informed: a survey on the acceptability of placebo use in the treatment of depression.

The aim of this study was to investigate the opinions of healthy students regarding the acceptability of placebo treatment if they were to experience depression. A survey was conducted among 344 students in five academic centers in Israel. After a thorough explanation of the placebo effect, its efficacy and limitations in the treatment of depression, the study participants completed a 32-item self-report questionnaire. Seventy percent (n = 243) of the participants answered that they would agree to treatment with a placebo as a first-line treatment if they were to experience depression in the future. Eighty-eight percent (n = 297) of the subjects did not think that a physician who administered placebos was deceitful. Once aware of the possible benefits and limitations of placebo treatment, most of our study population was willing to accept placebo as a legitimate treatment of depression. Additional studies on the possible use of placebo as an effective, safe, and acceptable form of therapy are warranted.

Ethical dilemmas of Statutory Committees for involuntary hospitalization of mentally ill patients.

Mentally ill patients whose reality judgements are severely impaired by reason of their illness and consequently present a danger to themselves and others, may be involuntarily admitted to a secure psychiatric ward for the safety of both themselves and the public. The Israeli Statute for the Treatment of Mentally Ill Patients, enacted in 1955 and amended in 1991, sets out rules and procedures for such involuntary confinement, and grants authority to the MOH District Psychiatrist to issue initial involuntary admission orders. However, a patient can appeal a District Psychiatrist order before a judicial statutory committee, comprising two senior psychiatrists and a legal expert in the capacity of magistrate. Such committee is also the statutory forum for determining whether involuntary hospitalization should be extended. The committee may quite often face ethical dilemmas when, on the one hand, there is no question that the patient's judgement is severely impaired but on the other hand, his/her condition does not fully meet the criteria of the statutory requirements for involuntary confinement. This paper discusses the legal aspects and requirements of involuntary admissions vis-a-vis the ethical dilemmas that such Statutory Committees may face when deciding to extend hospitalization or to release the patient from committal. The paper shall also illustrate dilemmas actually brought before the Committee that have ended in a final ruling that balances moral ethical dilemmas with the strict statutory requirements.

Live donor transplantation--the incompetent donor: comparative law.

Informed consent of the patient to medical treatment is an essential prerequisite for any invasive medical procedure. However in emergency cases, when the patient is unable to sign a consent form due to unconsciousness or to psychotic state, than the primary medical consideration shall take place. In such a case, in order to save life or even prevent a major medical hazard to the patient, doctors are allowed, in certain cases and in accordance with well accepted medical practice, to perform invasive procedures, major surgery or risky pharmacological treatment, without the explicit consent of the patient. All the above refers to the cases when avoidance of such non-consented treatment may harm severely the health and wellbeing of the patient and there is no doubt that such treatment is for the ultimate benefit of the patient. The question, however, shall arise when such a medical procedure is not necessarily for the benefit of the patient, but rather for the benefit of somebody else. Such is the case in the transplantation area and the question of living donor-donee relationship. This paper shall analyze the legal situation in cases of non competent donors whose consent cannot be considered legal consent given in full understanding and out of free will. It will also compare three legal systems, the Israeli, the American and the traditional Jewish law, with regard to the different approaches to this human problem, where the autonomy of the donor may be sacrificed for the purpose of saving life of another person.