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1.
Tijdschr Psychiatr ; 63(10): 717-722, 2021.
Artigo em Holandês | MEDLINE | ID: mdl-34757610

RESUMO

BACKGROUND: In the new Compulsory Mental Health Care Act (Wvggz), patient competence has a more central position. AIM: To describe the new position of patient competence in the Wvggz and to reflect on related moral questions. METHOD: Discussion of relevant legal texts and publications. RESULTS: In case of incompetency of a patient, a surrogate decision-maker has to attempt what decision the patient would make if he or she were competent. A new element in the Wvggz is that grandparents and grandchildren can also act as surrogate decision-makers. A competency judgment is mandatory in every decision on involuntary treatment, with the exception of involuntarily commitment. Competent refusal of care has to be respected, unless the patient is in a life threatening situation or there is a risk of other people getting harmed. CONCLUSION: The question is whether the changed position of patient competence in the new law will contribute to the aim of maintaining and enhancing patients' autonomy. Due care in competency judgments is complex and remains important.


Assuntos
Tratamento Involuntário , Psiquiatria , Feminino , Humanos , Princípios Morais
2.
Int J Law Psychiatry ; 78: 101736, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34450485

RESUMO

Scottish mental health legislation includes a unique criterion for the use of compulsion in the delivery of mental health care and treatment. Under the Mental Health (Care and Treatment) (Scotland) Act, 2003, patients must exhibit 'significantly impaired decision-making ability' (SIDMA) in order to be eligible for psychiatric detention or involuntary psychiatric treatment outside the forensic context. The SIDMA requirement represents a distinctive strategy in ongoing international efforts to rethink the conditions under which psychiatric compulsion is permissible. We reconstruct the history of the Scottish SIDMA requirement, analyse its differences from so-called 'fusion law,' and then examine how the SIDMA standard actually functions in practice. We analyse 100 reports that accompany applications for Compulsory Treatment Orders (CTOs). Based on this analysis, we provide a profile of the patient population that is found to exhibit SIDMA, identify the grounds upon which SIDMA is attributed to individual patients, and offer an assessment of the quality of the documentation of SIDMA. We demonstrate that there are systemic areas of poor practice in the reporting of SIDMA, with only 12% of CTOs satisfying the minimum standard of formal completeness endorsed by the Mental Welfare Commission. We consider what lessons might be drawn both for the ongoing review of mental health legislation in Scotland, and for law reform initiatives in other jurisdictions.


Assuntos
Tratamento Involuntário , Transtornos Mentais , Humanos , Transtornos Mentais/terapia , Saúde Mental , Escócia
6.
Eur Psychiatry ; 64(1): e48, 2021 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-34233774

RESUMO

BACKGROUND: Coercion in psychiatry is a controversial issue. Identifying its predictors and their interaction using traditional statistical methods is difficult, given the large number of variables involved. The purpose of this study was to use machine-learning (ML) models to identify socio-demographic, clinical and procedural characteristics that predict the use of compulsory admission on a large sample of psychiatric patients. METHODS: We retrospectively analyzed the routinely collected data of all psychiatric admissions that occurred between 2013 and 2017 in the canton of Vaud, Switzerland (N = 25,584). The main predictors of involuntary hospitalization were identified using two ML algorithms: Classification and Regression Tree (CART) and Random Forests (RFs). Their predictive power was compared with that obtained through traditional logistic regression. Sensitivity analyses were also performed and missing data were imputed through multiple imputation using chain equations. RESULTS: The three models achieved similar predictive balanced accuracy, ranging between 68 and 72%. CART showed the lowest predictive power (68%) but the most parsimonious model, allowing to estimate the probability of being involuntarily admitted with only three checks: aggressive behaviors, who referred the patient to hospital and primary diagnosis. The results of CART and RFs on the imputed data were almost identical to those obtained on the original data, confirming the robustness of our models. CONCLUSIONS: Identifying predictors of coercion is essential to efficiently target the development of professional training, preventive strategies and alternative interventions. ML methodologies could offer new effective tools to achieve this goal, providing accurate but simple models that could be used in clinical practice.


Assuntos
Tratamento Involuntário , Psiquiatria , Internação Compulsória de Doente Mental , Hospitalização , Humanos , Aprendizado de Máquina , Estudos Retrospectivos
7.
J Am Acad Psychiatry Law ; 49(3): 361-370, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34187872

RESUMO

Anorexia nervosa is among the most lethal of all psychiatric illnesses and is increasingly prevalent in children and adolescents. There are limited treatment options specifically for youth with severe and enduring illness who decline treatment. Although treatment guidelines increasingly favor outpatient family-based treatments, there is a continued role for inpatient psychiatric treatment and involuntary commitment for high-risk patients. Providers may be reluctant to pursue involuntary treatment given its controversial nature, and differences in state's commitment laws complicate the development of clear guidelines for this approach. If parents also oppose treatment, providers must consider involving the child welfare system while balancing the impact of terminating parental rights upon long-term treatment outcomes. The case example of an adolescent with severe and enduring anorexia nervosa who opposed involuntary treatment, as did the legal guardian, highlights Washington's unique mental health laws for minors, which allow for temporary suspension of patient and guardian decision-making authority without terminating parental rights. The article discusses the ethics of involuntary treatment, the intersection of anorexia nervosa with the child welfare system, legal cases establishing commitment criteria for anorexia nervosa, and Washington's mental health laws for minors to inform the treatment approach for high-risk adolescents with severe and enduring anorexia nervosa.


Assuntos
Anorexia Nervosa , Tratamento Involuntário , Adolescente , Assistência Ambulatorial , Anorexia Nervosa/terapia , Criança , Humanos , Pacientes Internados , Menores de Idade
8.
Psychiatr Serv ; 72(11): 1276-1281, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34030455

RESUMO

OBJECTIVE: The United Nations Convention on the Rights of Persons with Disabilities (UN CRPD) has been broadly incorporated into national frameworks for compulsory psychiatric treatment. Recently, instructions issued by the UN CRPD Committee discouraged any involuntary treatment and detention of people with mental disabilities, which has sparked clinical, legal, and ethical debates. Early-career psychiatrists (ECPs) are often at the front line of decisions to involuntarily detain psychiatric patients; here, the authors surveyed ECPs to gain insight into their experiences with compulsory psychiatric treatment in clinical practice. METHODS: An anonymous, voluntary, online survey among ECPs from 43 countries was conducted between July and August 2019. RESULTS: In total, 142 ECPs completed and were eligible to participate in the survey. Most of the survey respondents reported being involved in the practice of compulsory psychiatric care. More than half reported difficulties in providing compulsory psychiatric care, mostly because of the bureaucracy of legal procedures (e.g., legal correspondence with the court) and ethical issues around detention. Most respondents (96%) generally agreed with their country's legal mechanism for compulsory treatment; 43% indicated that it should remain unchanged, and 53% indicated that it should be revised. CONCLUSIONS: These findings call for a broader discussion in society and among psychiatrists regarding the practice of compulsory treatment while giving due consideration to the legal, therapeutic, and ethical issues involved. The views of ECPs will be helpful in future revisions of the ethical and operational frameworks of compulsory psychiatric care.


Assuntos
Pessoas com Deficiência , Tratamento Involuntário , Transtornos Mentais , Psiquiatria , Internação Compulsória de Doente Mental , Humanos , Transtornos Mentais/terapia , Inquéritos e Questionários
9.
J Forensic Sci ; 66(4): 1201-1209, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34032278

RESUMO

Over 50,000 defendants are referred for competency to stand trial evaluations each year in the United States (Psychological evaluations for the courts: A handbook for mental health professionals and lawyers, New York, NY: The Guildford Press; 2018). Approximately 20% of those individuals are found by courts to be incompetent and are referred for "restoration" or remediation (Psychological evaluations for the courts: A handbook for mental health professionals and lawyers, 4th edn. New York, NY: The Guildford Press; 2018; Bull Am Acad Psychiatry Law. 1991;19:63-9). The majority of those incompetent defendants meet criteria for psychotic illnesses (J Am Acad Psychiatry Law. 2007;35:34-43). Forensic mental health professionals frequently have such patients/defendants decline recommended treatment with psychotropic medication. For a significant minority of defendants diagnosed with psychotic disorders, treatment with medication is thought to be necessary to restore their competency to stand trial. Without psychiatric intervention to restore competency, defendants may be held for lengthy and costly hospitalizations while criminal proceedings are suspended. In these situations, clinicians are guided by the Supreme Court decision, Sell v. United States (2003). The Sell opinion describes several clinical issues courts must consider when determining whether a defendant can be treated involuntarily solely for the purpose of restoring his/her competency. This paper offers some guidance to clinicians and evaluators who are faced with making recommendations or decisions about involuntary treatment. Using a question and answer format, the authors discuss data that support a decision to request, or not request, court authorization for involuntary treatment. Specifically, eight questions are posed for forensic evaluators to consider in determining the prognosis or viability of successful treatment and restoration. Finally, a clinical vignette is also presented to highlight important factors to consider in Sell-related evaluations.


Assuntos
Tratamento Involuntário/legislação & jurisprudência , Competência Mental/legislação & jurisprudência , Pessoas Mentalmente Doentes/legislação & jurisprudência , Antipsicóticos/uso terapêutico , Psicologia Forense , Humanos , Transtornos Mentais/terapia , Psicoterapia , Estados Unidos
10.
Lancet Child Adolesc Health ; 5(7): 501-512, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33930330

RESUMO

BACKGROUND: Disparities in involuntary psychiatric hospitalisation between population subgroups have been identified in adults, but little is known about the factors associated with involuntary hospitalisation in children or adolescents. We did a systematic review, meta-analysis, and narrative synthesis to investigate the social and clinical factors associated with involuntary psychiatric hospitalisation among children and adolescents. METHODS: We searched MEDLINE, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials for studies of any type up to July 22, 2020, that compared the characteristics of voluntary and involuntary psychiatric inpatients (mean age of sample ≤18 years). We synthesised results using random effects meta-analysis on unadjusted data and by narrative synthesis. Heterogeneity between studies was calculated using I2. This study is registered on PROSPERO, CRD42020099892. FINDINGS: 23 studies from 11 countries were included in the systematic review and narrative synthesis, of which 19 studies (n=31 212) were included in the meta-analysis. On meta-analysis, involuntary rather than voluntary hospitalisation of minors was associated with a diagnosis of psychosis (eight studies; odds ratio 3·63, 95% CI 2·43-5·44, p<0·0001), substance misuse (five studies; 1·87, 1·05-3·30, p=0·032), or intellectual disability (four studies; 3·33, 1·33-8·34, p=0·010), as well as presenting with a perceived risk of harm to self (eight studies; 2·05, 1·15-3·64, p=0·015) or to others (five studies; 2·37, 1·39-4·03, p=0·0015). Involuntary hospitalisation was also found to be associated with being aged 12 years or older (three studies; 3·57, 1·46-8·73, p=0·0052) and being from a Black rather than a White ethnic group (three studies; 2·72, 1·88-3·95, p<0·0001). There was substantial between-study heterogeneity for most factors included in the meta-analysis (I2 from 51·3% to 92·3%). Narrative synthesis found that more severe illness and poorer global functioning was associated with involuntary hospitalisation. INTERPRETATION: Over-representation of involuntary psychiatric hospitalisation in certain groups might begin in childhood, potentially establishing a cycle of inequality that continues into adulthood. Further research into the systemic factors underlying these health-care inequalities and the barriers to accessing less coercive psychiatric treatment is urgently required, with specific consideration of racial and ethnic factors. FUNDING: UK National Institute for Health Research and Wellcome Trust.


Assuntos
Tratamento Involuntário , Transtornos Mentais/terapia , Adolescente , Criança , Proteção da Criança , Disparidades em Assistência à Saúde , Humanos , Fatores Sociais
11.
Subst Abuse Treat Prev Policy ; 16(1): 33, 2021 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-33836785

RESUMO

BACKGROUND: In 2016, following a flurry of government inquiries and taskforces including calls for mandatory treatment regimes, the Australian community nominated methamphetamine as the drug most likely to be associated as a problem substance. Mandatory treatment for alcohol and other drug problems in Australia consists of broadly two mechanisms compelling a person into treatment: involuntary treatment or civil commitment regimes; and coercive treatment regimes, usually associated with the criminal justice system. This paper aims to provide a review of the evidence for mandatory treatment regimes for people who use methamphetamines. METHODS: Using a narrative review methodology, a comprehensive literature and citation search was conducted. Five hundred two search results were obtained resulting in 41 papers that had cited works of interest. RESULTS: Small, but robust results were found with coercive treatment programs in the criminal justice system. The evidence of these programs specifically with methamphetamine use disorders is even less promising. Systematic reviews of mandatory drug treatment regimes have consistently demonstrated limited, if any, benefit for civil commitment programs. Despite the growing popular enthusiasm for mandatory drug treatment programs, significant clinical and ethical challenges arise including determining decision making capacity in people with substance use disorders, the impact of self determination and motivation in drug treatment, current treatment effectiveness, cost effectiveness and unintended treatment harms associated with mandatory programs. CONCLUSION: The challenge for legislators, service providers and clinicians when considering mandatory treatment for methamphetamines is to proportionately balance the issue of human rights with effectiveness, safety, range and accessibility of both existing and novel mandatory treatment approaches.


Assuntos
Tratamento Involuntário , Metanfetamina , Transtornos Relacionados ao Uso de Substâncias , Austrália , Humanos , Programas Obrigatórios
12.
Rev Esp Geriatr Gerontol ; 56(4): 241-243, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-33771360

RESUMO

We had the opportunity to know a judicial decision in relation to a nonagenarian COVID-19 patient, which is clarifying regarding the complex issue of involuntary admission and involuntary treatment of the elderly. The judge authorized the involuntary admission but denied the possibility of imposing medical treatment against the will of the patient. This situation invites us to review the different types of involuntary admission that our legal system provides and how involuntary medical treatment is regulated according to its purpose and the patient's ability to decide. In the field of public health, the determining element to be able to impose any sanitary measure against the will of the patient is the risk to the health of the population. In the case presented, the judge rejects the possibility of authorizing medical treatment for not contributing anything from the point of view of public health. However, it does authorize involuntary admission as it is essential to guarantee isolation.


Assuntos
COVID-19/terapia , Internação Involuntária/legislação & jurisprudência , Tratamento Involuntário/legislação & jurisprudência , Idoso de 80 Anos ou mais , Tomada de Decisões , Direitos Humanos , Humanos , Jurisprudência , Masculino , Espanha
13.
Soc Psychiatry Psychiatr Epidemiol ; 56(11): 2017-2027, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33751175

RESUMO

PURPOSE: Few studies have focused on the experience of involuntary psychiatric hospitalization among youth, especially the impact of these experiences on engagement with mental health services post-discharge. In this study, we contribute to a deeper understanding of youth experiences of involuntary hospitalization (IH) and its subsequent impacts on trust, help-seeking, and engagement with clinicians. METHODS: The study utilized a grounded theory approach, conducting in-depth interviews with 40 youth and young adults (ages 16-27) who had experienced at least one prior involuntary hospitalization. RESULTS: Three quarters of the youth reported negative impacts of IH on trust, including unwillingness to disclose suicidal feelings or intentions. Selective non-disclosure of suicidal feelings was reported even in instances in which the participant continued to meet with providers following discharge. Factors identified as contributing to distrust included perceptions of inpatient treatment as more punitive than therapeutic, staff as more judgmental than empathetic, and hospitalization overall failing to meet therapeutic needs. Conversely, participants reporting more mixed experiences of hospitalization and simultaneously strong indirect benefits, including greater family support, diminished family judgement members and greater access to care. CONCLUSION: Findings draw attention to the ways in which coercive experiences may impact youth pathways to and through care. Additional research is needed to understand the impact of these experiences across larger samples, and their influence on downstream outcomes including engagement and long-term wellbeing. Finally, these data may inform the development and testing of inpatient and post-discharge interventions designed to mitigate potential harm.


Assuntos
Tratamento Involuntário , Confiança , Adolescente , Adulto , Assistência ao Convalescente , Hospitalização , Humanos , Alta do Paciente , Adulto Jovem
14.
Can J Public Health ; 112(3): 456-459, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33428116

RESUMO

As is the case across Canada, the province of British Columbia is in the midst of an opioid overdose crisis. In response to the devastating impacts of this crisis on youth (under 19 years of age), the provincial government is considering amending the Mental Health Act to allow for involuntary, hospital-based stabilization care of youth following an overdose. This policy change represents one concrete action that the provincial government is exploring in response to public advocacy for enhanced supports for youth who overdose. At this juncture, however, we are concerned that stabilization care requires further interrogation in the context of key, interrelated public health and ethical dimensions pertaining to this legislation. In this commentary, we describe three key areas for public health deliberation: (1) the evidence underpinning stabilization care, (2) ethical considerations, and (3) the potential for unintended and unevenly distributed consequences. We then offer ways forward to guide and provide opportunities for a more equitable public health response to the overdose crisis and its impacts on youth. In doing so, we emphasize the need for meaningful engagement of youth as key stakeholders in the development of evidence- and ethics-informed substance use care and policy interventions.


Assuntos
Overdose de Drogas , Tratamento Involuntário , Políticas , Adolescente , Colúmbia Britânica/epidemiologia , Overdose de Drogas/epidemiologia , Overdose de Drogas/terapia , Ética , Prática Clínica Baseada em Evidências , Humanos
15.
Psychiatr Serv ; 72(3): 302-310, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33430653

RESUMO

Psychiatry has a contentious history of coercion in the care of patients with mental illness, and legal frameworks often govern use of coercive interventions, such as involuntary hospitalization, physical restraints, and medication over objection. Research also suggests that informal coercion, including subtle inducements, leverage, or threats, is prevalent and influential in psychiatric settings. Digital technologies bring promise for expanding access to psychiatric care and improving delivery of these services; however, use and misuse of digital technologies, such as electronic medical record flags, surveillance cameras, videoconferencing, and risk assessment tools, could lead to unexpected coercion of patients with mental illness. Using several composite case examples, the author proposes that the integration of digital technologies into psychiatric care can influence patients' experiences of coercion and provides recommendations for studying and addressing these effects.


Assuntos
Tratamento Involuntário , Transtornos Mentais , Psiquiatria , Coerção , Internação Compulsória de Doente Mental , Tecnologia Digital , Humanos , Transtornos Mentais/terapia
16.
Soc Psychiatry Psychiatr Epidemiol ; 56(1): 85-95, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32719905

RESUMO

PURPOSE: Current RCT and meta-analyses have not found any effect of community treatment orders (CTOs) on hospital or social outcomes. Assumed positive impacts of CTOs on quality-of-life outcomes and reduced hospital costs are potentially in conflict with patient autonomy. Therefore, an analysis of the cost and quality-of-life consequences of CTOs was conducted within the OCTET trial. METHODS: The economic evaluation was carried out comparing patients (n = 328) with psychosis discharged from involuntary hospitalisation either to treatment under a CTO (CTO group) or voluntary status via Section 17 leave (non-CTO group) from the health and social care and broader societal perspectives (including cost implication of informal family care and legal procedures). Differences in costs and outcomes defined as quality-adjusted life years (QALYs) based on the EQ-5D-3L or capability-weighted life years (CWLYs) based on the OxCAP-MH were assessed over 12 months (£, 2012/13 tariffs). RESULTS: Mean total costs from the health and social care perspective [CTO: £35,595 (SD: £44,886); non-CTO: £36,003 (SD: £41,406)] were not statistically significantly different in any of the analyses or cost categories. Mental health hospitalisation costs contributed to more than 85% of annual health and social care costs. Informal care costs were significantly higher in the CTO group, in which there were also significantly more manager hearings and tribunals. No difference in health-related quality of life or capability wellbeing was found between the groups. CONCLUSION: CTOs are unlikely to be cost-effective. No evidence supports the hypothesis that CTOs decrease hospitalisation costs or improve quality of life. Future decisions should consider impacts outside the healthcare sector such as higher informal care costs and legal procedure burden of CTOs.


Assuntos
Serviços Comunitários de Saúde Mental , Tratamento Involuntário , Transtornos Psicóticos , Análise Custo-Benefício , Humanos , Transtornos Psicóticos/terapia , Qualidade de Vida
17.
Am J Emerg Med ; 45: 242-247, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33041112

RESUMO

BACKGROUND: As the United States' population ages, the health care system will experience overall change. This study aims to identify factors in the older adult that may contribute to involuntary hold status in the ED. METHODS: This study is a retrospective review conducted at a suburban acute-care hospital ED of adult patients evaluated while on involuntary hold from January 1, 2014, through November 30, 2015. Older adults (patients born on or before 06/31/1964) were compared to younger adults (born on or after 07/01/1964) according to demographic and clinical variables including medical comorbidity, ED length of stay, reason for involuntary hold, psychiatric disorder, suicide attempt, substance use disorder, serum alcohol level, urine drug testing, medical comorbidity, violence in the ED, 30-day ED readmission, and 30-day mortality. RESULTS: Of 251 patients, 90 (35.9%) were older adults. The most common reason for involuntary hold in both cohorts was suicidal ideation. Medical comorbidities were more prevalent in older adults [60 (66.7%) vs. 64 (39.8%), P ≤.0001]. Older adults were less likely to report current drug abuse [31 (34.4%) vs. 77 (47.8%), P = .04]. The most commonly misused substance in both groups was alcohol; however, despite similar rates, blood alcohol levels (BAC) and urine drug screen (UDS) were performed less often in older adults. Cohorts were not significantly different with respect to sex, race, violence in the ED, psychiatric diagnosis, and ED LOS. CONCLUSIONS: Involuntary older adult patients present with medical comorbidities that impact mental health. In the ED, they are less likely report substance use, and drug screening may be underutilized. Medical needs make their care unique and may present challenges in transfer of care to inpatient psychiatric facilities.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Tratamento Involuntário , Idoso , Idoso de 80 Anos ou mais , Internação Compulsória de Doente Mental/estatística & dados numéricos , Comorbidade , Feminino , Humanos , Masculino , Competência Mental , Política Organizacional , Estudos Retrospectivos , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , Estados Unidos , Violência/estatística & dados numéricos
19.
Int J Law Psychiatry ; 73: 101634, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33068843

RESUMO

The Convention on the Rights of Persons with Disabilities (2006) (CRPD) has been instrumental for initiating and shaping the reform of mental health legislation in many countries, including the eight Australian jurisdictions. Multiple approaches have been proposed to assess and monitor the compliance of States Parties' mental health legislation with the CRPD, and to evaluate its success in protecting and promoting the human rights of people with disabilities. This article reports an effort to index the impact of legislation on human rights by measuring changes in the prevalence of compulsory treatment orders applied to people with mental illness after the introduction of CRPD influenced mental health legislation in the Australian state of Queensland. We found that despite reforms intended to enhance patient autonomy, the prevalence of compulsory treatment orders increased after implementation of the new legislation. Possible reasons behind this unintended consequence of the legislative reform may include a lack of systematized voluntary alternatives to compulsory treatment, a paternalistic and restrictive culture in mental health services and risk aversion in clinicians and society. We recommend that the reforms in mental health policy as well as legislation need to go further in order to achieve the goals embodied in the human rights framework of the CRPD.


Assuntos
Pessoas com Deficiência/legislação & jurisprudência , Direitos Humanos/legislação & jurisprudência , Tratamento Involuntário/classificação , Tratamento Involuntário/legislação & jurisprudência , Tratamento Involuntário/estatística & dados numéricos , Transtornos Mentais/terapia , Saúde Mental/legislação & jurisprudência , Política de Saúde , Humanos , Direitos do Paciente/legislação & jurisprudência , Autonomia Pessoal , Prevalência , Queensland/epidemiologia
20.
Int J Law Psychiatry ; 71: 101598, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32768119

RESUMO

The duty of care concept is a common law legal principle which underpins all healthcare interactions. However, evidence within the Australian context suggests misuse of this common law principle as a justification for non-consensual coercive treatment. Misuse seems to occur particularly where patients have impaired decision-making capacity and/or refuse treatment. In this article, we discuss the emerging evidence of misuse, which arguably reflects healthcare practitioner confusion between the doctrines of 'duty of care' and 'necessity', and posit that cognisance of lawful substitute consent processes are lacking. We then discuss the concept of duty of care as an obligation, as opposed to a power, before presenting the elements of a valid consent and legislation relating to substitute consent, which allow health practitioners to proceed with treatment. We conclude this article with a discussion of the circumstances where treatment may be given without consent.


Assuntos
Coerção , Consentimento Livre e Esclarecido/legislação & jurisprudência , Tratamento Involuntário/legislação & jurisprudência , Padrão de Cuidado , Austrália , Humanos
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