Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-22T08:53:28.087Z Has data issue: false hasContentIssue false

Consent to Neuroleptic Medication for Schizophrenia: Clinical, Ethical and Legal Issues

Published online by Cambridge University Press:  02 January 2018

Clare Brabbins*
Affiliation:
Scott Clinic
Jonathan Butler
Affiliation:
Chambers of David Harris, QC, 3rd and 4th Floor, Peel House, 5–7 Harrington Street, Liverpool L2 9XN
Richard Bentall
Affiliation:
Department of Clinical Psychology, Whelan Building, University of Liverpool, PO Box 147, Liverpool L69 3BX
*
Dr Clare Brabbins, Scott Clinic, Rainhill Road, St Helens, Merseyside L35 4PQ

Abstract

Background

The effects of neuroleptic medication on schizophrenic patients are both positive (reduction in symptoms) and negative (adverse side-effects). Given that altered cognitive functioning may be a feature of schizophrenia, the use of neuroleptics raises important ethical and legal issues.

Method

A selective review was carried out of papers addressing ethical arguments for and against obtaining consent from schizophrenic patients, and the ethical and legal requirements which must be met for consent to occur.

Results

Although a balance must be met between arguments for and against obtaining consent, clinicians should seek informed consent in all but exceptional circumstances. Obtaining consent depends on the adequate presentation of information, the absence of duress and the patients' capacity to consent. Various tests of capacity to consent have been proposed.

Conclusions

It is proposed that clinicians employ a proforma to record attempts to obtain informed consent during routine clinical practice.

Type
Review Article
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Appelbaum, P. S., Mirkin, S. A. & Bateman, A. L. (1981) Empirical assessment of competency to consent to psychiatric hospitalisation. American Journal of Psychiatry, 138, 11701176.Google Scholar
Appelbaum, P. S., & Roth, L. H. (1981) Clinical issues in the assessment of competency. American Journal of Psychiatry, 138, 14621467.Google ScholarPubMed
Appelbaum, P. S., & Grisso, T. (1988) Assessing patients' capacities to consent to treatment. The New England Journal of Medicine, 319, 16351638.Google Scholar
Beck, J. C. & Staffin, R. D. (1986) Patients' competency to give informed consent to medication. Hospital and Community Psychiatry, 37, 400402.Google Scholar
Brahams, D. (1985) Doctor's duty to inform patients of substantial or special risks when offering treatment. Lancet, 1, 528530.CrossRefGoogle ScholarPubMed
Department of Health and the Welsh Office (1993) Mental Health Act 1983 Code of Practice. London: HMSO.Google Scholar
Finn, S. E., Bailey, J. M., Schultz, R. T., et al (1990) Subjective utility ratings of neuroleptics in treating schizophrenia. Psychological Medicine, 35, 843848.Google Scholar
Gillon, R. (1986) Philosophical Medical Ethics. Chichester: Wiley.Google Scholar
Grossman, L. & Summers, F. (1980) A study of the capacity of schizophrenic patients to give informed consent. Hospital and Community Psychiatry, 31, 205206.Google ScholarPubMed
Gunn, M. (1994) The meaning of incapacity. Medical Law Review, 2, 829.CrossRefGoogle ScholarPubMed
Ingelfinger, F. J. (1972) Informed (but uneducated) consent. New England Journal of Medicine, 287, 465466.Google Scholar
Janofsky, J. S., McCarthy, R. J. & Folsrein, M. F. (1992) The Hopkins competency assessment test: A brief method for evaluating patients' capacity to give informed consent. Hospital and Community Psychiatry, 43, 132136.Google Scholar
Kleinman, I., Schacter, D. & Koritar, E. (1989) Informed consent and tardive dyskinesia. American Journal of Psychiatry, 146, 902904.Google ScholarPubMed
Law Commission (1993) Mentally Incapacitated Adults and Decision-Making: Medical Treatment and Research (Consultation Paper 129). London: HMSO.Google Scholar
Medical Defence Union (1992) Consent to Treatment. London: Medical Defence Union.Google Scholar
Medical Protection Society (1991) Consent and Confidentiality. London: Medical Protection Society.Google Scholar
Meisel, A. & Roth, L. H. (1981) What we do and do not know about informed consent. Journal of the American Medical Association, 246, 24732477.Google Scholar
Munetz, M. R. & Roth, L. H. (1985) Informing patients about tardive dyskinesia. Archives of General Psychiatry, 42, 866871.Google Scholar
Quaid, K. A., Faden, R. R., Vining, E. P., et al (1990) Informed consent for a prescription drug: Impact of disclosed information on patient understanding and medical outcomes. Patient Education and Counselling, 15, 249259.Google Scholar
Rogers, A., Pilgrim, D. & Lacey, R. (1993) Experiencing Psychiatry: Users' Views of Services. London: Macmillan/MIND Publications.CrossRefGoogle Scholar
Roth, L. H., Meisel, A. & Lidz, C. (1977) Tests of competency to consent to treatment. American Journal of Psychiatry, 134, 279284.Google Scholar
Schwartz, H. I., Vingiano, W. & Perez, C. D. (1988) Autonomy and the right to refuse treatment: Patients' attitudes after involuntary medication. Hospital and Community Psychiatry, 39, 10491054.Google ScholarPubMed
Tyrer, P., Smith, J. & Adshead, G. (1994) Ethical dilemmas in drug treatments. Psychiatric Bulletin, 18, 203204.CrossRefGoogle Scholar
Submit a response

eLetters

No eLetters have been published for this article.