Capacity to consent to treatment in psychiatry inpatients – a systematic review
Review Article
Aoife Curley, Carol Watson, Brendan D. Kelly
International Journal of Psychiatry in Clinical Practice, 23 December 2021
Abstract
Background
Mental capacity for treatment decisions in psychiatry inpatients is an important ethical and legal concern, especially in light of changes in mental capacity legislation in many jurisdictions.
Aims
To conduct a systematic review of literature examining the prevalence of mental capacity for treatment decisions among voluntary and involuntary psychiatry inpatients, and to assess any correlations between research tools used to measure mental capacity and binary judgements using criteria such as those in capacity legislation.
Method
We searched PsycINFO, Ovid MEDLINE and EMBASE for studies assessing mental capacity for treatment decisions in people admitted voluntarily and involuntarily to psychiatric hospitals.
Results
Forty-five papers emanating from 33 studies were identified. There was huge variability in study methods and often selective populations, but the prevalence of decision-making capacity varied between 5% and 83.7%. These figures resulted from studies using cut-off scores or categorical criteria only. The prevalence of decision-making capacity among involuntary patients ranged from 7.7% to 42%, and among voluntary patients ranged from 29% to 97.9%. Two papers showed positive correlations between clinicians’ judgement of decision-making capacity and scores on the MacArthur Competence Assessment Tool for Treatment; two papers showed no such correlation.
Conclusions
Not all voluntary psychiatry inpatients possess mental capacity and many involuntary patients do. This paradox needs to be clarified and resolved in mental health legislation; supported decision-making can help with this task.
Doing research with intellectually disabled participants: reflections on the challenges of capacity and consent in socio-legal research
Doing research with intellectually disabled participants: reflections on the challenges of capacity and consent in socio-legal research
Rosie Harding
Journal of Law and Society, 16 December 2021
Abstract
In this article, I reflect on the praxis of doing qualitative interview research involving intellectually disabled people as participants. I explore the ways in which ethical and legal norms work together to shape what is possible in research with intellectually disabled participants. I use stories from the field to explore issues of recruitment and sampling, working with ‘gatekeeper’ organizations, accessible information and informed consent, and data sharing and open access. As these reflections demonstrate, undertaking fieldwork involving intellectually disabled participants presents multiple challenges for socio-legal researchers. They also show that many of the challenges are surmountable, offering concerns, considerations, and solutions that can, and perhaps should, be considered by all socio-legal researchers who wish to ensure that all of the voices of society are included and reflected in their research.
Doctors’ knowledge regarding decision-making capacity: A survey of anesthesiologists
Doctors’ knowledge regarding decision-making capacity: A survey of anesthesiologists|
Research Article
Alastair Moodley, Ames Dhai
Clinical Ethics, 6 December 2021
Abstract
Informed consent for anesthesia is an ethical and legal requirement. A patient must have adequate decision-making capacity (DMC) as a prerequisite to informed consent. In determining whether a patient has sufficient DMC, anesthesiologists must draw on their knowledge of DMC. Knowledge gaps regarding DMC may result in incorrect assessments of patients’ capacity. This could translate to an informed consent process that is ethically and legally unsound. This study examined the DMC-related knowledge of anesthesiologists in a group of four university-affiliated hospitals. The findings suggest that anesthesiologists have several areas of knowledge deficiency regarding DMC and DMC assessment. These findings could inform the development of undergraduate and postgraduate curricula.
The introduction of electronic consent for the school aged immunization program
The introduction of electronic consent for the school aged immunization program
Rebecca Footer, Owen Foster
Public Health Nursing, 8 December 2021
Abstract
Historically, consent for treatment in the United Kingdom’s National Health Service has been collected using traditional paper forms. For public health services, such as immunizations, this process involved significant time, space, paper, and staff resources. In a bid to provide a more modern, secure, cost-effective and paperless service, an electronic consent (eConsent) form for the routine school aged immunization program was designed and successfully piloted for the HPV 1 vaccine in 25 schools during the summer of 2019, with an average of 80% return rate. This was not only significantly higher than paper consent returns, there was also a significantly quicker return rate. These factors resulted in the clinical record being updated more quickly than ever before which reduced clinical risk. Following the pilot, the program was launched countywide for all school aged immunizations in September 2020. Since its launch some minor issues have been identified but resolved quickly and efficiently. Although still in its early days it is felt that the eConsent system has promoted a more informed and easier collaboration across sectors and has reduced operating costs. Although the use of electronic consent needs to be used more widely, it is felt that this new practice is a success.
The ethical‐legal requirements for adolescent self‐consent to research in sub‐Saharan Africa: A scoping review
The ethical‐legal requirements for adolescent self‐consent to research in sub‐Saharan Africa: A scoping review
Busisiwe Nkosi, Brian Zanoni, Janet Seeley, Ann Strode
Bioethics, 14 October 2021
Open Access
Abstract
Support for the enrolment of adolescents in research has been constrained by uncertainties in parental involvement, and the lack of clarity in the ethical and legal frameworks. We conducted a scoping review to examine articles that explored the opinion of scholars on the question of adolescent consent and conditions for parental waivers in research in sub‐Saharan Africa (SSA). Guided by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) tool, we searched electronic databases (PubMed, EMBASSE, EBSCOHOST) and also reviewed the references of articles identified for additional relevant literature. We included full text English articles focusing on adolescent consent and parental waivers in SSA that were published between 2004 and 2020. We excluded studies focusing on healthcare, theses, and reviews. We reviewed a total of 21 publications from South Africa (n = 12), Kenya (n = 4) and Botswana, Malawi, Nigeria, Uganda and Zimbabwe (n = 1 each). We identified four broad thematic issues: the current position regarding parental waivers and self‐consent; parental involvement in the consent process; the role of community approval or consent when adolescent self‐consent approaches were used; and complexities and ambiguities in legal requirements and ethical guidelines on adolescent consent. Our findings show inconsistencies and ambiguities in the existing legal and ethical frameworks within and across different countries, and underscore the need for consistent and clearer guidance on parental waivers and adolescent self‐consent. Harmonization of the legal and ethical frameworks taking into account varying contexts is critically important to ensure research on adolescents in SSA meets adolescents’ specific unmet needs.
Bell v Tavistock: Rethinking informed decision-making as the practical device of consent for medical treatment
Bell v Tavistock: Rethinking informed decision-making as the practical device of consent for medical treatment
Research Article
Abeezar I. Sarela
Clinical Ethics, 27 December 2021
Abstract
The decision of the High Court in Bell v Tavistock has excited considerable discussion about lawful consent for puberty-blocking drug treatment for children with gender dysphoria. The present paper draws attention to a wider question that surfaces through this case: is informed decision-making an adequate practical tool for seeking and obtaining patients’ consent for medical treatment? Informed decision-making engages the premises of the rational choice theory: that people will have well-crystallised health goals; and, if they are provided with sufficient information about medical treatments, then they will be able to choose the treatment that satisfies their goals. Whilst appealing, the informed decision-making paradigm is assailed by various fallacies, which apply not only to children but also to adults. In Bell v Tavistock, the High Court seems to have recognised such fallacies, and it rejected informed decision-making as an adequate tool for consent from children with gender dysphoria. Similar considerations apply to adults in various situations. Thus, Bell v Tavistock can be seen as an attempt to refine the views on the consent that were expressed by the Supreme Court in Montgomery. It can be inferred that the Supreme Court did recognise the limitations of informed decision-making, but it did not develop this point. Further work is required to formulate an adequate model of decision-making, and Bell v Tavistock serves as a useful reminder to rethink informed decision-making as the device for consent.
Informed Consent for Surgical Care in East Africa
Informed Consent for Surgical Care in East Africa
Richard Wismayer
Journal of Advances in Medicine and Medical Research, 13 December 2021
Open Access
Abstract
In the developed world one of the pillars of ethical conduct in surgical practise is informed surgical consent. In low income developing countries only a few researchers have explored the practise of surgical consent pre-operatively. During the informed consent process, the patient has a right to make an autonomous and independent decision about his/her surgical treatment after having been provided the necessary information by the surgeon caring for the patient. Patient autonomy and independent decision-making is recommended by the World Medical Association (WMA) Declaration of Lisbon. Family and cultural background, education, religion and socioeconomic status may all influence informed consent in surgical practise. In East Africa, few studies have reviewed consent practises among surgeons to document best surgical practise and identify areas that need improvement in the East African setting. This review reports the author’s personal experience of the practise of surgical consent among surgeons in Uganda and reviews the specific challenges faced in East Africa. In Uganda, the administration and documentation of informed consent is still inadequate. Better medical ethics education and proper communication skills training in medical schools needs to be addressed. Refresher courses on medical ethics and communication skills may also be necessary for fully trained surgeons.
Patient’s knowledge, attitudes and practices on informed consent in a clinical setting; A study done at Colombo North Teaching Hospital in Sri Lanka
Patient’s knowledge, attitudes and practices on informed consent in a clinical setting; A study done at Colombo North Teaching Hospital in Sri Lanka
Research Article
N. S. Perera, B. P. P. Perera, P. Paranitharan
Sri Lanka Journal of Forensic Medicine, Science & Law, 3 December 2021; 12(2) pp 11-18
Abstract
Introduction
The signing of a consent form is a process with legal and ethical implications. It is required that informed written consent be obtained from a patient for an invasive procedure after proper explanation of the risks, benefits and alternative procedures.
Objective
To determine knowledge, attitudes and practices related to informed consent among patients.
Materials and Methods
A cross sectional descriptive study was carried out over a period of one year in a Tertiary care hospital in Sri Lanka. The participants were medical or surgical inward patients who were 18 years or above, who had consented to invasive procedure or surgery. The quantitative data of 420 patients were analyzed.
Results
Majority (96%) agreed that consent is important in medical practice. Many (61%) were of the view that it helps to make an informed decision. Majority (92%) preferred a doctor, who can explain more in the consent process than a nursing officer (11%). However, 61% were of the view that consent should be taken from the patient and relatives both, even if the patient is competent of giving consent. Majority of the participants (84%) wanted to discuss with family members before giving consent.
Conclusion
Majority of patients were aware of the concept of consent in medical practice and preferred the doctor and family members to be involved in the decision-making process. This finding is important to adopt a doctor-patient-family model in the consent taking process while respecting the patient’s wishes.
Virtual consent and the use of electronic informed consent form in clinical research in Brazil
Virtual consent and the use of electronic informed consent form in clinical research in Brazil
Original Article
Juliana Carvalho Rocha Alves da Silva, Helaine Carneiro Capucho
Revista da Associação Médica Brasileira, November 2021; 67(11)
Summary
Objective
In view of the need to apply term free and informed consent (IC) in clinical research involving humans, in accordance with the Brazilian ethical standards (CNS Resolution No. 466/2012), it is necessary to assess whether this practice is being effective and can be improved. The aim of this study was to evaluate the use of the IC in electronic format (e-IC), regarding its feasibility and suitability, as a complement to the written/physical consent form.
Methods
Quantitative-qualitative research with a questionnaire instrument.
Results
Greater retention of information and fewer wrong answers were observed after the application of the e-IC.
Conclusions
The use of e-IC is of great value to research participants in Brazil.
Knowledge on Informed Consent for Blood Transfusion Among Patients in Hospital Melaka and Its Associated Factors
Knowledge on Informed Consent for Blood Transfusion Among Patients in Hospital Melaka and Its Associated Factors
Original Article
Mohd Hilmi Senin, Bakiah Shaharuddin, Nor Amiza Mat Amin, Mastura Sopian
Malaysian Journal of Medicine and Health Sciences, November 2021; pp 22-31
Open Access
Abstract
Introduction
To perform blood transfusion, a physician should obtain informed consent from the patient. However, previous studies have shown a poor transfer of knowledge from the doctor to the patient regarding blood transfusion, with conflicting information as recollected by patients from informed consent discussions. This study aims to describe knowledge of informed consent for blood transfusion from the patients’ perspective.
Methods
A cross-sectional study was performed from October 2019 to May 2020 at Hospital Melaka. The instrument used in this study was a structured, validated questionnaire written in the Malaysian language. Respondents aged 18 and above, who had given their consent for blood transfusion within three days, were recruited using purposive sampling. Logistic regression was used to investigate potential predictors for good knowledge.
Results
Data analysis was performed on 239 sets of returned questionnaires, which showed that 85.8% of the respondents had good knowledge scores. Additionally, 94.1% of them were aware that informed consent is mandatory before the blood transfusion procedure. The lowest percentage of correct responses (43.9%) was regarding the timing of the informed consent. Respondents with a history of undergoing transfusion more than once (AOR = 2.18; 95% CI = 1.02, 4.65; p = 0.04), and practicing Buddhism as a religion (AOR = 0.36; 95% CI = 0.15–0.86; p = 0.02) showed significant associations with knowledge.
Conclusion
The respondents in this study were relatively knowledgeable about informed consent for blood transfusion. However, further analysis revealed the deficiency of knowledge among the respondents in several aspects of this topic. The findings can help Malaysian health authority plan for interventions that would improve knowledge of informed consent on blood transfusion among patients and the public.
Center for Informed Consent Integrity 