Implementing Electric Consent Aimed at People Living with Dementia and Their Caregivers: Did We Forget Those Who Forget?
Yvonne O’ Connor, Ian Twohig, Leona O’ Brien
Proceedings of the 54th Hawaii International Conference on System Sciences, 2021
Open Access
Abstract
As policy flows down from law and/or regulation (e.g. GDPR) our individual privacy concerns give rise to demands on improving accessibility, awareness and comprehension, the topic of eConsent is becoming more prevalent. We provide a critical voice by considering, but also challenging, the underlying assumptions that the status quo of eConsent design and implementation is appropriate for all people in society. By answering “what eConsent characteristics are prevalent in the context of dementia applications?”, this paper identifies that the “one size fits all” ethos for eConsent is not applicable in every context. As a result, a taxonomy that depicts the multifaceted concept of eConsent is proposed. It makes us aware of the different ethical, legal, social and technical implications of ICT use and provides an opportunity to create discourse in this area. It argues that future research examining the effectiveness of innovative ICTs must take the eConsent process into account.

How should the ‘privilege’ in therapeutic privilege be conceived when considering the decision-making process for patients with borderline capacity?
Original Research
Sumytra Menon, Vikki Entwistle, Alastair Vincent Campbell, Johannes J M van Delden
BMJ Medical Ethics, 22 December 2020
Open Access
Abstract
Therapeutic privilege (TP) is a defence that may be available to doctors who fail to disclose to the patient relevant information when seeking informed consent for treatment if they have a reasonable belief that providing that information would likely cause the patient concerned serious physical or mental harm. In a landmark judgement, the Singapore Court of Appeal introduced a novel interpretation of TP, identifying circumstances in which it might be used with patients who did not strictly lack capacity but might be inclined to refuse recommended treatments. In this paper, we explore the conceptual and practical challenges of this novel interpretation of TP. We propose that more emphasis should be placed on forms of shared and supported decision-making that foster the autonomy of patients with compromised mental capacity while being mindful of the need to safeguard their well-being. The kind of privilege that doctors might need to invoke is one of time and supportive expertise to ensure a flexible, responsive approach calibrated to the individual patients’ needs. The provision of such service would extinguish the need for the novel TP proposed by the Singapore Court of Appeal.

[Capacity to consent of people with dementia : Insights into the S2k AWMF guidelines 108-001]
J Haberstroh, VA Tesky, J Pantel
Journal of Gerontology and Geriatrics, 7 December 2020
Abstract
People with dementia often require medical and nursing care and are regularly confronted with the need to make decisions in this respect; however, in practice uncertainty often exists as to whether a person with dementia is capable of providing consent, what procedures should be used to obtain informed consent, how to provide the necessary information and how capacity to consent can be assured. By providing structured practical recommendations, the S2k guidelines “Consent of persons with dementia to medical treatment” (coordinated by the Association of the Scientific Medical Societies of Germany, AWMF, registration number 108-001) provide a first attempt to summarize and update the relevant medical, legal, ethical and psychological requirements that should be satisfied in this respect. This article enables insights into the guidelines and an overview of the most important recommendations.

Editor’s note: This is a German Language Publication

Ethics of Informed Consent, Coercive and Preventive Medication
Hanfried Helmchen
NeuroPsychopharmacotherapy, 5 December 2020; pp 1-16
Abstract
Acknowledgement of human rights and its translation into psychiatric action is an increasingly extensive achievement of the past decades. Orientation towards the individual patient means to recognize both his/her right and capacity of self-determination as well as to consider his/her preferences. This is particularly valid in the use of psychotropic medication in problematic situations such as in coercive and in preventive medication. In view of coercive medication in life-threatening psychiatric emergencies, psychiatrists must convert a seemingly antagonism between respecting the autonomy of the mentally ill and their obligation to care into an ethically acceptable complementary solution. Medication for primary prevention confronts the psychiatrist with difficulties of informing an (almost) healthy individual in view of uncertainties of conversion rates in schizophrenia as well as of lacking drugs with satisfying efficacy in dementia. The application of psychotropic drugs in such cases is often only the last choice due to their questionable or low efficiency, unwanted effects, and other preferences of the comprehensively informed patient.