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Competence of voluntary psychiatric patients to give valid consent to neuroleptic medication

  • Moli Paul (a1) and Femi Oyebode (a2)
Abstract
Aims and method

To ascertain the competence of voluntary psychiatric patients to consent to neuroleptic medication and whether there is a hierarchy of tests of competence. A prospective, observational study of consecutive, voluntary admissions to an acute ward using a questionnaire designed to test four levels of competence, the Mini-Mental State Examination and the Brief Symptom Inventory.

Results

All subjects (n=40) could communicate a choice; 5% were competent at all levels. Tests were arbitrary and not hierarchical. Symptom relief/trust in doctors motivated most decisions to accept treatment.

Clinical implications

The number and identity of individuals identified as competent will vary with the test set, and tests limited to cognitive criteria will not cover the complexity of the task.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Footnotes
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This paper formed part of the dissertation that won the Howard White Memorial Prize in 1998.

Footnotes
References
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Appelbaum, P. S. & Grisso, T. (1988) Assessing patients' capacities to consent to treatment. New England Journal of Medicine, 319, 1635 1638.
Department of Health & Welsh Office (1993) Code of Practice Mental Health Act 1983. London: HMSO.
Derogatis, L. R. & Melisaratos, N. (1983) The Brief Symptom Inventory: an introductory report. Psychological Medicine, 13, 595 605.
Folstein, F., Folstein, S. E. & McHugh, P. R. (1975) ‘Mini-Mental State’: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189 198.
Grant, L. (1998) Remind Me Who I Am, Again. London: Granta Books.
Law Commission (1993a) Mentally Incapacitated Adults and Decision-Making . A New Jurisdiction, Consultation Paper No. 128. London: HMSO.
Law Commission (1993b) Mentally Incapacitated Adults and Decision-Making . Medical Treatment and Research, Consultation Paper No. 129. London: HMSO.
Law Commission (1995) Mental Incapacity, Report 231. London: HMSO.
Lord Chancellors Office (1997) Who Decides? Making Decisions on Behalf of Mentally Incapacitated Adults. London: The Stationery Office.
Roth, L. H., Appelbaum, P. S., Sallee, R., et al (1982) The dilemma of denial in the assessment of competency to refuse treatment. American Journal of Psychiatry, 139, 910 913.
Silverman, W. A. (1989) The myth of informed consent: in daily practice and in clinical trials. Journal of Medical Ethics, 15, 6 11.
Smith, R. (1998) Informed consent: edging forwards (and backwards). British Medical Journal 316, 949 951.
Tancredi, L. (1982) Competency for informed consent. Conceptual limits of empirical data. International Journal of Law and Psychiatry, 5, 51 63.
L. v. Bournewood Communith and Mental Health Trust ex parte L. (1998) I, All ER, 634.
Sidaway v. Bethlem Royal Hospital Governors And Others (1985) 1, All ER.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Competence of voluntary psychiatric patients to give valid consent to neuroleptic medication

  • Moli Paul (a1) and Femi Oyebode (a2)
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