Depression and decision-making capacity for treatment or research: a systematic review

BMC Medical Ethics

Gareth S Owen¹  Matthew Hotopf¹  Thomas Hindmarch² 

[1] Department of Psychological Medicine, Institute of Psychiatry, King’s College London, Weston Education Centre, London SE5 9RJ, UK;King’s College London, London, UK

关键词: Mental capacity;    Mental competency;    Competence;    Informed consent;    Decision-making;    Depressed;    Depressive disorder;    Depression;   

Others  :  799620
DOI  :  10.1186/1472-6939-14-54

 received in 2012-11-07, accepted in 2013-11-26,  发布年份 2013

【 摘 要 】

Background

Psychiatric disorders can pose problems in the assessment of decision-making capacity (DMC). This is so particularly where psychopathology is seen as the extreme end of a dimension that includes normality. Depression is an example of such a psychiatric disorder. Four abilities (understanding, appreciating, reasoning and ability to express a choice) are commonly assessed when determining DMC in psychiatry and uncertainty exists about the extent to which depression impacts capacity to make treatment or research participation decisions.

Methods

A systematic review of the medical ethical and empirical literature concerning depression and DMC was conducted. Medline, EMBASE and PsycInfo databases were searched for studies of depression and consent and DMC. Empirical studies and papers containing ethical analysis were extracted and analysed.

Results

17 publications were identified. The clinical ethics studies highlighted appreciation of information as the ability that can be impaired in depression, indicating that emotional factors can impact on DMC. The empirical studies reporting decision-making ability scores also highlighted impairment of appreciation but without evidence of strong impact. Measurement problems, however, looked likely. The frequency of clinical judgements of lack of DMC in people with depression varied greatly according to acuity of illness and whether judgements are structured or unstructured.

Conclusions

Depression can impair DMC especially if severe. Most evidence indicates appreciation as the ability primarily impaired by depressive illness. Understanding and measuring the appreciation ability in depression remains a problem in need of further research.

【 授权许可】

   
2013 Hindmarch et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Grisso T, Appelbaum PS: Assessing Competence to Consent to Treatment: A guide for Physicians and Other Health Professionals. New York: Oxford University Press; 1998.
• [2]Owen GS, Richardson G, David AS, Szmukler G, Hayward P, Hotopf M: Mental capacity to make decisions on treatment in people admitted to psychiatric hospitals: cross sectional study. Brit Med J 2008, 337(7660):40-42.
• [3]Breden TM, Vollmann J: The cognitive based approach of capacity assessment in psychiatry: a philosophical critique of the MacCAT-T. Health Care Anal 2004, 12(4):273-283. discussion 265–272
• [4]Tan JOA, Stewart A, Hope T: Decision-making as a broader concept. Philosophy, Psychiatry, & Psychology 2009, 16(4):345-349.
• [5]Grisso T, Appelbaum PS: Appreciating anorexia: Decisional capacity and the role of values. Philosophy, Psychiatry, & Psychology 2006, 13(4):293-301.
• [6]Owen GS, Freyenhagen F, Richardson G, Hotopf M: Mental Capacity and Decisional Autonomy: An Interdisciplinary Challenge. Inquiry 2009, 52(1):79-107.
• [7]Kim SY, Appelbaum PS, Swan J, Stroup TS, McEvoy JP, Goff DC, Jeste DV, Lamberti JS, Leibovici A, Caine ED: Determining when impairment constitutes incapacity for informed consent in schizophrenia research. Br J Psychiatry 2007, 191:38-43.
• [8]Cairns R, Maddock C, Buchanan A, David AS, Hayward P, Richardson G, Szmukler G, Hotopf M: Reliability of mental capacity assessments in psychiatric in-patients. Br J Psychiatry 2005, 187:372-378.
• [9]Appelbaum PS, Roth LH: Competency to consent to research: a psychiatric overview. Arch Gen Psychiatry 1982, 39(8):951-958.
• [10]Leeman CP: Depression and the right to die. Gen Hosp Psychiatry 1999, 21(2):112-115.
• [11]Elliott C: Caring about risks. Are severely depressed patients competent to consent to research? Arch Gen Psychiatry 1997, 54(2):113-116.
• [12]Halpern J: When concretized emotion-belief complexes derail decision-making capacity. Bioethics 2012, 26(2):108-116.
• [13]Meynen G: Depression, possibilities, and competence: a phenomenological perspective. Theor Med Bioeth 2011, 32(3):181-193.
• [14]Rudnick A: Depression and competence to refuse psychiatric treatment. J Med Ethics 2002, 28(3):151-155.
• [15]Sullivan MD, Youngner SJ: Depression, Competence, and the Right to Refuse Lifesaving Medical-Treatment. Am J Psychiat 1994, 151(7):971-978.
• [16]Young EW, Corby JC, Johnson R: Does depression invalidate competence? Consultants’ ethical, psychiatric, and legal considerations. Camb Q Healthc Ethics 1993, 2(4):505-515.
• [17]Appelbaum PS, Grisso T, Frank E, O’Donnell S, Kupfer DJ: Competence of depressed patients for consent to research. Am J Psychiatry 1999, 156(9):1380-1384.
• [18]Cohen BJ, McGarvey EL, Pinkerton RC, Kryzhanivska L: Willingness and competence of depressed and schizophrenic inpatients to consent to research. J Am Acad Psychiatry Law 2004, 32(2):134-143.
• [19]Bean G, Nishisato S, Rector NA, Glancy G: The psychometric properties of the Competency Interview Schedule. Can J Psychiatry 1994, 39(8):368-376.
• [20]Bean G, Nishisato S, Rector NA, Glancy G: The assessment of competence to make a treatment decision: an empirical approach. Can J Psychiatry 1996, 41(2):85-92.
• [21]Grisso T, Appelbaum PS: Comparison of standards for assessing patients’ capacities to make treatment decisions. Am J Psychiatry 1995, 152(7):1033-1037.
• [22]Lapid MI, Rummans TA, Poole KL, Pankratz VS, Maurer MS, Rasmussen KG, Philbrick KL, Appelbaum PS: Decisional capacity of severely depressed patients requiring electroconvulsive therapy. J ECT 2003, 19(2):67-72.
• [23]Owen GS, David AS, Richardson G, Szmukler G, Hayward P, Hotopf M: Mental capacity, diagnosis and insight in psychiatric in-patients: a cross-sectional study. Psychol Med 2009, 39(8):1389-1398.
• [24]Owen GS, Ster IC, David AS, Szmukler G, Hayward P, Richardson G, Hotopf M: Regaining mental capacity for treatment decisions following psychiatric admission: a clinico-ethical study. Psychol Med 2011, 41(1):119-128.
• [25]Vollmann J, Bauer A, Danker-Hopfe H, Helmchen H: Competence of mentally ill patients: a comparative empirical study. Psychol Med 2003, 33(8):1463-1471.
• [26]Silverstone PH, Salsali M: Low self-esteem and psychiatric patients: Part I–The relationship between low self-esteem and psychiatric diagnosis. Ann Gen Psychiatry 2003, 2:2. BioMed Central Full Text
• [27]Berg JW, Appelbaum PS, Grisso T: Constructing competence: formulating standards of legal competence to make medical decisions. Rutgers Law Rev 1996, 48(2):345-371.
• [28]Grisso T, Appelbaum PS: Values and limits of the MacArthur treatment competence study. Psychol Public Pol L 1996, 2(1):167-181.
• [29]Simon D, Loh A, Wills CE, Harter M: Depressed patients’ perceptions of depression treatment decision-making. Health Expect 2007, 10(1):62-74.
• [30]Stacey D, Menard P, Gabor I, Jacobsen M, Sharif F, Ritchie L, Bunn H: Decision-making needs of patients with depression: a descriptive study. Journal of Psychiatric & Mental Health Nursing 2008, 15(4):287-295.
• [31]Rabone and another (Appellants) v Pennine Care NHS Foundation Trust. UKSC 2. 2012.
• [32]Mental Capacity Act Chapter 9. London: The Stationary Office; 2005.
• [33]Ganley v Jones. EWCA Civ; 2011:754. Para (9–22)
• [34]Elliot C: A Philosophical Disease: Bioethics. Culture and Identity: Routledge; 1999.
• [35]Buchanan AE, Brock DW: Deciding for Others. Cambridge: Cambridge University Press; 1990.