INFORMATION (RISK) DISCLOSURE TO PSYCHIATRIC PATIENTS

Information (Risk) Disclosure to Psychiatric Patients



INTRODUCTION

It is ethically, morally and professionally wrong to treat a patient without obtaining a valid consent. For the valid consent to be attained, it becomes imperative for the patient to be given full information about any proposed treatment (which primarily comes under the category of information and risk disclosure), patient must also possess the requisite capacity to show consent (capacity) in addition to being free from any undue influence (voluntariness). Although the primary focus of this paper is information disclosure, the other elements that validate consent will also be discussed. The need to discuss these elements is informed by the complex link existing between the three of them. The paper will focus on adult psychiatric patients who voluntarily accept treatment and those who are detained under the Mental Health Act (MHA) of 1983; as amended, with and without capacity. There is no doubt that a psychiatric patient whose cognitive ability is impaired is likely to lack capacity to understand information given to them about their treatment and thus these patients are more likely to come under any undue pressure or influence exercised upon them.

The main question around which this paper will predominantly revolve is whether psychiatric (mentally ill) patients are sufficiently informed about their treatments. The consequences of not informing at all or not informing enough will be discussed. In determining the consequences, one would have to examine the standards by which the amount and level of information disclosed is measured. The legal standards of disclosure in England and Wales is the 'Prudent doctor standard', while the standard recognised in United States of America, Canada and Australia is the 'Prudent patient standard'.

To effectively explore this subject area, there is need to, first, understand the general principles of informed consent, as understood on both sides of the Atlantic along with the ethical, legal, and clinical reasons behind it. The ethical principles of autonomy and paternalism that underpins the concept of informed consent will be discussed. The aim here is to bring forth the constant and uneasy tension that exists between respect for autonomous right of the patient for freedom and self-determination on one hand, and serving patient's best interest using clinical knowledge and judgment on the other hand, especially when a psychiatric patient is involved.

Given the peculiar nature of mental illness, and the fact that some of the patients in this group could be detained under the Mental Health Act 1983 without their consent irrespective of their level of competence, it makes it even more interesting to know how much information have been disclosed to them. The paper will also examine the safeguards put in place, if any, to address concerns bothering on detained patients and those without capacity. From practical experience, it has been suggested that psychiatric patients are not usually given sufficient information about their treatments. If that is true, attempts will be made to bring forth justifications for non-disclosure. The paper will also consider the impact of ...