octbull2.vp:CorelVentura 7.0 - Canadian Psychiatric Association

Despite the consensus that informed consent is legally and
ethically necessary, as well as being recommended by
both the Canadian and American Psychiatric Associations, psychiatrists may not be documenting it consistently. Schachter and Kleinman studied the charts of 30
psychiatrists treating patients with antipsychotic medication and found that the informed consent process was
documented only 23 per cent of the time (18). They noted
that physicians who spent more time reading the medical
literature were more likely to document informed consent.
I hope that this brief discussion of informed consent will
serve as a review of key concepts, an overview of contemporary issues and an impetus to consider the practical
aspects of informed consent in clinical work. Observing
the legal and ethical principles described above, with attention to practical details, will help physicians develop
an atmosphere of collaborative decision-making with their
patients.
References
1. Bray JH, Shepherd JN, Hays JR. Legal and ethical issues in informed consent to psychotherapy. Am J Family Therapy
1985;13(2):50–60.
5. Capen K. Supreme Court reaffirms landmark informed-consent ruling in chickenpox case. CMAJ 1997;157:553–4.
6. Simon RI. Informed consent: maintaining a clinical perspective. In:
Simon RI. Clinical psychiatry and the law, 2nd ed. Washington
(DC): American Psychiatric Press; 1992. p 121–53.
7. Reibl v Hughes 2 S.C.R. 880 (1980).
8. American Psychiatric Association resource document on principles
of informed consent in psychiatry. J Am Acad Psychiatry Law
1997;25:121–5.
9. Marta J, Lowy FH. Le consentement éclairé: un atout pour la psychothérapie? Can J Psychiatry 1993;38:547–51.
10. Wenning K. Long-term psychotherapy and informed consent. Hospital and Community Psychiatry 1993;44:364–7.
11. Grimes AL, McCullough LB, Kunik ME, Molinari V, Workman Jr,
RH. Informed consent and neuroanatomic correlates of intentionality
and voluntariness among psychiatric patients. Psychiatr Serv
2000;51:1561–7.
12. O’Reilly RL. Mental health legislation and the right to appropriate
treatment. Can J Psychiatry 1998;43:811–5.
13. Dunn LB, Jeste DV. Enhancing informed consent for research and
treatment. Neuropsychopharmacology 2001;24:595–607.
14. Brabbins C, Butler J, Bentall R. Consent to neuroleptic medication
for schizophrenia: clinical, ethical, and legal issues. Br J Psychiatry
1996;168:540–4.
15. Slovenko R. Update on legal issues associated with tardive dyskinesia. J Clin Psychiatry 2000;61(Suppl 4):45–57.
2. Appelbaum PS. Informed consent to psychotherapy: recent developments. Psychiatr Serv 1997;48:445–6.
16. Klerman GL. The psychiatric patient’s right to effective treatment:
implications of Osheroff v. Chestnut Lodge. Am J Psychiatry
1990;147:409–18.
3. Arboleda-Florez J. Consent in psychiatry: the position of the Canadian Psychiatric Association. Can J Psychiatry 1988;33:314–8.
17. Beck P. The confidentiality of psychiatric records and the patient’s
right to privacy. Can J Psychiatry 2001;46(3), Insert.
4. CMPA Consent: A guide for Canadian physicians, 3rd edition. Ottawa: Canadian Medical Protective Association; 1996. P 11–4.
18. Schachter D, Kleinman I. Psychiatrists’ documentation of informed
consent. Can J Psychiatry 1998;43:1012–7.
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Quotable Quotes l Citations dignes de mention
“Our biggest concern is that a large group of
psychiatrists will retire within the next 10 years. So we
believe that early grooming of undergraduate students
for a career in psychiatry would be a good long-term
solution to the shortage.”
Dr. Jean-Marie Albert, who spoke to Psychiatric News
about the downward trend of medical students
choosing a career in psychiatry in Canada and about
ways to reverse the trend. The article appeared on
June 7, 2002.
“An increasingly important factor for graduating
students is the rising debt they have accumulated.
That may deter prospective students who perceive
that psychiatrists work hard and that their
remuneration is modest, compared with that of other
specialists.”
Dr. Michael Myers, who was also interviewed by
Psychiatric News on methods to recruit more students
into psychiatry. l
18
« Notre principale préoccupation est qu’un large groupe
de psychiatres vont prendre leur retraite dans les dix
prochaine années. Nous croyons donc que le
conditionnement précoce des étudiants de premier cycle à
une carrière en psychiatrie serait une bonne solution à
long terme à la pénurie. »
Le Dr Jean-Marie Albert, qui s’est adressé à Psychiatric
News à propos des étudiants en médecine qui ont de
moins en moins tendance à choisir une carrière en
psychiatrie au Canada, et à propos des façon de
renverser cette tendance. L’article est paru le 7 juin 2002.
« Un facteur de plus en plus important pour les étudiants
diplômés est la dette croissante qu’ils ont accumulée.
Cela peut éloigner des étudiants éventuels qui croient que
les psychiatres travaillent dur et que leur rémunération est
modeste, comparativement à celle d’autres spécialistes. »
Le Dr Michael Myers, qui a aussi été interviewé par
Psychiatric News sur les méthodes pour recruter
davantage d’étudiants en psychiatrie.
CPA Bulletin de l’APC—October 2002 octobre