octbull2.vp:CorelVentura 7.0 - Canadian Psychiatric Association
Transcription
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. b NEWS b NOUVELLES b NEWS b NOUVELLES b NEWS b NOUVELLES b NEWS b NOUVELLES 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