The patient as "subject" and capacity to give informed consent.
In line with Western countries, the idea of "capacity assessment" to determine a person's course of treatment is being introduced to Japanese psychiatry. Herein, some problems associated with the informed consent of mental patients are discussed, and a typical case is presented. The author points out that, when involuntary treatment is necessary, the clinician must consider, 1) the self as a "subject" of the incapable, 2) the dissociation between a subject and a choice, 3) the nature of choice in life, 4) contextual assessment of mental intervention in the patient's life situation. Neglecting these issues will lead to inhumane medical practice in psychiatry.
Kumakura
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Department of Public Health, Toho University School of Medicine, Tokyo, Japan.
D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence*; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence*; D007564:Japan; D007872:Legal Guardians; D016743:Mental Competency / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D010344:Patient Advocacy / Q000331:legislation & jurisprudence; D010817:Physician-Patient Relations; D011613:Psychotherapy / Q000331:legislation & jurisprudence*; D011619:Psychotropic Drugs / Q000008:administration & dosage; D012559:Schizophrenia / Q000534:rehabilitation; D012565:Schizophrenic Psychology; D016312:Treatment Refusal / Q000331:legislation & jurisprudence
D011619:Psychotropic Drugs