Individuals with major depression may benefit from psychiatric treatment, yet they may refuse such treatment, sometimes because of their depression. Hence the question is raised whether such individuals are competent to refuse psychiatric treatment. The standard notion of competence to consent to treatment, which refers to expression of choice, understanding of medical information, appreciation...

BACKGROUND The Cohort Multiple Randomised Controlled Trial (cmRCT) is a newly proposed pragmatic trial design; recently several cmRCT have been initiated. This study tests the unresolved question of whether differential refusal in the intervention arm leads to bias or loss of statistical power and how to deal with this. METHODS We conduct simulations evaluating a hypothetical cluster cmRCT in...

In true medical emergencies, informed consent is presumed or implied without application of the usual standard. In the litigation over the right to refuse treatment in psychiatry, a limited right for involuntarily committed patients to refuse treatment has been upheld, absent a finding of a psychiatric emergency. Increasingly, clinicians may find that their sole extrajudicial option in institut...

Objective: To gain insight into the standards of rationality that physicians use when evaluating patients’ treatment refusals. Design of the study: Qualitative design with indepth interviews. Participants: The study sample included 30 patients with cancer and 16 physicians (oncologists and general practitioners). All patients had refused a recommended oncological treatment. Results: Patients ba...

Health professionals faced with refusal of life-saving treatment may wish to override a person's wishes, especially if that person suffers from a mental disorder. Mental illness does not automatically mean a patient is incapable of making decisions of this nature. It is not always clear whether an individual is legally competent to decide whether to undergo treatment or not. This article discus...

We would like to point out some serious problems and contradictions in the study “Regulation of Conscientious Objection to Abortion: An International Comparative Multiple-Case Study,” by Wendy Chavkin, Laurel Swerdlow, and Jocelyn Fifield (Health and Human Rights Journal, vol. 19, no. 1, 2017). The study purports to show that it is possible to accommodate health care providers’ “conscientious o...

Nonemergent forcible medication is a controversial procedure that has received somewhat less study in acute hospitals and in states where a simple in-house "treatment-driven" clinical review procedure is followed. We reviewed the charts of all patients so medicated by the New Jersey "Rennie" process on a large general acute adult psychiatric service, finding 43 (3%) of 1420 admitted patients so...

BACKGROUND In England and Wales mental health services need to take account of the Mental Capacity Act 2005 and the Mental Health Act 1983. The overlap between these two causes dilemmas for clinicians. AIMS To describe the frequency and characteristics of patients who fall into two potentially anomalous groups: those who are not detained but lack mental capacity; and those who are detained bu...

Family accommodation is a common and widely studied phenomenon in families of youth with obsessive-compulsive disorder (OCD). Family accommodation has been associated with increased symptom severity, poorer functional outcomes, and reduced treatment response. While family accommodation is increasingly targeted in family-based treatment of OCD, there are cases where youth refuse treatment. In th...