Competence and decision-making: Ethics and clinical psychiatric practice

Abstract

The interface between psychiatry and the law is often unclear and complicated. Ethics in psychiatry is a complex, controversial, often ambiguous topic. Conflicts arise about confidentiality, informed consent, involuntary hospitalisation, right to treatment and right to refuse treatment, among other daily clinical issues. There is an extended responsibility to others as well as to the mentally ill vulnerable person. An overarching departure point would be to address ‘competence' with a view to understanding the above issues better. The making of decisions pertaining to health and personal issues is dependent on the ability of the patient to function in various areas. The concept of competence is viewed differently from the clinical as opposed to the legal viewpoint. Some jurisdictions have introduced into legislation more specific legal guidelines for recoding mental capacity.
This discussion takes a practical clinical standpoint and introduces an ‘umbrella' concept via a general approach, while also specifically addressing individual ethical issues.

South African Journal of Bioethics & Law Vol. 1 (2) 2008: pp. 61-63