Coercing Future Freedom: Consent and Capacities for Autonomous Choice

Lamb R. Weinberger L. , “Mental Health Courts as a Way to Provide Treatment to Violent Persons with Severe Mental Illness” JAMA 300, no. 6 (2008): 772–724.

Id., at 772.

Id., at 772.

I cover much of this information about the importance of autonomy in health care and the ways in which these notions are complicated with respect to mental illness in Epright M. C. , “Caring about Mental Illness: Autonomy, Freedom and Care,” (Re) Interpretations: The Shapes of Justice in Women's Experience (Newcastle-upon-Tyne, U.K.: Cambridge Scholar's Press, 2008): 243–344.

See especially Beauchamp T. Childress J. , The Principles of Biomedical Ethics (New York: Oxford University Press, 1994).

I outline this concern at length in Epright M. C. , “Bioethics and Justice: Economics, Care, and Conflict,” Biomedical Ethics Humanist Perspectives (Amherst, NY: Prometheus Books, 2006).

For an excellent collection of essays on the Cowart case, see Kliever L. D. , Dax's Case: Essays in Medical Ethics and Human Meaning (Dallas: Southern Methodist University Press, 1989).

This conversation occurred during an ethics consultation. The physician in question was an oncologist who honestly wanted to do what was best for his patient. When I pointed out that his claim was paternalistic, he stated that “I didn't go into medicine to kill my patients.” Such an example indicates that although we have come a long way, there is more work to be done with respect to teaching physicians the importance of patient autonomy.

Amador X. F. , “Assessment of Insight in Psychosis,” American Journal of Psychiatry 150, no. 6 (June 1993): 873–879, at 873.

Pini S. , “Insight Into Illness in Schizophrenia, Schizoaffective Disorder, and Mood Disorders with Psychotic Features,” American Journal of Psychiatry 158, no. 1 (January 2001): 122–125, at 122. See also, Young D. A. , “Further Parameters of Insight and Neuropsychological Deficit in Schizophrenia and Other Chronic Mental Diseases,” Journal of Nervous and Mental Diseases 186, no. 1 (1998): 44–50; Amador X. F. , “Awareness of Illness in Schizophrenia, Schizoaffective and Mood Disorders,” Archives of General Psychiatry 51, no. 10 (1994): 826–836; and David A. , “Insight and Psychotic Illness: Cross-Sectional and Longitudinal Associations,” British Journal of Psychiatry 167, no. 5 (1995): 621–628.

See Amador , supra note 8.

Id., at 877 See Pini , supra note 10, at 123–124.

Lamb R. H. Weinberger L. E. , “Mental Health Courts as a Way to Provide Treatment to Violent persons with Severe Mental Illness,” JAMA 300, no. 6 (2008): 772–724. See also, Elbogen E. B. , “The Impact of Perceived Need for Treatment on Risk of Arrest and Violence among People with Severe Mental Illness,” Criminal Justice Behavior 34, no. 2 (2007): 197–210.

Id. (Lamb and Weinberger), at 722. See also, Pia L. Tarnietto M. , “Unawareness in Schizophrenia: Neuropsychological and Neuroanatomical Findings,” Psychiatry and Clinical Neuroscience 60, no. 5 (2006): 531–537

Yen C.-F. , “Correlates of Insight Among Patients with Bipolar I Disorder in Remission,” Journal of Affective Disorders 78, no. 1 (2004): 57–60.

Weinstock R. Copelan R. Bagheri A. , “Competence to Give Informed Consent for Medical Procedures,” Bulletin of the American Academy of Psychiatry Law 12, no. 2 (1984): 117–125; Roth L. H. Meisel A. Lidz C. W. , “Tests of Competency to Consent to Treatment,” American Journal of Psychiatry 134 (1977): 279–284.

It must be noted that most of the data that I will cite is derived not from studies of patients who like Hyde, have schizoaffective disorder, but from patient's with mood disorders (of which schizoaffective disorder is one), bipolar disorder, or schizophrenia (both of which are related to schizoaffective disorder). Few neuroimaging studies have been done specifically upon patients with schizoaffective disorder, but the disorders mentioned above are directly related to this disorder, particularly with respect to psychotic features, which are the object of my argument.

See especially, Sung L. Lyoo I. K. , “Regional Cerebral Cortical Thinning in Bipolar Disorder,” Bipolar Disorders 8, no. 1 (2006): 65–74 and Strakowski S. M. , “The Functional Neuroanatomy of Bipolar Disorder: A Review of Neuroimaging Findings,” Molecular Psychiatry 10, no. 1(2005): 105–116.

See especially, Drevets W. , “Subgenual Prefrontal Cortex Abnormalities in Mood Disorders,” Nature 386, no. 6627 (1997): 824–827; Lim K. O. , “Cortical Gray Matter Deficit in Patients with Bipolar Disorder,” Schizophrenia Research 40, no. 3 (1999): 219–227; Coffman J. A. , “Cognitive Impairment and Cerebral Structure in Bipolar Disorder,” Biological Psychiatry 27, no. 11 (1990): 1188–1196.

Rajkowska G. , “Cell Pathology in Bipolar Disorder,” Bipolar Disorders 4, no. 3 (2002): 105–116.

Agartz I. , “Abnormal Brain White Matter in Schizophrenia: A Diffusion Tensor Imaging Study,” Clinical Neuroscience and Neuropathology 12, no. 10 (2001): 2251–2254, and Zipursky R. B. , “Widespread Cerebral Gray Matter Volume Deficits in Schizophrenia,” Archives of General Psychiatry 49, no. 3 (1992): 40–47, and Gur R. E. , “Reduced Dorsal and Orbital Prefrontal Gray Matter Volumes in Schizophrenia,” Archives of General Psychiatry 57, no. 8 (2000): 761–768.

Cotter D. R. , “Glial Cell Abnormalities in Major Psychiatric Disorders: The Evidence and Implications,” Brain Research Bulletin 55, no. 5 (2001): 585–595.

Rajkowska G. , “Cell Pathology in Bipolar Disorder,” Bipolar Disorders 4, no. 5 (2002): 105–116; Bearden C. E. , “Greater Cortical Gray Matter Density in Lithium-Treated Patients,” Biological Psychiatry 62, no. 1 (2007): 7–16.

Pfenning A. , “Neurocognitive Impairment and Dementia in Mood Disorders,” Journal of Neuropsychiatry and Clinical Neuroscience 19, no. 4 (2007): 373–382.

Mill John Stuart discusses the problems associated with the so-called autonomous decision to sell one's self into a situation whereby one would never have the ability to make future decisions. See On Liberty, at 106–107 in The Basic Writings of John Stuart Mill (New York: Random House, Inc., 2002).

Elbogen E. B. , “the Impact of Perceived Need for Treatment on Risk of Arrest and Violence among People with Severe Mental Illness,” Criminal Justice Behavior 34, no. 2 (2007): 197–210.