By Fred Rum M.D., Donald Pfaff PH.D. (auth.), Donald W. Pfaff (eds.)
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Extra info for Ethical Questions in Brain and Behavior: Problems and Opportunities
D's psychiatrist, Dr. 1. After Dr. L interviews Mr. D and becomes familiar with the situation, he informs Mr. D that he ought to enter the hospital or at least begin taking his lithium again; meanwhile, he should let someone else safeguard his money. (Culver and Gert, 1982, pp. 171-172) Cases of manic behavior, such as the one just described, are clear instances in which persons are unable to assess their own best interest, and it is relatively easy to provide objective criteria by way of justifying that judgment.
If a person appears to lack autonomy in the second of the two senses just noted, whether by virtue of illness, injury, organic brain syndrome, "brainwashing," or any other causal factor, the question arises whether there is any genuine autonomy to be violated in overriding treatment refusals or bypassing informed consent procedures. It is this issue-in part factual, in part conceptual, and in part ethical-that forms the central focus of problems of decision making involving the cognitively impaired.
28 Ruth Macklin Characteristics of the Patient or Subject 1. Is the patient clearly incapable of granting consent for treatment or research, or instead, of questionable mental capacity? 2. Is the cause of impairment known? H so, (a) Is the impairment reversible (as in cases of dementing illness caused by poor nutrition or drug interactions)? (b) Is the impairment the beginning of an inexorable or predictable decline (as in cases of senile dementia of the Alzheimer's type)? (c) Might an improved level of cognitive functioning be achieved by administering psychoactive drugs?