Bioethics and advance directives in psychiatric in the hospital context

Liliana Mondragón-Barrios; Fernando Lolas Stepke

doi:10.17711/SM.0185-3325.2023.033

Liliana Mondragón-Barrios

Fernando Lolas Stepke

DOI: https://doi.org/10.17711/SM.0185-3325.2023.033

Abstract

Introduction. Mental health services have been a focus of human rights advocates and recent legal reforms in some Latin American countries, which have called for a change from the paradigm of hospitalization to one of accompanying and supporting the person with mental health issues, which make it possible to apply the Advance Directives in Psychiatry (PADs). This change will require time, as well as economic, material, and human resources, and transformations in attitudes, culture, and society, but the implementation of PADs cannot be postponed: they must be used to protect the autonomy of the persons affected, within a bioethical framework.

Objective. Identify possible bioethical conditions in the prevailing conventional hospital context in Latin America that allow for an implementation of PADs.

Method. A participant-observer study was carried out in two psychiatric hospital services from June to September 2022.

Results. A thematic analysis found three themes: 1) clinical care, 2) patient predisposition, and 3) medical-legal questions. This study considered part of theme 2, including the following sub-themes: a) patient self-perception, b) biography/narrative versus diagnostic classification, and c) negotiation.

Discussion and conclusion. Prominent among the sub-themes discussed are recognition of the values of autonomy and its elements in all of the expressions of the person with mental illness, as well as actions of the physician or health care team in synergy with supported decision-making, a distinctive feature of the anticipatory process of the PAD.

Keywords:

Bioethics, advance directives, psychiatry, hospitalization, mental health, autonomy

HTML PDF EPUB

Issue

Vol. 46 No. 5 (2023): Salud mental

References

Amering, M., Stastny, P., & Hopper, K. (2005). Psychiatric advance directives: qualitative study of informed deliberations by mental health service users. British Journal of Psychiatry, 186, 247-252. doi: 10.1192/bjp.186.3.247

Appelbaum, P. (2004). Law & Psychiatry: Psychiatric Advance Directives and the Treatment of Committed Patients. Psychiatric Services, 55(7), 751-763. doi: 10.1176/appi.ps.55.7.751

Bárcenas, K., & Preza, N. (2019). Desafíos de la etnografía digital en el trabajo de campo onlife. Virtualis, 10(18), 134-151. doi: 10.2123/virtualis.v10i18.287

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. doi: 10.1191/1478088706qp063oa

Casado, M., & Vilà, A. (2014). Documento sobre bioética y discapacidad. Observatori de Bioètica i Dret. Universidad de Barcelona.

Castillo, I. (2018). Diario de campo: características, para qué sirve, ejemplo. Lifeder. Retrieved from https://www.lifeder.com/diario-de-campo/

Cuevas-Esteban, J., Romero, E., Moreno-Orea, A., Ibáñez-Caparrós, A., Bustos-Cardona, T., Martínez-Cirera, B., & de Pablo, J. (2022). ¿Llegó el momento de abrir las puertas en la hospitalización de agudos de psiquiatría? Actas Españolas de Psiquiatría, 50(4), 206-207.

Gloeckler, S., Ferrario, A., & Biller-Andorno, N. (2022). An Ethical Framework for Incorporating Digital Technology into Advance Directives: Promoting Informed Advance Decision Making in Healthcare. The Yale Journal of Biology and Medicine, 95(3), 349-353. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/pmc9511942/

Granados, R. (2020). Revisión teórica de herramientas metodológicas aplicadas en la investigación criminológica. Derecho y Cambio Social, 59, 501-511.

Hiu, S., Su, A., Ong, S., & Poremski, D. (2020). Stakeholder perspective on barrier to the implementation of Advance Care Planning in a traditionally paternalistic healthcare system. PLoS One, 15(11), e0242085. doi: 10.1371/journal.pone.0242085

Howitt, D. (2010). Introduction to qualitative methods in psychology. Harlow: Prentice Hall.

Larraín, H. (2008). El Diario de campo o Bitácora: el instrumento número 1 del científico investigador. Eco-antropología. Retrieved from http://eco-antropologia.blogspot.com/2008/02/el-diario-de-campo-o-bitcora-el.html

Marshall, P., & Gómez Yuri, H. (2022). Advance directives in mental health and the revocation problem. Acta Bioethica, 28(2), 205-214. Retrieved from https://actabioethica.uchile.cl/index.php/AB/article/view/68991

Martí, M. (2015). La salud mental. De un modelo rehabilitador a un modelo social. In B. Román, A. Palaudarias, & J. M. Esquirol (Eds.). V Congreso Internacional de Bioética. Filosofía y Salud Mental (pp. 70-79). Aporia, Sant Pere Claver: Institut Docent-Recerca.

Michel, T., Tachtler, F., Slovak, P., & Fitzpatrick, G. (2020). Young People’s Attitude Toward Positive Psychology Interventions: Thematic Analysis. Journal of Medical Internet Research Human Factors, 7(4), e21145. doi: 10.2196/21145

Ministerio de Salud. (2021). Ley 21.331 Del reconocimiento y protección de los derechos de las personas en la atención de salud mental. Diario Oficial Mayo 11, 2021. Retrieved from Ley-21331 11-MAY-2021 MINISTERIO DE SALUD - Ley Chile - Biblioteca del Congreso Nacional (bcn.cl)

Mondragón, L., & Guarneros, T. (2020). Directrices Anticipadas en Psiquiatría. In N. Martínez (Ed.). Salud Mental Forense (pp. 124-137). Ciudad de México, México: Editorial Tirant lo Blanch México.

Mondragón, L., Monroy, Z., Ito, M. E., & Medina-Mora, M. E. (2010). Disyuntivas en las concepciones sobre autonomy beneficencia que afectan la terapéutica del intento suicida. Acta Bioethica, 16(1), 77-86. doi: 10.4067/S1726-569X2010000100011

Mondragón, L., Romero, M., & Borges, G. (2008). Ethnography in an emergency room: Evaluating patients with alcohol consumption. Salud Pública de México, 50(4), 308-315.

Monje, C. A. (2011). Metodología de la investigación cuantitativa y cualitativa. Una guía didáctica. Colombia: Universidad Surcolombiana.

Nicaise, P., Lorant, V., & Dubois, V. (2013). Psychiatric Advance Directives as a complex and multistage intervention: a realist systematic review. Health & Social Care in the Community, 21(1), 1-14. doi: 10.1111/j.1365-2524.2012.01062.x

Noguero, A., & Peregalli, S. (2021). Alternativas a los internamientos en salud mental: hospitalización domiciliaria desde la perspectiva española y anglosajona. Revista de Bioética y Derecho, 53, 37-55. doi: 10.1344/rbd2021.53.34726

Potthoff, S., Finke, M., Scholten, M., Gieselmann, A., Vollmann, J., & Gather, J. (2022). Opportunities and risks of self-binding directives: A qualitative study involving stakeholders and researchers in Germany. Frontiers in Psychiatry, 13, 974132. doi: 10.3389/fpsyt.2022.974132

Scholten, M., Gieselmann, A., Gather, J., & Vollmann, J. (2019). Psychiatric Advance Directives Under the Convention on the Rights of Persons with Disabilities: Why Advance Instructions Should Be Able to Override Current Preferences. Frontiers in Psychiatry, 10, 631. doi: 10.3389/fpsyt.2019.00631

Scholten, M., Weller, P. J., Kim, S. Y. H., & Vollmann, J. (2021). Editorial: Human Rights and Mental Health: Current Developments in Competence Assessment and Supported Decision-Making. Frontiers in Psychiatry, 12, 682606. doi: 10.3389/fpsyt.2021.682606

Secretaría de Salud. (2022). Decreto por el que se reforman, adicionan y derogan diversas disposiciones de la Ley General de Salud, en materia de Salud Mental y Adicciones. Diario Oficial de la Federación, Mayo 16, 2022. Retrieved from DOF - Diario Oficial de la Federación

Srebnik, D., & Kim, S. (2006). Competency for Creation, Use and Revocation of Psychiatric Advance Directives. Journal of the American Academy of Psychiatry and the Law, 34(4), 501-510.

Srebnik, D., Appelbaum, P., & Russo, J. (2004). Assessing Competence to Complete Psychiatric Advance Directives with the Competence Assessment Tool for Psychiatric Advance Directives. Comprehensive Psychiatry, 45(4), 239-245. doi: 10.1016/j.comppsych.2004.03.004

Stavert, J. (2021). Supported Decision-Making and Paradigm Shifts: Word Play or Real Change? Frontiers in Psychiatry, 11, 571005. doi: 10.3389/fpsyt.2020.571005

Szmukler, G. (2019). “Capacity”, “best interests”, “will and preferences” and the UN Convention on the Rights of Persons with Disabilities. World Psychiatry, 18(1), 34-41. doi: 10.1002/wps.20584

United Nations. (2006). Convention on the Rights of Persons with Disabilities. Retrieved from https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html

Valenti, E., Giacco, D., Katasakou, C., & Priebe, S. (2014). Which values are important for patients during involuntary treatment? A qualitative study with psychiatric inpatients. Journal of Medical Ethics, 40(12), 832-836. doi: 10.1136/medethics-2011-100370

Esta obra está bajo una Licencia Creative Commons Atribución-NoComercial 4.0 Internacional.

##plugins.themes.bootstrap3.article.main##

Abstract

References