Communication in psychiatric coercive treatment and patients' decisional capacity to consent

Abstract

Effective communication and the acquisition of a valid consent are central to a good doctor-patient relationship and a clinician's ethical obligation in order to respect patients' autonomy, as well as their right to be involved in treatment decisions. However, often clinicians face several issues in performing this task, among which the most frequently reported are the fear of hurting the patient by communicating a bad diagnosis or not knowing how to manage the patient's emotional reactions. In addition, there are vulnerable populations, such as those represented by psychiatric patients, who are at higher risk of decisional incapacity. Especially for those patients, it is in fact particularly difficult for clinicians to find the proper balance between respecting the right of capable patients to make choices about their treatment and the right of incapable patients to be protected from the possible harmful consequences of their improper decisions. However, nor the presence of a severe psychiatric disorder nor a status of "involuntary hospitalized patient" has been reported to be a label for incapacity. Several tools have been developed to assist clinicians in patients' decisional capacity evaluations, together with interventions aimed at enhancing informed consent acquisition in order to achieve shared decision-making and lead the patient to become actively involved in his/her treatment decisions. Such an approach would lead to a decrease in the perceived coercion, often reported in mental healthcare settings and also from patients who are not involuntarily hospitalized, and to an increase in patients' adherence to treatment.