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Fluctuating capacity and advance decision-making in Bipolar Affective Disorder: Self-binding directives and self-determination

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Fluctuating capacity and advance decision-making in Bipolar Affective Disorder : Self-binding directives and self-determination. / Gergel, Tania; Owen, Gareth.

In: International Journal of Law and Psychiatry, Vol. 40, 05.2015, p. 92-101.

Research output: Contribution to journalArticle

Harvard

Gergel, T & Owen, G 2015, 'Fluctuating capacity and advance decision-making in Bipolar Affective Disorder: Self-binding directives and self-determination' International Journal of Law and Psychiatry, vol. 40, pp. 92-101. DOI: 10.1016/j.ijlp.2015.04.004

APA

Gergel, T., & Owen, G. (2015). Fluctuating capacity and advance decision-making in Bipolar Affective Disorder: Self-binding directives and self-determination. DOI: 10.1016/j.ijlp.2015.04.004

Vancouver

Gergel T, Owen G. Fluctuating capacity and advance decision-making in Bipolar Affective Disorder: Self-binding directives and self-determination. International Journal of Law and Psychiatry. 2015 May;40:92-101. Available from, DOI: 10.1016/j.ijlp.2015.04.004

Author

Gergel, Tania ; Owen, Gareth. / Fluctuating capacity and advance decision-making in Bipolar Affective Disorder : Self-binding directives and self-determination. In: International Journal of Law and Psychiatry. 2015 ; Vol. 40. pp. 92-101

Bibtex Download

@article{2036d91d231a4af4ba2b8a195c1113f4,
title = "Fluctuating capacity and advance decision-making in Bipolar Affective Disorder: Self-binding directives and self-determination",
abstract = "For people with Bipolar Affective Disorder, a self-binding (advance) directive (SBD), by which they commit themselves to treatment during future episodes of mania, even if unwilling, can seem the most rational way to deal with an imperfect predicament. Knowing that mania will almost certainly cause enormous damage to themselves, their preferred solution may well be to allow trusted others to enforce treatment and constraint, traumatic though this may be. No adequate provision exists for drafting a truly effective SBD and efforts to establish such provision are hampered by very valid, but also paralysing ethical, clinical and legal concerns. Effectively, the autonomy and rights of people with bipolar are being ‘protected’ through being denied an opportunity to protect themselves. From a standpoint firmly rooted in the clinical context and experience of mania, this article argues that an SBD, based on a patient-centred evaluation of capacity to make treatment decisions (DMC-T) and grounded within the clinician–patient relationship, could represent a legitimate and ethically coherent form of self-determination. After setting out background information on fluctuating capacity, mania and advance directives, this article proposes a framework for constructing such an SBD, and considers common objections, possible solutions and suggestions for future research.",
author = "Tania Gergel and Gareth Owen",
year = "2015",
month = "5",
doi = "10.1016/j.ijlp.2015.04.004",
language = "English",
volume = "40",
pages = "92--101",
journal = "International Journal of Law and Psychiatry",
issn = "0160-2527",
publisher = "Elsevier Limited",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Fluctuating capacity and advance decision-making in Bipolar Affective Disorder

T2 - International Journal of Law and Psychiatry

AU - Gergel,Tania

AU - Owen,Gareth

PY - 2015/5

Y1 - 2015/5

N2 - For people with Bipolar Affective Disorder, a self-binding (advance) directive (SBD), by which they commit themselves to treatment during future episodes of mania, even if unwilling, can seem the most rational way to deal with an imperfect predicament. Knowing that mania will almost certainly cause enormous damage to themselves, their preferred solution may well be to allow trusted others to enforce treatment and constraint, traumatic though this may be. No adequate provision exists for drafting a truly effective SBD and efforts to establish such provision are hampered by very valid, but also paralysing ethical, clinical and legal concerns. Effectively, the autonomy and rights of people with bipolar are being ‘protected’ through being denied an opportunity to protect themselves. From a standpoint firmly rooted in the clinical context and experience of mania, this article argues that an SBD, based on a patient-centred evaluation of capacity to make treatment decisions (DMC-T) and grounded within the clinician–patient relationship, could represent a legitimate and ethically coherent form of self-determination. After setting out background information on fluctuating capacity, mania and advance directives, this article proposes a framework for constructing such an SBD, and considers common objections, possible solutions and suggestions for future research.

AB - For people with Bipolar Affective Disorder, a self-binding (advance) directive (SBD), by which they commit themselves to treatment during future episodes of mania, even if unwilling, can seem the most rational way to deal with an imperfect predicament. Knowing that mania will almost certainly cause enormous damage to themselves, their preferred solution may well be to allow trusted others to enforce treatment and constraint, traumatic though this may be. No adequate provision exists for drafting a truly effective SBD and efforts to establish such provision are hampered by very valid, but also paralysing ethical, clinical and legal concerns. Effectively, the autonomy and rights of people with bipolar are being ‘protected’ through being denied an opportunity to protect themselves. From a standpoint firmly rooted in the clinical context and experience of mania, this article argues that an SBD, based on a patient-centred evaluation of capacity to make treatment decisions (DMC-T) and grounded within the clinician–patient relationship, could represent a legitimate and ethically coherent form of self-determination. After setting out background information on fluctuating capacity, mania and advance directives, this article proposes a framework for constructing such an SBD, and considers common objections, possible solutions and suggestions for future research.

U2 - 10.1016/j.ijlp.2015.04.004

DO - 10.1016/j.ijlp.2015.04.004

M3 - Article

VL - 40

SP - 92

EP - 101

JO - International Journal of Law and Psychiatry

JF - International Journal of Law and Psychiatry

SN - 0160-2527

ER -

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