Owen Gareth S, David Anthony S, Hayward Peter, Richardson Genevra, Szmukler George, Hotopf Matthew
Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, Cutcombe Road, London SE5 9RS, UK.
Br J Psychiatry. 2009 Nov;195(5):403-7. doi: 10.1192/bjp.bp.109.065151.
An individual's right to self-determination in treatment decisions is a central principle of modern medical ethics and law, and is upheld except under conditions of mental incapacity. When doctors, particularly psychiatrists, override the treatment wishes of individuals, they risk conflicting with this principle. Few data are available on the views of people regaining capacity who had their treatment wishes overridden.
To investigate individuals' views on treatment decisions after they had regained capacity.
One hundred and fifteen people who lacked capacity to make treatment decisions were recruited from a sample of consecutively admitted patients to a large psychiatric hospital. After 1 month of treatment we asked the individuals for their views on the surrogate treatment decisions they received.
Eighty-three per cent (95% CI 66-93) of people who regained capacity gave retrospective approval. Approval was no different between those admitted informally or involuntarily using Mental Health Act powers (chi(2) = 1.52, P = 0.47). Individuals were more likely to give retrospective approval if they regained capacity (chi(2) = 14.2, P = 0.001).
Most people who regain capacity following psychiatric treatment indicate retrospective approval. This is the case even if initial treatment wishes are overridden. These findings moderate concerns both about surrogate decision-making by psychiatrists and advance decision-making by people with mental illness.
个人在治疗决策中的自主决定权是现代医学伦理和法律的核心原则，除非在无行为能力的情况下，该权利会得到维护。当医生，尤其是精神科医生无视个人的治疗意愿时，他们可能会与这一原则产生冲突。关于那些治疗意愿被无视后恢复行为能力者的观点，现有数据很少。
调查个人恢复行为能力后对治疗决策的看法。
从一家大型精神病院连续收治的患者样本中招募了115名无能力做出治疗决策的人。在治疗1个月后，我们询问这些人对他们所接受的替代治疗决策的看法。
恢复行为能力的人中有83%（95%可信区间66 - 93）给予了追溯认可。通过《精神健康法》权力非自愿入院者和非正式入院者之间的认可情况没有差异（卡方检验χ(2)=1.52，P = 0.47）。如果恢复行为能力，个人更有可能给予追溯认可（卡方检验χ(2)=14.2，P = 0.001）。
大多数接受精神科治疗后恢复行为能力的人表示给予追溯认可。即使最初的治疗意愿被无视，情况依然如此。这些发现减轻了对精神科医生替代决策以及精神疾病患者预先决策的担忧。
