Marazia Chantal, Rucci Paola, Fangerau Heiner, Voßberg Dilara, Rolfes Vasilija, Iozzino Laura, Iommi Marica, Gosek Pawel, Heitzman Janusz, Ferrari Clarissa, Macis Ambra, Markiewicz Inga, Picchioni Marco, Salize Hans Joachim, Stompe Thomas, Wancata Johannes, Appelbaum Paul S, de Girolamo Giovanni
Department of the History, Philosophy and Ethics of Medicine, Medical Faculty, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany.
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
Schizophr Bull Open. 2022 Jun 16;3(1):sgac037. doi: 10.1093/schizbullopen/sgac037. eCollection 2022 Jan.
Consent to treatment is a cornerstone of medical ethics and law. Nevertheless, very little empirical evidence is available to inform clinicians and policymakers regarding the capacities of forensic patients with schizophrenia spectrum disorders (SSDs) to make decisions about their treatment, with the risk of clinical and legal inertia, silent coercion, stigmatization, or ill-conceived reforms.
In this multinational study, we assessed and compared with treatment-related decisional capacities in forensic and non-forensic patients with SSD. 160 forensic and 139 non-forensic patients were used in Austria, Germany, Italy, Poland, and England. Their capacity to consent to treatment was assessed by means of the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Multiple generalized linear regression models were used to identify the socio-demographic and clinical variables associated with MacCAT-T scores.
In total, 55 forensic (34.4%) and 58 non-forensic patients (41.7%) showed high treatment-related decisional capacity, defined as scoring ≥75% of the maximum scores for the understanding, appreciation and reasoning, and 2 for expressing a choice. Forensic patients showed differences in their capacity to consent to treatment across countries. Of all socio-demographic and clinical variables, only "social support" was directly relevant to policy.
Forensic patients have treatment-related decisional capacities comparable with their non-forensic counterparts. Social contacts might provide a substantial contribution towards enhancing the decisional autonomy of both forensic and non-forensic patients, hence improving the overall quality and legitimacy of mental health care.
治疗同意是医学伦理和法律的基石。然而，关于精神分裂症谱系障碍（SSD）的法医鉴定患者做出治疗决策的能力，几乎没有实证证据可用于指导临床医生和政策制定者，存在临床和法律惰性、隐性强制、污名化或构思不周的改革风险。
在这项跨国研究中，我们评估并比较了法医鉴定的SSD患者和非法医鉴定的SSD患者与治疗相关的决策能力。在奥地利、德国、意大利、波兰和英国，共纳入了160名法医鉴定患者和139名非法医鉴定患者。通过麦克阿瑟治疗能力评估工具（MacCAT-T）评估他们同意治疗的能力。使用多个广义线性回归模型来确定与MacCAT-T分数相关的社会人口统计学和临床变量。
总体而言，55名法医鉴定患者（34.4%）和58名非法医鉴定患者（41.7%）表现出较高的与治疗相关的决策能力，定义为在理解、评估和推理方面得分≥最高分数的75%，在表达选择方面得分为2分。法医鉴定患者在不同国家的同意治疗能力存在差异。在所有社会人口统计学和临床变量中，只有“社会支持”与政策直接相关。
法医鉴定患者具有与非法医鉴定患者相当的与治疗相关的决策能力。社会交往可能对提高法医鉴定和非法医鉴定患者的决策自主性有很大贡献，从而提高精神卫生保健的整体质量和合法性。
