Menschen dürfen selbst bestimmen, welche medizinischen oder pflegerischen Maßnahmen durchgeführt ... more Menschen dürfen selbst bestimmen, welche medizinischen oder pflegerischen Maßnahmen durchgeführt oder unterlassen werden sollen. Einwilligungsfähigkeit und Freiwilligkeit sind Voraussetzungen, um dieses Recht auf Selbstbestimmung auszuüben – sie lassen sich jedoch besonders in der psychiatrischen Versorgung nicht immer einfach beurteilen. Eine Hilfestellung bietet der folgende Artikel.
The right to make autonomous decisions is enshrined in law. However, the question how persons wit... more The right to make autonomous decisions is enshrined in law. However, the question how persons with cognitive deficits can be enabled to make autonomous decisions has not been satisfactorily addressed. In particular, the concept of supported decision-making and its implementation into practice has been poorly explored for persons with dementia (PwD).This article describes the empirical development and implementation of support tools to enhance informed consent processes (so called enhanced consent procedures/ECP) for PwD on whether to undergo lumbar puncture. In the end of the process of pilot testing and further development of the tools, the following tools were defined: (1) Standardized Interview Structure, (2) Elaborated Plain Language, (3) Ambience and Room Design, (4) Keyword Lists, (5) Priority Cards, (6) Visualization, and (7) Simplified Written Informed Consent (Patient Information), as well as the general attitude (8) Person-Centered Attitude of the facilitator. As the devel...
Background Self-binding directives (SBDs) are psychiatric advance directives that include the pos... more Background Self-binding directives (SBDs) are psychiatric advance directives that include the possibility for service users to consent in advance to compulsory care in future mental health crises. Legal provisions for SBDs exist in the Netherlands since 2008 and were updated in 2020. While ethicists and legal scholars have identified several benefits and risks of SBDs, few data on stakeholder perspectives on SBDs are available. Aims The aim of the study was to identify opportunities and challenges of SBDs perceived by stakeholders who have personal or professional experience with legally enforceable SBDs. Methods Data collection was carried out in the Netherlands from February 2020 to October 2021 by means of semi-structured interviews. Participants were selected through purposive sampling and snowball methods. Interviews were conducted with mental health service users (n = 7), professionals (n = 13), and an expert on SBD policy (n = 1), resulting in a total number of 21 interviews....
PurposeSelf-binding directives (SBDs) are a special type of psychiatric advance directive in whic... more PurposeSelf-binding directives (SBDs) are a special type of psychiatric advance directive in which mental health service users can consent in advance to involuntary hospital admission and involuntary treatment during future mental health crises. This study presents opportunities and risks of SBDs reported by users with bipolar disorder, family members of people with bipolar disorder, professionals working with people with bipolar disorder and researchers with expertise in mental health ethics and law.MethodsSeventeen semi-structured interviews with users, family members and professionals, and one focus group with five researchers were conducted. The data was analyzed using qualitative content analysis.ResultsSix opportunities and five risks of SBDs were identified. The opportunities were promotion of autonomy and self-efficacy of users, relief of responsibility for family members, early intervention, reduction of (perceived) coercion, positive impact on the therapeutic relationship ...
Zusammenfassung Ziel Erfassung von Erfahrungen und Einschätzungen leitender PsychiaterInnen zu Ve... more Zusammenfassung Ziel Erfassung von Erfahrungen und Einschätzungen leitender PsychiaterInnen zu Veränderungen in der psychiatrischen Unterbringungspraxis während der COVID-19-Pandemie. Methodik Onlineumfrage unter den Mitgliedern des Landesverbands leitender ÄrztInnen für Psychiatrie und Psychotherapie in Nordrhein-Westfalen (LLPP) sowie Analyse von LLPP-Vorstandsprotokollen. Ergebnisse Sowohl in Situationen mit als auch ohne unmittelbaren COVID-19-Bezug wurden Veränderungen in der psychiatrischen Unterbringungspraxis wahrgenommen, u. a. bei richterlichen Anhörungen sowie Entscheidungen über Zwangsmaßnahmen. Schlussfolgerung Die prozeduralen Standards in Unterbringungsverfahren müssen aufrechterhalten werden. Zwangsmaßnahmen dürfen nur angewendet werden, wenn sie die geltenden ethischen und rechtlichen Voraussetzungen erfüllen. Bei Einführung und Rücknahme von restriktiven Maßnahmen zur Pandemiebekämpfung muss eine unberechtigte Ungleichbehandlung von Menschen mit einer psychischen E...
Menschen dürfen selbst bestimmen, welche medizinischen oder pflegerischen Maßnahmen durchgeführt ... more Menschen dürfen selbst bestimmen, welche medizinischen oder pflegerischen Maßnahmen durchgeführt oder unterlassen werden sollen. Einwilligungsfähigkeit und Freiwilligkeit sind Voraussetzungen, um dieses Recht auf Selbstbestimmung auszuüben – sie lassen sich jedoch besonders in der psychiatrischen Versorgung nicht immer einfach beurteilen. Eine Hilfestellung bietet der folgende Artikel.
The right to make autonomous decisions is enshrined in law. However, the question how persons wit... more The right to make autonomous decisions is enshrined in law. However, the question how persons with cognitive deficits can be enabled to make autonomous decisions has not been satisfactorily addressed. In particular, the concept of supported decision-making and its implementation into practice has been poorly explored for persons with dementia (PwD).This article describes the empirical development and implementation of support tools to enhance informed consent processes (so called enhanced consent procedures/ECP) for PwD on whether to undergo lumbar puncture. In the end of the process of pilot testing and further development of the tools, the following tools were defined: (1) Standardized Interview Structure, (2) Elaborated Plain Language, (3) Ambience and Room Design, (4) Keyword Lists, (5) Priority Cards, (6) Visualization, and (7) Simplified Written Informed Consent (Patient Information), as well as the general attitude (8) Person-Centered Attitude of the facilitator. As the devel...
Background Self-binding directives (SBDs) are psychiatric advance directives that include the pos... more Background Self-binding directives (SBDs) are psychiatric advance directives that include the possibility for service users to consent in advance to compulsory care in future mental health crises. Legal provisions for SBDs exist in the Netherlands since 2008 and were updated in 2020. While ethicists and legal scholars have identified several benefits and risks of SBDs, few data on stakeholder perspectives on SBDs are available. Aims The aim of the study was to identify opportunities and challenges of SBDs perceived by stakeholders who have personal or professional experience with legally enforceable SBDs. Methods Data collection was carried out in the Netherlands from February 2020 to October 2021 by means of semi-structured interviews. Participants were selected through purposive sampling and snowball methods. Interviews were conducted with mental health service users (n = 7), professionals (n = 13), and an expert on SBD policy (n = 1), resulting in a total number of 21 interviews....
PurposeSelf-binding directives (SBDs) are a special type of psychiatric advance directive in whic... more PurposeSelf-binding directives (SBDs) are a special type of psychiatric advance directive in which mental health service users can consent in advance to involuntary hospital admission and involuntary treatment during future mental health crises. This study presents opportunities and risks of SBDs reported by users with bipolar disorder, family members of people with bipolar disorder, professionals working with people with bipolar disorder and researchers with expertise in mental health ethics and law.MethodsSeventeen semi-structured interviews with users, family members and professionals, and one focus group with five researchers were conducted. The data was analyzed using qualitative content analysis.ResultsSix opportunities and five risks of SBDs were identified. The opportunities were promotion of autonomy and self-efficacy of users, relief of responsibility for family members, early intervention, reduction of (perceived) coercion, positive impact on the therapeutic relationship ...
Zusammenfassung Ziel Erfassung von Erfahrungen und Einschätzungen leitender PsychiaterInnen zu Ve... more Zusammenfassung Ziel Erfassung von Erfahrungen und Einschätzungen leitender PsychiaterInnen zu Veränderungen in der psychiatrischen Unterbringungspraxis während der COVID-19-Pandemie. Methodik Onlineumfrage unter den Mitgliedern des Landesverbands leitender ÄrztInnen für Psychiatrie und Psychotherapie in Nordrhein-Westfalen (LLPP) sowie Analyse von LLPP-Vorstandsprotokollen. Ergebnisse Sowohl in Situationen mit als auch ohne unmittelbaren COVID-19-Bezug wurden Veränderungen in der psychiatrischen Unterbringungspraxis wahrgenommen, u. a. bei richterlichen Anhörungen sowie Entscheidungen über Zwangsmaßnahmen. Schlussfolgerung Die prozeduralen Standards in Unterbringungsverfahren müssen aufrechterhalten werden. Zwangsmaßnahmen dürfen nur angewendet werden, wenn sie die geltenden ethischen und rechtlichen Voraussetzungen erfüllen. Bei Einführung und Rücknahme von restriktiven Maßnahmen zur Pandemiebekämpfung muss eine unberechtigte Ungleichbehandlung von Menschen mit einer psychischen E...
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