Question 46#

A test for capacity to make treatment decisions includes all of the following EXCEPT:

A. Ability to understand the choice

B. Capacity by definition is a legal concept; it refers to the ability to enter into valid contracts. Every adult is presumed to have capacity unless proved otherwise. Capacity is also task specific; one can have capacity to decide on treatment but can lack capacity to dispose of an estate. A test for capacity includes:

1. able to understand the nature of a decision that needs to be made
2. able to weigh risks and benefits of any decision
3. able to retain information long enough to make a decision
4. able to communicate the decision clearly

It is not necessary for the patient to believe in the information given to him.

Reference:

1. Johnstone EC et al., eds. Companion to Psychiatric Studies, 7th edn. Churchill Livingstone, 2004, p. 736.

Question 47#

Which is the most important ethical principle underlying informed consent?

A. Beneficience

B. For an informed consent to be valid, as a general rule, fi ve areas of information must be provided:

1. description of the medical condition or problem
2. nature and purpose of the proposed treatment
3. risks and benefits of the proposed treatment
4. viable alternatives to the proposed treatment
5. prognosis with and without treatment

The most important ethical principle preserved by obtaining informed consent is that of patient autonomy.

Reference:

1. Sadock BJ and Sadock VA. Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th edn. Lippincott Williams & Wilkins, 2007, p. 1372.

Question 48#

Over-riding patient confidentiality cannot be substantiated reasonably if it is carried out under which of the following situations?

A. Grave danger to a third party

E. Personal information should not be disclosed to a third party without the patient’s express consent, except when:

1. serious risk to third parties outweighs the interests on patient’s privacy, for example child abuse
2. disclosure of information is required by law, for example a notifiable disease
3. patient explicitly agrees to disclosure to a third party

Death of a patient does not waive one’s responsibility to maintain confidentiality.

Reference:

1. Sadock BJ and Sadock VA. Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th edn. Lippincott Williams & Wilkins, 2007, p. 1387.

Question 49#

Which of the following cannot be considered as an exception to direct informed consent?

A. Waiver

E. When a person is passively compliant it is necessary to consider absence of informed consent. This is often seen when patients are prescribed ECT – without knowing all required information, they will agree for a course of treatment passively as the doctor has prescribed it. Legal privilege is the right to maintain secrecy or confidentiality when summoned by court. The right of legal privilege belongs to the patient. Therapeutic privilege is different from this legal privilege. Therapeutic privilege is used when a psychiatrist withholds information in the belief that giving a patient all of the information would harm the patient. This is not commonly practiced. While detaining a patient under the mental health act, often there is no consent from the patient for hospitalization. But this is commonly done against patient’s approval on the grounds of safety of the patient and the others. An incompetent person is one who is incapable of giving informed consent; in which case, consent can be granted only by that person’s guardian, or other persons with legal authority to give consent (e.g. a lasting power of attorney for health-care issues). Consent is presumed when a person is suffering from an emergent situation that requires treatment but is unable to give consent. Waiver is a situation where a patient asks the therapist not to give him a particular part of health information as that would be detrimental for him to know it. Again, this is rarely used.

Reference:

1. Kay J and Tasman A, eds. Essentials of Psychiatry. Wiley, 2006, p. 88.

Question 50#

In ethology, imprinting refers to which of the following processes?

A. Learning modified by consequences

E. Ethology refers to the biological study of animal behaviour. Imprinting is a specialized form of learning which occurs early in life (critical phase). The exposure to the stimulus situation must occur during the critical period, and the exposure can be of short duration without any reinforcement. This type of learning is particularly resistant to change. It has not been clearly demonstrated in human infants so far.

Reference:

1. Sadock BJ and Sadock VA. Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th edn. Lippincott Williams & Wilkins, 2007, p. 160.