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2023, Number 5

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Salud Mental 2023; 46 (5)

Bioethics and advance directives in psychiatric in the hospital context

Mondragón-Barrios L, Lolas SF

Language: English
References: 32
Page: 261-267
PDF size: 180.25 Kb.


ABSTRACT

Introduction. Mental health services have been a focus of human rights advocates and recent legal reforms in some Latin American countries, which have called for a change from the paradigm of hospitalization to one of accompanying and supporting the person with mental health issues, which make it possible to apply the Advance Directives in Psychiatry (PADs). This change will require time, as well as economic, material, and human resources, and transformations in attitudes, culture, and society, but the implementation of PADs cannot be postponed: they must be used to protect the autonomy of the persons affected, within a bioethical framework. Objective. Identify possible bioethical conditions in the prevailing conventional hospital context in Latin America that allow for an implementation of PADs. Method. A participant-observer study was carried out in two psychiatric hospital services from June to September 2022. Results. A thematic analysis found three themes: 1) clinical care, 2) patient predisposition, and 3) medical-legal questions. This study considered part of theme 2, including the following sub-themes: a) patient self-perception, b) biography/narrative versus diagnostic classification, and c) negotiation. Discussion and conclusion. Prominent among the sub-themes discussed are recognition of the values of autonomy and its elements in all of the expressions of the person with mental illness, as well as actions of the physician or health care team in synergy with supported decision- making, a distinctive feature of the anticipatory process of the PAD.


REFERENCES

  1. Amering, M., Stastny, P., & Hopper, K. (2005). Psychiatric advance directives:qualitative study of informed deliberations by mental health service users.British Journal of Psychiatry, 186, 247-252. doi: 10.1192/bjp.186.3.247

  2. Appelbaum, P. (2004). Law & Psychiatry: Psychiatric Advance Directives and theTreatment of Committed Patients. Psychiatric Services, 55(7), 751-763. doi:10.1176/appi.ps.55.7.751

  3. Bárcenas, K., & Preza, N. (2019). Desafíos de la etnografía digital en el trabajo decampo onlife. Virtualis, 10(18), 134-151. doi: 10.2123/virtualis.v10i18.287

  4. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. QualitativeResearch in Psychology, 3(2), 77-101. doi: 10.1191/1478088706qp063oa

  5. Casado, M., & Vilà, A. (2014). Documento sobre bioética y discapacidad. Observatoride Bioètica i Dret. Universidad de Barcelona.

  6. Castillo, I. (2018). Diario de campo: características, para qué sirve, ejemplo.Lifeder. Retrieved from https://www.lifeder.com/diario-de-campo/

  7. Cuevas-Esteban, J., Romero, E., Moreno-Orea, A., Ibáñez-Caparrós, A., Bustos-Cardona, T., Martínez-Cirera, B., & de Pablo, J. (2022). ¿Llegó el momento deabrir las puertas en la hospitalización de agudos de psiquiatría? Actas Españolasde Psiquiatría, 50(4), 206-207.

  8. Gloeckler, S., Ferrario, A., & Biller-Andorno, N. (2022). An Ethical Framework forIncorporating Digital Technology into Advance Directives: Promoting InformedAdvance Decision Making in Healthcare. The Yale Journal of Biology andMedicine, 95(3), 349-353. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/pmc9511942/

  9. Granados, R. (2020). Revisión teórica de herramientas metodológicas aplicadas en lainvestigación criminológica. Derecho y Cambio Social, 59, 501-511.

  10. Hiu, S., Su, A., Ong, S., & Poremski, D. (2020). Stakeholder perspective on barrierto the implementation of Advance Care Planning in a traditionally paternalistichealthcare system. PLoS One, 15(11), e0242085. doi: 10.1371/journal.pone.0242085

  11. Howitt, D. (2010). Introduction to qualitative methods in psychology. Harlow:Prentice Hall.

  12. Larraín, H. (2008). El Diario de campo o Bitácora: el instrumento número 1del científico investigador. Eco-antropología. Retrieved from http://ecoantropologia.blogspot.com/2008/02/el-diario-de-campo-o-bitcora-el.html

  13. Marshall, P., & Gómez Yuri, H. (2022). Advance directives in mental health and therevocation problem. Acta Bioethica, 28(2), 205-214. Retrieved from https://actabioethica.uchile.cl/index.php/AB/article/view/68991

  14. Martí, M. (2015). La salud mental. De un modelo rehabilitador a un modelo social. InB. Román, A. Palaudarias, & J. M. Esquirol (Eds.). V Congreso Internacionalde Bioética. Filosofía y Salud Mental (pp. 70-79). Aporia, Sant Pere Claver:Institut Docent-Recerca.

  15. Michel, T., Tachtler, F., Slovak, P., & Fitzpatrick, G. (2020). Young People’s AttitudeToward Positive Psychology Interventions: Thematic Analysis. Journal ofMedical Internet Research Human Factors, 7(4), e21145. doi: 10.2196/21145

  16. Ministerio de Salud. (2021). Ley 21.331 Del reconocimiento y protección de losderechos de las personas en la atención de salud mental. Diario Oficial Mayo11, 2021. Retrieved from Ley-21331 11-MAY-2021 MINISTERIO DE SALUD- Ley Chile - Biblioteca del Congreso Nacional (bcn.cl)

  17. Mondragón, L., & Guarneros, T. (2020). Directrices Anticipadas en Psiquiatría. InN. Martínez (Ed.). Salud Mental Forense (pp. 124-137). Ciudad de México,México: Editorial Tirant lo Blanch México.

  18. Mondragón, L., Monroy, Z., Ito, M. E., & Medina-Mora, M. E. (2010). Disyuntivasen las concepciones sobre autonomy beneficencia que afectan la terapéuticadel intento suicida. Acta Bioethica, 16(1), 77-86. doi: 10.4067/S1726-569X2010000100011

  19. Mondragón, L., Romero, M., & Borges, G. (2008). Ethnography in an emergencyroom: Evaluating patients with alcohol consumption. Salud Pública de México,50(4), 308-315.

  20. Monje, C. A. (2011). Metodología de la investigación cuantitativa y cualitativa. Unaguía didáctica. Colombia: Universidad Surcolombiana.

  21. Nicaise, P., Lorant, V., & Dubois, V. (2013). Psychiatric Advance Directives as acomplex and multistage intervention: a realist systematic review. Health & SocialCare in the Community, 21(1), 1-14. doi: 10.1111/j.1365-2524.2012.01062.x

  22. Noguero, A., & Peregalli, S. (2021). Alternativas a los internamientos en salud mental:hospitalización domiciliaria desde la perspectiva española y anglosajona.Revista de Bioética y Derecho, 53, 37-55. doi: 10.1344/rbd2021.53.34726

  23. Potthoff, S., Finke, M., Scholten, M., Gieselmann, A., Vollmann, J., & Gather, J.(2022). Opportunities and risks of self-binding directives: A qualitative studyinvolving stakeholders and researchers in Germany. Frontiers in Psychiatry, 13,974132. doi: 10.3389/fpsyt.2022.974132

  24. Scholten, M., Gieselmann, A., Gather, J., & Vollmann, J. (2019). Psychiatric AdvanceDirectives Under the Convention on the Rights of Persons with Disabilities:Why Advance Instructions Should Be Able to Override Current Preferences.Frontiers in Psychiatry, 10, 631. doi: 10.3389/fpsyt.2019.00631

  25. Scholten, M., Weller, P. J., Kim, S. Y. H., & Vollmann, J. (2021). Editorial: HumanRights and Mental Health: Current Developments in Competence Assessmentand Supported Decision-Making. Frontiers in Psychiatry, 12, 682606. doi:10.3389/fpsyt.2021.682606

  26. Secretaría de Salud. (2022). Decreto por el que se reforman, adicionan y derogandiversas disposiciones de la Ley General de Salud, en materia de Salud Mentaly Adicciones. Diario Oficial de la Federación, Mayo 16, 2022. Retrieved fromDOF - Diario Oficial de la Federación

  27. Srebnik, D., & Kim, S. (2006). Competency for Creation, Use and Revocation ofPsychiatric Advance Directives. Journal of the American Academy of Psychiatryand the Law, 34(4), 501-510.

  28. Srebnik, D., Appelbaum, P., & Russo, J. (2004). Assessing Competence to CompletePsychiatric Advance Directives with the Competence Assessment Tool forPsychiatric Advance Directives. Comprehensive Psychiatry, 45(4), 239-245.doi: 10.1016/j.comppsych.2004.03.004

  29. Stavert, J. (2021). Supported Decision-Making and Paradigm Shifts: WordPlay or Real Change? Frontiers in Psychiatry, 11, 571005. doi: 10.3389/fpsyt.2020.571005

  30. Szmukler, G. (2019). “Capacity”, “best interests”, “will and preferences” and the UNConvention on the Rights of Persons with Disabilities. World Psychiatry, 18(1),34-41. doi: 10.1002/wps.20584

  31. United Nations. (2006). Convention on the Rights of Persons with Disabilities.Retrieved from https://www.un.org/development/desa/disabilities/conventionon-the-rights-of-persons-with-disabilities.html

  32. Valenti, E., Giacco, D., Katasakou, C., & Priebe, S. (2014). Which values areimportant for patients during involuntary treatment? A qualitative studywith psychiatric inpatients. Journal of Medical Ethics, 40(12), 832-836. doi:10.1136/medethics-2011-100370




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