Ethics in treating patients

with mental illness

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reference
Newell, E.R. Competency, consent, and
electroconvulsive therapy: a mentally ill
prisoners right to refuse invasive medical
treatment in Oregons criminal justice system.
Sited from:
The UNESCO Chair in Bioethics. Informed
Consent. The International Center for Health,
Law, and Ethics; Faculty of Law, University of
Haifa, Israel, 2003
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competent patiens
Has ability to understand the

nature of his illness for which

tratment is recommended
Has ability to appreciate the
consequences of giving or
refusing consent.
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incompetent patiens
One whose insanity or mental

deficiency deprives him of the

ability to control his own interest

memberi informasi, mempertimbangkan

situasi, mengukur fakta2 yg relevan,
melaksanakan pilihan, menggunakan informasi
secara realistis, mengambil keputusan yang
cukup tepat & beralasan, memahami sifat2
penyakitnya dan tritmen yang ditawarkan,
mempertimbangkan konsekuensi stl
memberikan atau menolak suatu persetujuan
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Competence
Degress
Vary over time
Influenced by different circumtances

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Health profesionals
respect the views of
incompetent patients
as long as it is not
presumed to harm himself or
someone else
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CASE, examined :
light of his illness
his condition and fitness
at a relevant time

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Informed consent
Informed choice
Informed refusal
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Electro Compulsive Therapy

= terapi kejang listrik
1933, shock treatments by Manfred

Sakel
Populer dalam PD II
1950, standar tritmen untuk depresi
di Amerika dan Eropa
Kontroversi : seizure, torture
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Electro Compulsive Therapy

= terapi kejang listrik
Patient decide to consent :
Adjusted to individual needs
Based on the judgment of the ECT
physician
Medication used to relax muscles
Given oxygen to breathe
Vital sign will be monitored
Observed until it is time to leave the ECT
area
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Electro Compulsive Therapy

= terapi kejang listrik
Opponents to ECT :
Long term cognitive effects

memory loss, problems remembering past

events and new information, permanent
gaps in memory

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Electro Compulsive Therapy

= terapi kejang listrik
The National Mental Health Association,
recommended :

As an alternative with extreme

caution
Only after all other treatment
approaches (medication and
psychotherapy) have either failed
Seriously and thoroughly evaluated
and rejected
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 Issues
..

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