The practice of empathy as a prerequisite for informed consent

The patient-physician relationship, as formulated in the traditional biomedical model of medicine, is inherently flawed. In entering this relationship, most patients seek simply to be delivered from illness back to normal psychosocial functioning. The physician, however, almost invariably responds with a purely biologic approach to diagnosis and treatment that often does not effectively address the patient's needs. This precludes the opportunity for a consensus between them, and may in fact lead to the physician manipulating the patient's decisions about the course of therapy. The relationship should be reshaped within a new scientific model of patient care that combines the biomedical analysis of disease with an empathic understanding of the patient's illness experience. Truly informed consent is viewed as a natural outcome of the application of this more comprehensive framework.     

BRCA1 testing and informed consent in a woman with mild retardation

Cancer predisposition testing can pose complex genetic counseling issues. This casereport discusses whether it is appropriate to provide BRCA1 testing to a woman withlimited intellectual capacity and documented psychological distress. This case is one ofseveral cancer counseling cases presented to our Genetic Counseling Supervision Groupover the past three and a half years. The Supervision Group provided valuable feedback and supportto proceed with this challenging case.     

The collaborative assessment and management of suicidality versus treatment as usual: a retrospective study with suicidal outpatients

The Collaborative Assessment and Management of Suicidality (CAMS) is a novel clinical approach used to identify, assess, and manage suicidal outpatients (Jobes & Drozd, 2004). The results of a retrospective study evaluating the impact of CAMS versus treatment as usual (TAU) on suicidal outpatients are presented. Patients in the CAMS treatment group (n = 25) resolved their suicidality significantly more quickly than TAU patients (n = 30). CAMS was also significantly associated with decreased medical health care utilization in the 6 months after the start of suicide-related mental health treatment. These results provide promising preliminary support for the effectiveness of CAMS and a foundation for prospective research.     

Goodness-of-fit ethic for informed consent to research involving adults with mental retardation and developmental disabilities

This article reviews current theory and research on informed consent policies for adults with mental retardation within a relational ethics framework that re-conceptualizes consent vulnerability in terms of the goodness-of-fit between participant decisional capacities and the specific consent context. Conceptualizing informed consent competence as a product of the relationship between person and consent context shifts assessment of decisional capacity away from an exclusive focus on a research participant's cognitive deficiencies to (a) an examination of those aspects of the consent setting that are creating or exacerbating consent vulnerability and (b) consideration of how the setting can be modified to produce a consent process that best reflects and protects the hopes, values, concerns, and welfare of adults with developmental disabilities.     

Emotionally-focused therapy and treatment as usual comparison groups in decreasing depression: A clinical pilot study

Abstract

Decades of research have shown that depression can have deleterious effects on couple relationships. Emotionally-focused therapy (EFT; Johnson, 2004 Johnson, S. M. (2004). The practice of emotionally focused couple therapy: Creating connection. East Sussex, UK: Brunner-Routledge. [Google Scholar]) is an empirically validated form of couple therapy, which has shown effectiveness in reducing depressive symptoms in couples where the wife has depression. The aim of the current pilot study was to examine the extent to which EFT and the comparison treatment as usual (TAU) therapy group decrease depressive symptoms in distressed couples. Results show that both groups were effective in decreasing depressive symptoms, with EFT showing a clinically significant reduction. Clinical implications and future research are discussed.     

Conflict of interest issues in informed consent for research on human subjects: a South Asian perspective

Health research for progress in the control and conquest of disease afflicting man is unquestionable. Concerns arise when motives other than the advancement of scientific knowledge and benefit for individuals and society are the driving force behind clinical trials. These conflicts of interests become even more pronounced when dealing with populations rendered vulnerable by virtue of poverty and ignorance. South Asia with its teeming millions represents one such region. This essay examines the reasons that make this population vulnerable to exploitation. Informed consent in the process of research is an area where such conflicts are prone to arise. In order to ensure that conflicting interests of researchers and funding agencies are kept in check, the processes of informed consent and ethical review of research need to be strengthened. Suggestions are put forward to modify the consent process to match the needs of South Asia and to strengthen the ethical review process for safeguarding the rights of the study subjects. But perhaps the most important safeguard against exploitation is the virtuous researcher himself with noble intentions. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

Organizational control and treatment program design as dimensions of institutionalization in settings for juvenile offenders

The relationship between organizational control and normalization in treatment program design was examined in 30 community-based settings for juvenile offenders. Although these two dimensions were hypothesized to be converging indicators of the institutionality of a setting, the findings indicated that they are only marginally related. More hierarchical models of decision making were not associated with more depersonalized, isolating programming, and involvement of residents and line staff in decision making did not covary with autonomy and personalization in programming. The results are discussed as evidence that institutionality is a multidimensional construct, and that future investigations must distinguish between organizational decision making and characteristics of treatment program design when assessing the institutional quality of residential service settings.     

The development of a culturally informed, family-focused treatment for schizophrenia

With the changing demographics in the United States, there is an increasing need for psychotherapy interventions that have been tailored for and empirically evaluated with culturally diverse groups. This article discusses the development and evaluation of a family-focused, culturally informed therapy for schizophrenia (CIT-S) that is currently being pilot tested at the University of Miami. Case examples of CIT-S with participating families are provided, along with a discussion of interesting and challenging cultural issues that we have encountered during the pilot phase of this treatment study.     

Informed consent as a prescription calling for debate between analysts and researchers(1)

This article is a review of the international scientific literature on informed consent and its use in some of the constituent organizations of the International Psychoanalytical Association (IPA). Because psychoanalysis comprises a theory based on practice, the dearth of clinical material for study, training and research purposes is a serious problem for analysts. Supervisions, presentations at scientific societies and congresses, publications and teaching material involve patients to an extent that goes beyond the work done in their sessions. Should consent be requested in these cases? This contribution addresses controversial and long‐standing issues such as informed consent and confidentiality, audio recording of treatments, knowledge production, the ambivalence of participating subjects over time and the perspective of analysts and patients respectively. The authors consider the various alternative approaches available for the handling of these ethical dilemmas without losing sight of the patient’s dignity and personal rights, while also taking account of the position of the analyst.