Neuroethics and treatment without consent.

IF 3.4 3区 医学 Q2 CLINICAL NEUROLOGY
Harry G Kennedy, Mary Davoren
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Abstract

Objectives: We consider the neuroethics of treatment without consent from a broader perspective than the accepted starting point of functional mental capacities. Notably, in common law jurisdictions, consciousness is seldom admitted in criminal law as a topic for expert evidence of mentalistic defenses or impairments in civil proceedings, yet consciousness and personality are central in Roman law jurisdictions.

Methods: The framework we have adopted is to consider treatment without consent under the headings goals, processes, treatment, and evaluation. The ECHR and the judges of the European Court of Human Rights (ECtHR) are drawn from both common law and Roman law jurisdictions, so that their interpretations and precedents may be informative concerning alternatives to strict application of capacity tests.

Results: There are variable thresholds for treating without consent according to the complexity and amount of information involved, the seriousness of the consequences of untreated illness, the effectiveness of the treatments available and the benefits of earlier intervention, particularly for disease-modifying treatments. Theory-driven principled approaches and scientific medical process approaches to ethical treatment are contrasted.

Conclusions: Carrara's emphasis on the importance of consciousness and its layered dysfunctions as evidence of competence or impairment appears more robust than a narrow approach based only on functional mental capacity. Capacity-whether general or functional, remains amenable to rules of evidence and legal judgment at the expense of increasingly excessive simplification. Carrara's emphasis on the inherent dignity of the person appears most in keeping with modern human rights principles.

神经伦理学和未经同意的治疗。
目的:我们从更广泛的角度考虑未经同意治疗的神经伦理学,而不是公认的功能性心理能力的起点。值得注意的是,在普通法管辖范围内,意识很少在刑法中被承认为精神主义辩护或民事诉讼中损害的专家证据的主题,然而意识和人格在罗马法管辖范围内是核心。方法:我们采用的框架是在目标、过程、治疗和评估的标题下考虑未经同意的治疗。欧洲人权法院和欧洲人权法院(欧洲人权法院)的法官来自普通法和罗马法管辖区,因此,他们的解释和先例可能提供有关严格适用能力测试的替代办法的资料。结果:根据所涉信息的复杂性和数量、未经治疗的疾病后果的严重性、现有治疗方法的有效性和早期干预的益处,特别是对疾病改善治疗的益处,在未经同意的情况下进行治疗的阈值是可变的。理论驱动的原则方法和科学的医疗过程方法的伦理治疗进行了对比。结论:Carrara强调意识的重要性及其分层功能障碍作为能力或损伤的证据,似乎比仅基于功能性心理能力的狭隘方法更有力。能力,无论是一般能力还是职务能力,仍然服从证据规则和法律判断,代价是日益过度简化。卡拉拉对人的固有尊严的强调似乎最符合现代人权原则。
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来源期刊
CNS Spectrums
CNS Spectrums 医学-精神病学
CiteScore
6.20
自引率
6.10%
发文量
239
审稿时长
>12 weeks
期刊介绍: CNS Spectrums covers all aspects of the clinical neurosciences, neurotherapeutics, and neuropsychopharmacology, particularly those pertinent to the clinician and clinical investigator. The journal features focused, in-depth reviews, perspectives, and original research articles. New therapeutics of all types in psychiatry, mental health, and neurology are emphasized, especially first in man studies, proof of concept studies, and translational basic neuroscience studies. Subject coverage spans the full spectrum of neuropsychiatry, focusing on those crossing traditional boundaries between neurology and psychiatry.
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