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Shared decision-making in mental health: a novel proposal
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Published:
Oct 1, 2021
Versions:
2021-10-01 (1)
Keywords:
mental health, joint decision making, relational autonomy, health vulnerability, social stigma
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Abstract
The health system tends to underestimate the ability to make decisions of people with mental illnesses, characterizing them as vulnerable and adopting a stigmatizing attitude towards this vulnerability. Therefore, their autonomy, in the classical sense of the term, is reduced or nullified. Another way to respond to vulnerability is by promoting autonomy, conceiving it as contextual and autonomy in a relational way. This could be beneficial for people with mental suffering because it allows analyzing what conditions could improve or harm the exercise of autonomy and consider the help of others in decision-making.
The shared decision-making process is a form of collaboration between professionals, patients and/or family members, in which the available evidence is shared with the patient and contextualized when faced with the task of making decisions in the medical environment.
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How to Cite
Buedo, P., & Luna, F. (2021). Shared decision-making in mental health: a novel proposal. Medicina Y Ética, 32(4), 1087–1011. https://doi.org/10.36105/mye.2021v32n4.05
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References
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33. Luna F. Identifying and evaluating layers of vulnerability, a way forward. Developing World Bioeth. 2018; 1-10. https://doi.org/10.1111/dewb.12206
34. Kilbride M & Joffe S. The new age of patient autonomy. Implications for the patient-physician relationship. JAMA. 2018; 20, 320(19): 1973-1974. https://doi.org/10.1001/jama.2018.14382
35. Ubel P, Scherr J & Fagerlin A. Autonomy: What’s shared decision making have to do with it? The American Journal of Bioethics. 2018; 18(2): W11-W12. https://doi.org/10.1080/15265161.2017.1409844
36. Van Nistelrooij I, et al. How shared is shared decision-making? A care-ethical view on the role of partner and family. J Med Ethics. 2017; 0: 1-8. https://doi.org/10.1136/medethics-2016-103791
37. Sandman L & Munthe C. Shared decision-making and patient autonomy. Theor Med Bioeth. 2009; 30: 289-310. https://doi.org/10.1007/s11017-009-9114-4
38. Lewis J. Does shared decision making respect a patient’s relational autonomy? J Eval Clin Pract. 2019; 1-7. https://doi.org/10.1111/jep.13185
39. Berger J. Informed consent is inadequate and shared decision making is ineffective: Arguing for the primacy of authenticity in decision-making paradigms. The American Journal of Bioethics. 2017; 17(11): 45-47. https://doi.org/10.1080/15265161.2017.1378759
40. Childress J. Needed: A more rigorous analysis of models of decision making and a richer account of respect for autonomy. American Journal of Bioethics. 2017; 17(11): 52-54. https://doi.org/10.1080/15265161.2017.1382168
41. Bae J. Shared decision making: Relevant concepts and facilitating strategies. Epidemiol Health. 2017; 39: 1-5. https://doi.org/10.4178/epih.e2017048
42. Cudd A. Analyzing oppression. New York: Oxford University Press; 2006. https://doi.org/10.1093/0195187431.001.0001
2. Stagnaro J. Algunos problemas de la psiquiatría contemporánea analizados desde la perspectiva bioética. Vertex Revista Argentina de Psiquiatría. 2007; 18: 376-381.
3. Olofsson B, Jacobsson L. A plea for respect: Involuntary hospitalized psychiatric patients narratives about being subjected to coercion. Journal of Psychiatric and Mental Health Nursing. 2001; 8: 357-366. https://doi.org/10.1046/j.1365-2850.2001.00404.x
4. Hernández Figaredo P. Psiquiatría y ética médica. Humanidades Médicas. 2007; 7(2).
5. Mascayano Tapia F, Lips Castro W, Mena Poblete C, Manchego Soza C. Estigma hacia los trastornos mentales: características e intervenciones. Salud Mental. 2015; 38(1): 53-58. https://doi.org/10.17711/SM.0185-3325.2015.007
6. Ben-Zeev D, Young M, Corrigan P. DSM-V and the stigma of mental illness. Journal of Mental Health. 2010; 19(4): 318-327. https://doi.org/10.3109/09638237.2010.492484
7. Corrigan P, Kerr A, Knudsen M. The stigma of mental illness: Explanatory models and methods for change. Applied and Preventive Psychology. 2005; 11(3): 179-190. https://doi.org/10.1016/j.appsy.2005.07.001
8. Castro H. Estigma y enfermedad mental: un punto de vista histórico-social. Revista de Psiquiatría y Salud Mental Hermilio Valdizán. 2005; 6(1): 33-42.
9. Link B, Phelan J. Conceptualizing stigma. Annual Review of Sociology. 2001; 27: 363-385. https://doi.org/10.1146/annurev.soc.27.1.363
10. Slade M. Implementing shared decision making in routine mental health care. World Psychiatry. 2017; 16(2): 146-153. https://doi.org/10.1002/wps.20412
11. Organización Mundial de la Salud. Mental health: Central to human development, 2010.
12. Nott J, et al. Shared decision-making in psychiatry: A study of patient attitudes. Australasian Psychiatry. 2018; 25(6). https://doi.org/10.1177/1039856217739730
13. Hamann J, Leucht S, Kissling W. Shared decision making in psychiatry. Acta Psychiatrica Scandinavica. 2003; 107(6): 403-409. https://doi.org/10.1034/j.1600-0447.2003.00130.x
14. NHS England. Shared decision making. 2019.
15. Barani M, Kopitowski K. Toma de decisiones compartidas: centrando los cuidados médicos realmente en nuestros pacientes. Rev. Hosp. Ital. B. Aires. 2013; 33(2): 60-64.
16. Elwyn G, et al. Shared decision making: A model for clinical practice. Journal of General Internal Medicine. 2012; 27(10): 1361-1367. https://doi.org/10.1007/s11606-012-2077-6
17. Christman J. Relational autonomy, liberal individualism, and the social constitution of selves. Philosophical Studies: An International Journal for Philosophy in the Analytic Tradition. 2004; 117(1/2): 143-164. https://doi.org/10.1023/B:PHIL.0000014532.56866.5c
18. Childress J. El lugar de la autonomía en la bioética. En: Luna F, Salles A. Bioética. Investigación, muerte, procreación y otros temas de ética aplicada. Buenos Aires: Editorial Sudamericana. 1998; 133-144.
19. Beauchamp T, Childress J. Principles of Biomedical Ethics. New York: Oxford University Press. 2009.
20. Butler J. Dar cuenta de sí mismo. Violencia ética y responsabilidad. Buenos Aires: Amorrortu. 2009.
21. Nedelsky J. Reconceiving rights as relationship. Review of Constitutional Studies. 1993; 1(1).
22. Ells C, Hunt M, Chambers-Evans J. Relational autonomy as an essential component of patient-centered care. International Journal of Feminist Approaches to Bioethics. 2011; 4(2): 79-101. https://doi.org/10.3138/ijfab.4.2.79
23. Salles A. Enfoques éticos alternativos. En: Luna F, Salles A. Bioética: nuevas reflexiones sobre debates clásicos. Buenos Aires: Fondo de Cultura Económica. 2008; 92-98.
24. Mackenzie C. Feminist innovation in philosophy: Relational autonomy and social justice. Women’s Studies International Forum. 2019; 72: 144-151. https://doi.org/10.1016/j.wsif.2018.05.003
25. Pichón-Riviere E. El proceso grupal. Del psicoanálisis a la psicología social. Buenos Aires: Editorial Nueva Visión; 2012.
26. Galende E, Ardila S. El concepto de comunidad en la salud mental comunitaria. Revista Salud Mental y Comunidad. 2011; 1(1): 39-50.
27. Bleichmar S. La construcción del sujeto ético. Buenos Aires: Editorial Paidós; 2011.
28. Organización Mundial de la Salud. Mental health and development: Targeting people with mental health conditions as a vulnerable group. 2010.
29. Luna F. Vulnerabilidad: la metáfora de las capas. Jurisprudencia Argentina. 2008; 4(1): 60-67.
30. Luna F. Vulnerabilidad: un concepto muy útil. Abandonando los “corsés teóricos”. Revista Redbioética/UNESCO. 2011; 2(4).
31. Levine C, Faden R, Grady C, Hammerschmidt D, Eckenwiler L, Sugarman J. The limitations of vulnerability as a protection for human research participants. Consortium to examine clinical research ethics. American Journal of Bioethics. 2004; 4(3): 44-49. https://doi.org/10.1080/15265160490497083
32. Luna F. Rubens, corsets and taxonomies: A response to Meek Lange, Rogers and Dodds. Bioethics. 2015; 29: 448-450. https://doi.org/10.1111/bioe.12109
33. Luna F. Identifying and evaluating layers of vulnerability, a way forward. Developing World Bioeth. 2018; 1-10. https://doi.org/10.1111/dewb.12206
34. Kilbride M & Joffe S. The new age of patient autonomy. Implications for the patient-physician relationship. JAMA. 2018; 20, 320(19): 1973-1974. https://doi.org/10.1001/jama.2018.14382
35. Ubel P, Scherr J & Fagerlin A. Autonomy: What’s shared decision making have to do with it? The American Journal of Bioethics. 2018; 18(2): W11-W12. https://doi.org/10.1080/15265161.2017.1409844
36. Van Nistelrooij I, et al. How shared is shared decision-making? A care-ethical view on the role of partner and family. J Med Ethics. 2017; 0: 1-8. https://doi.org/10.1136/medethics-2016-103791
37. Sandman L & Munthe C. Shared decision-making and patient autonomy. Theor Med Bioeth. 2009; 30: 289-310. https://doi.org/10.1007/s11017-009-9114-4
38. Lewis J. Does shared decision making respect a patient’s relational autonomy? J Eval Clin Pract. 2019; 1-7. https://doi.org/10.1111/jep.13185
39. Berger J. Informed consent is inadequate and shared decision making is ineffective: Arguing for the primacy of authenticity in decision-making paradigms. The American Journal of Bioethics. 2017; 17(11): 45-47. https://doi.org/10.1080/15265161.2017.1378759
40. Childress J. Needed: A more rigorous analysis of models of decision making and a richer account of respect for autonomy. American Journal of Bioethics. 2017; 17(11): 52-54. https://doi.org/10.1080/15265161.2017.1382168
41. Bae J. Shared decision making: Relevant concepts and facilitating strategies. Epidemiol Health. 2017; 39: 1-5. https://doi.org/10.4178/epih.e2017048
42. Cudd A. Analyzing oppression. New York: Oxford University Press; 2006. https://doi.org/10.1093/0195187431.001.0001