Conceptions of decision-making capacity in psychiatry: interviews with Swedish psychiatrists

“The sub-categories were then sorted into wider categories [27,28].”

“The sub-categories were then sorted into wider categories [27,28].”

“Hence, when subcategories were in line with the main aspects of capacity described in the theoretical literature, the established concepts of understanding, appreciation, reasoning and choice were used [4,5].”

“The respondents were recruited continuously during the project, partly through chain-referral, according to a purposive sampling method [24], with the aim of covering views and experiences from psychiatrists with different backgrounds and experiences.”

“There is an extensive literature on philosophical aspects of decision-making capacity [4], and several empirical studies on standards of capacity and clinical assessments of capacity have been conducted [6-13].”

“Impulse control is typically not discussed in the standard literature on decisionmaking capacity [4,5,31].”

“According to the standard view of the normative role of autonomy in healthcare, respect for autonomy means that patients have a right to choose and a right to accept or decline information [1].”

“Rather, it has been analysed as part of a separate capacity for voluntary choice [4,32].”

“Our results may indeed lend support to the wellknown allegation of a double standard when comparing psychiatric and somatic patients [2,35].”

“However, even in severe cases of mental illness, decisional capacity may be retained [7,11-13].”

“Laws on involuntary psychiatric treatment typically focus on presence of (severe) mental illness, need of treatment, or danger to self or others – not on the patient’s ability to make autonomous decisions [2,14-16].”

“For instance, it has been argued that decisional capacity requires a set of values or goals that is authentic to the decision-maker, and that decisions should be in line with these to qualify as competent [18,29].”

“incorrigible beliefs that no one cares about whether or not the person lives or dies (as in the case described by one of the respondents above), that nothing will be better, or unreasonable beliefs about personal guilt [34].”

“However, even in severe cases of mental illness, decisional capacity may be retained [7,11-13].”

“Hence, when subcategories were in line with the main aspects of capacity described in the theoretical literature, the established concepts of understanding, appreciation, reasoning and choice were used [4,5].”

“Laws on involuntary psychiatric treatment typically focus on presence of (severe) mental illness, need of treatment, or danger to self or others – not on the patient’s ability to make autonomous decisions [2,14-16].”

“There is an extensive literature on philosophical aspects of decision-making capacity [4], and several empirical studies on standards of capacity and clinical assessments of capacity have been conducted [6-13].”

“Laws on involuntary psychiatric treatment typically focus on presence of (severe) mental illness, need of treatment, or danger to self or others – not on the patient’s ability to make autonomous decisions [2,14-16].”

“However, even in severe cases of mental illness, decisional capacity may be retained [7,11-13].”

“However, even in severe cases of mental illness, decisional capacity may be retained [7,11-13].”

“There is an extensive literature on philosophical aspects of decision-making capacity [4], and several empirical studies on standards of capacity and clinical assessments of capacity have been conducted [6-13].”

“There is an extensive literature on philosophical aspects of decision-making capacity [4], and several empirical studies on standards of capacity and clinical assessments of capacity have been conducted [6-13].”

“In contrast to this, it has been argued that lack of decision-making capacity should be a necessary criterion for involuntary treatment in psychiatric care just as in somatic care [2,16,17].”

“The idea is controversial as both the precise meaning and normative relevance of authenticity are contested [2,29,30].”

“It was often presumed that patients in need of compulsory treatment were also deci-sionally incapable [42].”

“Laws on involuntary psychiatric treatment focus on the presence of severe mental illness, need of treatment or danger to self or others but not on the patient's ability to make autono‐ mous decisions (Sjöstrand et al., 2015).”

“The interviews’ guiding questions were based on the definition of supported decision making [36–38] and informed by a literature review on similar issues concerning service users [16,39], family caregivers [20,40,41], and healthcare professionals [42,43].”

“(2015), even in severe cases of mental illness, decisional capacity can be retained, and the rate of decision-making incapacity may not be very different among psychiatric inpatients compared to general hospital inpatients in similar circumstances of disease burden [35].”

“Others have raised doubt about determining authentic desires [85, 87, 88].”

“…medication when conducting medication reviews, which are not seen amongst somatic patients, e.g., • Impaired cognitive capabilities of patients 20 – 23 • Possible drug addiction 24,25 • Compulsory treatment order • Challenges in the collaboration between GP and psychiatrist 23 • GPs lack of…”

“depressive and manic episodes in the spectrum of mood disorders) can considerably compromise the decision-making capacity, so a certain number of patients are considered incompetent [17].”