Anosognosia and schizophrenia: the ethical intersection of insight, treatment and coercion

Marley, James
January 2007
BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1
Academic Journal
Background Anosognosia is a symptom present in some individuals diagnosed with schizophrenia. This neurological condition can greatly impair or eliminate the person's ability to have insight into the presence and/or nature of his or her illness. Such impairment in insight raises important ethical issues regarding how these individuals should be viewed with regards to autonomy, free will, self-determination and the extent to which coercion (such as involuntary hospitalization or forced medication) is justifiable. This paper will discuss this condition and explore the ethical implications and tensions brought on by anosognosia. Methods The presentation will be based on the author's clinical experience with this population as well as the research and literature on anosognosia, ethics of care, and coercion. In particular, the work of Stephen Darwall, Xavier Amador, and others will be used to explore the perspective of ethics of care as the basis for addressing these ethical tensions. Case examples from the presenter's clinical practice will help illustrate the nature of these ethical tensions. Results The presentation will include a model and rationale based on ethics of care that may be helpful in resolving the ethical tensions generated by the symptom of anosognosia. The model presents an ethical decision making process as well as clinical steps mental health practitioners can utilize to resolve such ethical tensions when issues of coercion are at stake. Conclusion Under some circumstances, certain levels of coercion may be justified based on an ethics of care approach when individuals with schizophrenia have substantially impaired insight into the presence and nature of their illness.


Related Articles

  • BALANCING CIVIL LIBERTIES WITH CLINICAL CARE: Reviewing the Recent Change in the Involuntary Admissions Statute. de Nesnera, Alexander; Shagoury, Paul; Woodbury, Elizabeth Howell // New Hampshire Bar Journal;Winter2012, Vol. 52 Issue 4, p44 

    The article presents information on the statutes of New Hampshire with reference to the balancing between the civil liberties and medical care. It discusses the evolution of the involuntary hospitalization for the mentally ill and the involuntary treatment of patients in New Hampshire....

  • Taking the Role of the Family Seriously in Treating Chinese Psychiatric Patients: A Confucian Familist Review of China's First Mental Health Act. RUIPING FAN; MINGXU WANG // Journal of Medicine & Philosophy;Aug2015, Vol. 40 Issue 4, p387 

    This essay argues that the Chinese Mental Health Act of 2013 is overly individualistic and fails to give proper moral weight to the role of Chinese families in directing the process of decision-making for hospitalizing and treating the mentally ill patients. We present three types of reactions...

  • Coercion and cooperation and psychiatry for the person. Mezzich, Juan E. // BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1 

    Coercive treatment in its various forms represents a critical challenge for clinical care. This can be usefully discussed vis-á-vis the opportunities open by cooperation and engagement. The framework of Psychiatry for the Person, a major WPA initiative, can be helpful for such analyses. This...

  • The use of seclusion and restraint during 15 years -- a nationwide study in Finland. Keski-Valkama, Alice; Sailas, Eila; Eronen, Markku; Lönnqvist, Jouko; Kaltiala-Heino, Riittakerttu // BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1 

    Background Internationally, concerns over the use of seclusion and restraint in psychiatric care have increased over the past decades. In Finland, restriction of freedom and use of coercion in psychiatry are regulated by the Mental Health Act of 1991. After its implementation, the Act (revision...

  • Patients' view of seclusion -- preliminary report. Keski-Valkama, Alice; Eronen, Markku; Kaltiala-Heino, Riittakerttu // BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1 

    Background Seclusion, putting a patient involuntarily alone in a locked unfurnished room from which she/he cannot freely exit, is a prevailing coercive measure in modern psychiatric practice. In recent years, clinical, ethical, and legal debate has increased awareness of its controversial...

  • Covert Treatment of Violent Patients: Ethics Commentary. PICKERING, NEIL // Asian Bioethics Review;Sep2013, Vol. 5 Issue 3, p212 

    The author offers his ethical commentary on a case study related to covert treatment of violent patients. He cites the possibility that the plan of the patient's wife to administer his medication covertly may result in negative consequences, leading to the patient's doctors not supporting the...

  • Involuntary Treatment and Forcibly Restraining Patients: Ethics Commentary. ROBERTSON, MICHAEL // Asian Bioethics Review;Sep2013, Vol. 5 Issue 3, p230 

    The author offers his ethical commentary on a case study related to involuntary treatment and forcibly restraining patients. He notes that the patient's mental illness which impaired her insight and judgement is denying her of a potentially life-saving treatment, such as the electroconvulsive...

  • Covert Treatment of Violent Patients: Legal Commentary. CALVIN HO // Asian Bioethics Review;Sep2013, Vol. 5 Issue 3, p203 

    The author offers his legal commentary on the case study related to covert treatment of violent patients. He presents several factors in determining whether the patient has the capacity to make informed choice including understanding the information given to him, retaining the information long...

  • Treatment without consent -- dialogue, or psychiatric language games? Opoczynska, Malgorzata; Rostworowska, Maria; Cwiklinski, Zbigniew; Robak, Jolanta; Dziasek, Ireneusz; Marciak, Miroslawa; Pytko, Halina; Karolczyk, Bernadetta // Archives of Psychiatry & Psychotherapy;Mar2011, Vol. 13 Issue 1, p5 

    Aim. The main aim of presented paper is the discussion with the anti-psychiatry's and postpsychiatry's critique of psychiatric inpatient wards and their practices. Method and subject. Basing on the story of one patient, the chance for dialogue with the inpatient even in the case of actual forced...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics