From: Depression and decision-making capacity for treatment or research: a systematic review
Author & year | Source material used (e.g. Clinical experience or case study) | Significant findings |
---|---|---|
Elliot (1997)[11] | Clinical experience. Elliot integrates his personal experience and reasoning with that of other published literature. | When depressed research subjects cannot be held accountable for their treatment decisions, they lack capacity. Competency requires decisional authenticity and a minimal concern for one’s own welfare. |
Halpern (2010)[12] | Case study. An example case is used as the foundation in explaining ‘Concretized Emotion-Belief Complexes’. | Depression may lead to ‘Concretized Emotion-Belief Complexes’ where patients hold rigid beliefs such that they are unable to engage in appreciation. Emotional and cognitive factors influence capacity. |
Leeman (1999)[10] | Case study. Two case vignettes, those of John Smith an Elizabeth Bouvia are considered in relation to capacity. | Depression may cause a breakdown in the appreciation component of mental capacity, but assessing this clinically poses a difficult task. |
Meynen (2010)[13] | A phenomenological conceptual argument founded on other academic literature. | Depression renders an individual unable to appreciate future possibilities. |
Rudnick (2002)[14] | Case study. An anonymised case vignette serves to illustrate and articulate the way depression can impair capacity. | Depression can render an individual lacking capacity, despite leaving cognitive components of capacity in tact. A consideration of emotion should be integrated into capacity assessment. |
Sullivan & Youngner (1994)[15] | Review article. Academic literature both medical and legal is amalgamated with a number of case studies featured. | Depression produces subtle distortions of decision making that are difficult to detect. Decisions made by depressed individuals may seem reasonable. Depression and its severity does not necessarily impede decision-making. The appreciation component of depression must be assessed carefully, as depression may impair appreciative ability. Symptoms of depression can readily interfere with understanding, appreciation and reasoning ability. |
Young E.W. (1993)[16] | Four case studies demonstrate the deficits in capacity that may manifest in depression, with comments from the perspective of the psychiatrist, the ethicist, and the legal counsel. | Depression can impair appreciation. Determination of competence requires that multiple factors are considered including a consideration of patient circumstances, their familial perception of the situation, reversibility of the patient’s emotional state and cognitive functioning. |