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Table 1 Results from clinical ethical analyses

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.