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Ethics consultation as a mental prosthesis: addressing ethical dilemmas in neuropsychiatric disorders
  1. Craig Waldence McFarland1,
  2. Emily Rodriguez2,
  3. Julia M Pace3,
  4. Joseph E Brower1,
  5. Takumi J Britt4
  1. 1 Harvard University, Cambridge, Massachusetts, USA
  2. 2 Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3 Northeastern University, Boston, Massachusetts, USA
  4. 4 Stanford University, Stanford, California, USA
  1. Correspondence to Craig Waldence McFarland; craigmcfarland{at}college.harvard.edu

https://doi.org/10.1136/jme-2024-110352

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    Neuropsychiatric disorders introduce distinct challenges to clinical decision-making. Affected patients often experience impairments or absences in rationality, lucidity and cogni-emotional capacities, rendering it difficult for them to engage in the decision-making process. In turn, dynamics of the patient-physician relationship become strained, including when physicians employ bioethical principlism or moral case deliberation to arrive at ethically justified courses of action–both of which require sufficient communication and rationality that may be impaired or altogether absent in the presence of psychopathology.

    The complexity of neuropsychiatric conditions therefore compels interrogation towards how ethics consultations are currently constructed and conducted when full communication or rational decision-making cannot be assumed. Delany et al, for example, present a robust, methodical framework for ethical deliberation.1 Such methodologies for facilitating ethical decision-making, although valuable in predominant contexts, assume full participant engagement and decision-making capacities (eg, independent moral agency). Neuropsychiatric disorders complicate this assumption, making it difficult for patients with limited decision-making capacity to engage meaningfully in proposed ethics consultations.2

    This paper will explore how neuropsychiatric disorders complicate the assumptions of full participant engagement underlying ethical frameworks. It will argue that, by adapting ethics consultations to function as a ‘mental prosthesis’, clinicians can better navigate the ethical challenges posed by neuropsychiatric disorders, helping to ensure that patient autonomy is upheld even in cases of impaired cognitive …

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    Footnotes

    • X @erodbioethics

    • Contributors CWMcF, JP, ER and TJB were directly involved in the creation of the article. CWMcF, as the lead author, was primarily responsible for conceptualising the main thesis, conducting the initial literature review and drafting the manuscript. JP, ER and TJB assisted in the editing of the article and expanding initial ideas, ensuring clarity and coherence in the ideas presented. All authors agreed to be accountable for all aspects of the work submitted.

    • Funding This study was funded by Lester Kissel Grant in Practical Ethics. (No Grant/Award Number to report).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

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