Abstract
<p>The article argues that a functional approach is ethically better than a categorical approach in deciding whether involuntarily admitted patients have the capacity to give informed consent to participation in research. Congruent with current South African laws, a functional approach requires that a patient’s capacity to give informed consent to participation in research should be assessed clinically rather than assumed by virtue of his/her belonging to a category of legal admission status. Concerns about protection against exploitation may cause a categorical approach to appear attractive, but these concerns can be addressed deliberately through a functional approach without attracting the infringements of rights and entitlements of patients that are brought about by a categorical approach.</p>
Highlights
The article argues that a functional approach is ethically better than a categorical approach in deciding whether involuntarily admitted patients have the capacity to give informed consent to participation in research
Researchers in psychiatry, sponsors of psychiatric research and research ethics committees are confronted with an ethical question, viz. whether patients admitted involuntarily to a psychiatric hospital can give informed consent to participate in research
This article compares two approaches, and I argue that a functional approach is ethically preferable to a categorical approach to this question
Summary
A functional approach requires that a patient’s capacity to give informed consent to participation in research should be assessed clinically rather than be assumed by virtue of his/her belonging to any one category. Regulation 35 of the current Mental Health Care Act assumes explicitly that an involuntarily admitted patient can have the capacity to give informed consent to interventions other than those concerning his or her admission. It states that ‘an involuntary mental health care user, an assisted mental health care user, a state patient or a mentally ill prisoner who is capable of giving informed consent to treatment or an operation, must decide whether to have the treatment or operation or not’.4. The Code of Practice for the British Mental Health Act[7] prescribes that informed consent to treatment be obtained from a patient when he or she is capable of giving it, whether or not the patient has been admitted to hospital involuntarily
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