Paul S. Appelbaum – författare

Informed consent - as an ethical ideal and legal doctrine - has been the source of much concern to clinicians. Drawing on a diverse set of backgrounds and two decades of research in clinical settings, the authors - a lawyer, a physician, a social scientist, and a philosopher - help clinicians understand and cope with their legal obligations and show how the proper handling of informed consent can improve , rather than impede, patient care. Following a concise review of the ethical and legal foundations of informed consent, they provide detailed, practical suggestions for incorporating informed consent into clinical practice. This completely revised and updated edition discusses how to handle informed consent in all phases of the doctor-patient relationship, use of consent forms, patients' refusals of treatment, and consent to research. It comments on recent laws and national policy, and addresses cutting edge issues, such as fulfilling physician obligations under managed care. This clear and succinct book contains a wealth of information that will not only help clinicians meet the legal requirements of informed consent and understand its ethical underpinnings, but also enhance their ability to deal with their patients more effectively. It will be of value to all those working in areas where issues of informed consent are likely to arise, including medicine, biomedical research, mental health care, nursing, dentistry, biomedical ethics, and law.

The presumed link between mental disorder and violence has been the driving force behind mental health law and policy for centuries. Legislatures, courts, and the public have come to expect that mental health professionals will protect them from violent acts by persons with mental disorders. Yet for three decades research has shown that clinicians'' unaided assessments of "dangerousness" are barely better than chance. Rethinking Risk Assessment: The MacArthur Study of Mental Disorder and Violence tells the story of a pioneering investigation that challenges preconceptions about the frequency and nature of violence among persons with mental disorders, and suggests an innovative approach to predicting its occurrence. The authors of this massive project -- the largest ever undertaken on the topic -- demonstrate how clinicians can use a "decision tree" to identify groups of patients at very low and very high risk for violence. This dramatic new finding, and its implications for the every day clinical practice of risk assessment and risk management, is thoroughly described in this remarkable and long-anticipated volume. Taken to heart, its message will change the way clinicians, judges, and others who must deal with persons who are mentally ill and may be violent will do their work.

The major mental health reforms of the last generation in the U.S.A. have given rise to much discussion and often heated debate; but have they actually produced any real changes? This book is the first overview of this controversial subject - and the author's appraisal of the consequences of these reforms is surprising. Changes which were originally aimed at making it more difficult to hospitalize and treat people with mental illness, and easier to punish them, have actually resulted in far less change than was predicted or intended. This stimulating book argues that, when the law contradicted commonsense ideas of how to deal with the mentally ill, it was bent or ignored, whether by judges, medical professionals, or family members.

The authenticity of memories of childhood sexual abuse has become one of the major social controversies of the 1990's. As persons who report histories of abuse have sought remedies in civil and criminal proceedings in the courts,the accuracy of their memories--particularly when they have been recalled after a period of time--has been subject to intense scrutiny. This volume brings together many of the leading participants in the debate. Beginning by defining opposing positions, the contributors offer a variety of perspectives on the nature of the memory, including reviews of some of the most exciting recent developments in this fast-moving area of investigation. Next, consideration is given to the impact of trauma on memory, both in adults and in children. With this framework in place, the authors then turn to an examination of the variety of treatment approaches available to help patients who have been victims of trauma and who are struggling with memories of those events. Finally, they address the legal dilemmas for patients, mental health professionals, and society as a whole that have arisen from the trauma and memory controversy. As a whole, this book provides an unparalleled examination of this important and intriguing issue.

One of the most challenging tasks facing clinicians today is the assessment of patients' capacities to consent to treatment. The protection of a patient's right to decide, as well as the protection of incompetent patients from the potential harm of the decisions they might make, rests largely on clinicians' abilities to judge patients' capacities to decide what treatment they will receive.Confusing laws and complex ethical questions surrounding competence to consent to treatment have made the process of competence assessment intimidating for many clinicians. Health professionals - physicians, medical students nad residents, nurses, and mental health practitioners - have long needed a consice guidebook that translates the issue for practice. This is what this book accomplishes. The aurthors describe the place of competence in the doctrine of informed consent and show how assessments of competence to consent to treatment can be structured by using a specific set of general medical and psychiatric treatment settings, explain how the assessment should be conducted, and offer a structured interview method to assist the task. They also explore the often difficult process of making the judgement about competence and desire what to do when patients' capacities are limited.

Informed consent - as an ethical ideal and legal doctrine - has been the source of much concern to clinicians. Drawing on a diverse set of backgrounds and two decades of research in clinical settings, the authors - a lawyer, a physician, a social scientist, and a philosopher - help clinicians understand and cope with their legal obligations and show how the proper handling of informed consent can improve , rather than impede, patient care. Following a concise review of the ethical and legal foundations of informed consent, they provide detailed, practical suggestions for incorporating informed consent into clinical practice. This completely revised and updated edition discusses how to handle informed consent in all phases of the updated edition discusses how to handle informed consent in all phases of the doctor-patient relationship, use of consent forms, patients' refusals of treatment, and consent to research. It comments on recent laws and national policy, and addresses cutting edge issues such as fulfilling physician obligations under managed care. This clear and succinct book contains a weath of information that will not only help clinicians meet the legal requirements of informed consent and understand its ethical underpinnings, but also enhance their ability to deal with their patients more effectively. It will be of value to all those working in areas where issues of informed consent are likely to arise, including medicine, biomedical research, mental health care, nursing, dentistry, biomedical ethics, and law.

Rethinking Risk Assessment tells the story of a pioneering investigation that challenges preconceptions about the frequency and nature of violence among persons with mental disorders, and suggests an innovative approach to predicting its occurrence.

The authenticity of memories of childhood sexual abuse has become one of the major social controversies of the 1990''s. As persons who report histories of abuse have sought remedies in civil and criminal proceedings in the courts, the accuracy of their memories--particularly when they have been recalled after a period of time--has been subject to intense scrutiny. This volume brings together many of the leading participants in the debate to provide a comprehensive picture of the psychological, physiological, and legal aspects of trauma. Beginning by defining the opposing positions in the debate, the contributors then offer a variety of perspectives on the nature of memory, including reviews of some of the most exciting recent developments in this fast-growing area of investigation. Next, consideration is given to the impact of trauma on memory, both in adults and in children. With this framework in place, the authors turn to an examination of the variety of treatment approaches available to victims of trauma, who are trying to cope with the painful consequences of those events. The book argues against a unidimensional approach to trauma, calling instead for a multidisciplinary synthesis that includes developmental, neurobiological, cognitive, and psychodynamic perspectives. Chapters address the legal dilemmas for patients, mental health professionals and society as a whole that have arisen from the trauma and memory controversy. Most importantly, the editors shift the focus of their discussion from the laboratory to the courtroom and from the research journal to the psychotherapist''s office, looking at the issues from every relevant angle. This is the only book in the field to treat the trauma and memory controversy comprehensively, from basic research on memory processes through clinical approaches to legal and policy issues. Trauma and Memory is a valuable tool for clinicians treating patients with traumatic memories. It is also intended for psychologists, physicians, social workers and lawyers who need a comprehensive reference on trauma and sexual abuse during childhood.

The presumed link between mental disorder and violence has been the driving force behind mental health law and policy for centuries. Legislatures, courts, and the public have come to expect that mental health professionals will protect them from violent acts by persons with mental disorders. Yet for three decades research has shown that clinicians'' unaided assessments of "dangerousness" are barely better than chance. Rethinking Risk Assessment: The MacArthur Study of Mental Disorder and Violence tells the story of a pioneering investigation that challenges preconceptions about the frequency and nature of violence among persons with mental disorders, and suggests an innovative approach to predicting its occurrence. The authors of this massive project -- the largest ever undertaken on the topic -- demonstrate how clinicians can use a "decision tree" to identify groups of patients at very low and very high risk for violence. This dramatic new finding, and its implications for the every day clinical practice of risk assessment and risk management, is thoroughly described in this remarkable and long-anticipated volume. Taken to heart, its message will change the way clinicians, judges, and others who must deal with persons who are mentally ill and may be violent will do their work.

Informed consent - as an ethical ideal and legal doctrine - has been the source of much concern to clinicians. Drawing on a diverse set of backgrounds and two decades of research in clinical settings, the authors - a lawyer, a physician, a social scientist, and a philosopher - help clinicians understand and cope with their legal obligations and show how the proper handling of informed consent can improve , rather than impede, patient care. Following a concise review of the ethical and legal foundations of informed consent, they provide detailed, practical suggestions for incorporating informed consent into clinical practice. This completely revised and updated edition discusses how to handle informed consent in all phases of the doctor-patient relationship, use of consent forms, patients'' refusals of treatment, and consent to research. It comments on recent laws and national policy, and addresses cutting edge issues, such as fulfilling physician obligations under managed care. This clear and succinct book contains a wealth of information that will not only help clinicians meet the legal requirements of informed consent and understand its ethical underpinnings, but also enhance their ability to deal with their patients more effectively. It will be of value to all those working in areas where issues of informed consent are likely to arise, including medicine, biomedical research, mental health care, nursing, dentistry, biomedical ethics, and law.

Ethical decision making in the context of conflicting values takes on a fresh immediacy when the self itself is in conflict. Divided Staffs, Divided Selves: A Case Approach to Mental Health Ethics brings the immediacy of a clinical case conference to a wide range of students and clinicians. The book provides both clinical case material and a method for engaging in a dialogue choices in the mental health care field. The essays that introduce the volume place the ethical problems of treating mentally ill people in the context of the health care ethics movement and traditions of ethical decision making. The individual cases arise from clinical and consultative experiences. This case material will serve as the basis for learning and reflection by clinicians in interaction with their colleagues, and it also will be especially valuable to students studying ethical concepts who do not have access to real-life cases or problems.