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MENTAL RETARDATION - YET ANOTHER ISSUE IN MENTAL CAPACITY TO CONSENT
- Yatan PS Balhara, Malhotra Sameer, Varghese Sunny (18 November 2005)
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Yatan PS Balhara, resident, department of psychiatry all india institute of medical sciences, new delhi , india, 110029, Malhotra Sameer, Varghese Sunny
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ypsbalhara{at}rediffmail.com Yatan PS Balhara, et al.
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Mental retardation/ sub normal intelligence is another important factor that poses the clinicians with the clinical dilemma to assess their capacity to consent. This becomes even more dicey when the reason to give the consent is not directly related to the patient's beneficience, although it has got a strong impact on his/ her future. The current author with two other authors (case report published elsewhere)have repored one such dialemma faced in case of a lady with sub normal intelligence, whose husband was in need of a renal transplantation because of an end stage renal disease . We were put in a great clinical turmoil because of the lack of the well defined laws on the issue and the specific problem because of the husband being the only care provider to the patient. We had to decide whether the act of donation of the kidney would be of benificienc to the patient and whether it wouldn't violate the principle of "first do no harm" in light of the lack of the psychosocial support to the patient and her daughter in case the husband is denied the transplant and the likely poor prognosis. First of all we had to decide if she was competent enough to understand the complexities of the issue and its possible implications? Does her subnormal intelligence (mild mental retardation) leave her with a capacity to comprehend the issues concerned? In order to assess her competence in this regard what all criteria need to be looked upon? The basic tenets of informed consent are based on the elements of information, decisional capacity and voluntarism. An individual’s decision to give or withhold consent cannot be considered valid unless he or she has the capacity to make that decision. Nevertheless, this presumption may be called into question, particularly if he or she has a “mental disability”. Any decision on the part of the clinician should be ethically sound. The clinician has to be sure that he has done justice to the subject and importantly has not gone beyond the law while making any decision. According to a recent Consensus Statement on Live Organ Donors “the person who gives consent for a live organ transplant should be competent, willing to donate, free from coercion, medically and psychosocially suitable and fully informed of the risks, benefits and alternative treatment available to the recipient” (2) In India, neither the Organ Transplant Act, 1994 (3) nor the Mental Health Act, 1987 (4) provide any light into this matter, both of which are silent regarding the capabilities of the mentally challenged to take such decisions. According to court rulings in U.K”an operation can be performed on a mentally retarded adult without his consent only if the weight of professional opinion is that the procedure is in the individuals’ interest” (5). referencs- 1. Malhotra S, Balhara Y PS, Varghese ST. Organ donation in mental retardation: A clinical dilemma.Indian Journal of Medical Sciences.2004, 58(10);444. 2. WORLD HEALTH ORGANIZATION. Guiding principles on human organ transplantation. Lancet 1991;337:1470 3. THE TRANSPLANTATION OF HUMAN ORGANS ACT (INDIA), 1994 4. THE MENTAL HEALTH ACT OF INDIA (INDIA), 1987 5. LUTTRELL S. Making decisions about medical treatment for mentally incapable adults in U.K . Lancet 1997; 350:950-953. |
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