Ethical complexities in assessing patients’ insight
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It is generally agreed in most jurisdictions that all competent patients must be fully informed about any proposed treatment, including medications, and have the absolute right to either consent to or refuse treatment. This introduces the dread word “competent” that is often mistakenly taken as being required as a demonstration of insight. It is also often assumed that a person suffering a condition such as schizophrenia is incapable of insight. The Supreme Court of Canada, in 2003, in Starson v. Swayze laid this one to rest. The appellant knew that he had schizophrenia, its nature and effects, and was appealing a decision of a lower court that he should be forcibly given antipsychotic medication on a continuing basis. He argued that he had the right to decide for himself when he should take the medication and when he could avoid it so that he could work without the thought-numbing effect of the drug. His profession required clear thinking.
The court found for him, noting that he knew the nature of his condition and was capable i.e. competent to make these decisions for himself. He had, in other words, insight.