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Ethical complexities in assessing patients’ insight
  1. Laura Guidry-Grimes
  1. Correspondence to Dr Laura Guidry-Grimes, Department of Medical Humanities and Bioethics, University of Arkansas for Medical Sciences, Little Rock, AR 72211, USA; LGuidryGrimes{at}uams.edu

Abstract

The question of whether a patient has insight is among the first to be considered in psychiatric contexts. There are several competing conceptions of clinical insight, which broadly refers to a patient’s awareness of their mental illness. When a patient is described as lacking insight, there are significant implications for patient care and to what extent the patient is trusted as a knower. Insight is currently viewed as a multidimensional and continuous construct, but competing conceptions of insight still lack consensus on the specifics. Studies also give contradictory evidence regarding the frequency and consequences of poor insight. A number of crucial questions remain unanswered. After outlining some of the key theoretical disagreements about what insight means, I highlight ethical issues that have not received much attention in the literature. Given the conceptual ambiguities and the absence of standardised bedside tools, there are significant ethical concerns about insight assessments. I highlight two main ethical concerns, specifically that these assessments risk: (1) marginalising patients by setting unattainable ideals for self-knowledge and (2) minimising the patient’s own perspective on their mental health. I close with recommendations for documenting and responding to concerns about poor insight, so patients who are vulnerable to losing epistemic trust are better supported in their therapeutic relationships.

  • psychiatry
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Footnotes

  • Contributors I am the sole author of this philosophical work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

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

  • Presented at A version of this paper was presented at the American Society for Bioethics and Humanities Conference and International Conference on Clinical Ethics Consultation, and a later version was presented at Grand Rounds at the University of Washington and University of Kentucky.

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