POPULATION MIXING AND EXCESS OF CHILDHOOD LEUKEMIA
POPULATION MIXING AND EXCESS OF CHILDHOOD LEUKEMIA
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DOI：
10.1136/bmj.306.6882.930-a
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发表时间：
1993-04-03
影响因子：
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通讯作者：
STILLER, C
中科院分区：
文献类型：
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作者：
KINLEN, LJ;STILLER, C
EDITOR,-Nick Kosky is right to be concerned when surgical teams ask him, as duty psychiatrist, to give consent for operative procedures on behalf of psychiatric patients detained under the Mental Health Act. Although most patients who have been admitted on a section are perfectly capable of deciding for themselves, the referrals that Kosky mentions might have been justified had he instead been asked to advise about the patients' ability to give real consent. As Kosky points out, competence to consent can vary with the complexity of the factors that need to be taken into account, but, also, competencecan change from day to day depending on the cause of the intellectual disability. In these circumstances how does a surgeon with skills appropriate to that trade decide if a patient's consent is valid? In a paper on assessing patients' capacity to consent Appelbaum and Grisso warn that im-properly depriving a patient of his or her rights to make decisions is a serious infringement of liberty. 2 Usually the evaluation of someone's competence presents no problem, but if doubt exists Appelbaum and Grisso favour formal analysis. They recommend that a third party assessor should be present throughout the interview during which the procedure is explained to the patient in order to understand what has been said and to observe the patient's responses to that information. Then, using questions specifically designed to show ability in four areas-to communicate a choice, to understand the relevant information, to appreciate the importance of the circumstances and their consequences, and to manipulate information rationally-the assessor should judge whether the patient's consent is real. Once competence, or its absence, has been established, correct practice along the lines recom-mended by the NHS Management Executive may ensue. 3
