Patients' preference and mental capacity

doi:10.1136/bmj.b385

Published 2 February 2009, doi:10.1136/bmj.b385
Cite this as: BMJ 2009;338:b385

Letters

Do patients’ preferences matter?

Patients’ preference and mental capacity

The first 150 words of the full text of this article appear below.

When McPherson writes: "Where treatment choices have differentand well understood outcomes, what matters most when decidingwhich treatment is best is the patient’s preference,"I presume he refers to patients who have capacity.¹ Even thepreferences of patients who have capacity may be based on misinterpretationor perceived benefit of less effective drug or treatment. Forexample, hypomanic patients may prefer to continue with lesseffective drugs so as to remain in an aroused "grandiose andelated" state, and psychotic patients may have a delusionalexplanation for their preference.

In addition, if the effect is measured in self rating scales,bias is well known and the effect may not be real. Patients’preferences are important in many of the psychological therapiesbut, again, are not always in the best interest so far as theeffectiveness of treatments for that patient is concerned. Forexample, a severely psychotically depressed patient . . . [Full text of this article]

Anita Damle, consultant psychiatrist¹

¹ St Andrew’s Healthcare, Northampton NN1 5DG

pratibhajog@hotmail.com