The author contrasts the "paternalistic" and the "civil libertarian" views of non-consensual treatment of institutionalized psychiatric patients. Citing court cases and relevant literature, he emphasizes that competent patients have the right to refuse treatment, even when this decision is considered foolish. Involuntary hospitalization need not imply incompetence to refuse treatment, and the determination of such incompetence should be subject to rigorous safeguards. The nature of psychiatric treatment and the institutional setting necessitates procedures to ensure that consent truly is voluntary and informed. For patients judged incompetent, the decision to treat without consent should be influenced by various considerations related to diagnosis, prognosis, and the nature of the proposed treatment.

Canada↗

PubMed1985

Refractoriness of platelets to prostaglandins after infusion in rabbits.

Continuous intravenous infusion of prostacyclin (prostaglandin I2, PGI2) in rabbits induced refractoriness to PGI2-induced inhibition of platelet function. Although inhibited during earlier stages, platelet response to adenosine diphosphate and thrombin became normal within 24 hours of PGI2 infusion. Cross-mixing experiments with platelets and plasma from infused and control animals suggested that the altered response to PGI2 was caused by a defect intrinsic in the platelets. PGI2-stimulated cyclic adenosine monophosphate (cAMP) production was reduced in platelets from infused rabbits as compared with those from controls. Platelets refractory to PGI2 were refractory to PGE1 and PGD2, as well. Because PGE1 but not PGD2 shares the same platelet receptor as PGI2, the phenomenon could not be ascribed to receptor-specific downregulation, which was also shown by refractoriness of platelets from infused rabbits to the nonprostanoid inhibitor of platelet function adenosine. Either increased concentrations of ineffective inhibitors or their combination with phosphodiesterase inhibitors overcame refractoriness of resistant platelets, which also responded to inhibition by dibutyryl cAMP, indicating residual activity of adenylate cyclase. That at least the catalytic subunit of the enzyme was still working in refractory platelets was shown by inhibition of aggregation induced by forskolin, a non-receptor-mediated activator of adenylate cyclase. Impairment of the adenylate cyclase regulatory subunit, possibly accompanied by multireceptor downregulation, may explain the paradoxical refractoriness of platelets to prolonged infusion of PGI2. Such an effect may limit the benefit of PGI2 in treatment of thromboembolic disease.

6-Ketoprostaglandin F1 alpha↗

PubMed1983

Consent to randomized treatment: a reply to Brewin.

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Disclosure↗

PubMed1983

Experimentation with human subjects: a critique of the views of Hans Jonas.

The ethics of experimentation on human subjects has become the subject of much debate among medical scientists and philosophers. Ethical problems and conflicts of interest become especially serious when research subjects are recruited from the class of patients. Are patients who are ill and suffering in a position to give voluntary and informed consent? Are there inevitable conflicts of interest and moral obligation when a personal physician recruits his own patients for an experiment designed partly to advance scientific knowledge and only partly as therapy for those patients? The views of the eminent American ethicist Hans Jonas on these issues are briefly summarised and criticised, and some moral guidelines are then proposed to regulate experimentation on human subjects.

Ethics, Medical↗

PubMed1982

The ethics of the randomized clinical trial.

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Clinical Trials as Topic↗