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Biomedical subjects

H Bursztajn

Publications and source records attributed to H Bursztajn.

At least 19 recordsLinked to original sources
PubMed1991

Medical and judicial perceptions of the risks associated with use of antipsychotic medication.

To determine whether occupational perspective influences the decision to prescribe antipsychotic medications, we presented a group of psychiatrists and judges with a hypothetical case involving a potentially psychotic patient. The subjects were asked what probability of drug-induced tardive dyskinesia they would accept in order to prevent psychotic decompensation. The subjects were then asked to estimate the actual probability that tardive dyskinesia would occur if the patient received antipsychotic medications. From the responses to these questions we inferred their treatment decisions. Although the psychiatrists and judges agreed on an acceptable level of risk, they differed significantly in their estimates of the actual risk involved and, by inference, their decisions concerning treatment. Our findings have several implications for adjudication of cases involving treatment decisions and the right to refuse treatment.

Antipsychotic Agents↗
PubMed1988

Parens patriae considerations in the commitment process.

Seventy-one commitment-seeking decisions made by 36 clinicians in a state-funded mental health center were studied to determine the extent to which clinicians attend to legally mandated "dangerousness" criteria in seeking commitment. A previous finding that clinicians rely largely on the dangerousness criteria was replicated. In addition, clinicians were found to be sensitive to clinical indicators of the patient's need for treatment, a question which is central to the parens patriae approach to involuntary hospitalization. Further, patients who were judged to be more seriously ill or more dangerous were more likely to retract their requests for discharge. This finding suggests that the patient's request for release and the psychiatrist's petition for commitment together constitute an interactive, transactional process in which the clinician's and the patient's views of the patient's need for hospitalization influence each other.

Commitment of Persons with Psychiatric Disorders↗
PubMed1988

"Magical thinking," suicide, and malpractice litigation.

Prospective clinical assessment of suicidality differs significantly from that used retrospectively in malpractice litigation. In the latter context, the judge or jury may be susceptible to hindsight reasoning and a disproportionate emphasis on the specific method of suicide, exaggerating its foreseeability and "magically" linking the means of death to the treating clinician, especially in the case of suicide by an overdose of prescribed medication. Such magical thinking, moreover, is rooted in the clinical context of suicide: The errors of reasoning observed in the courtroom exhibit striking parallels with the mind-set of the suicidal patient. An understanding of these dynamics suggests appropriate precautions for the clinician and thus contributes to the prevention both of suicide and of malpractice litigation.

Humans↗
PubMed1986

Depression, self-love, time, and the "right" to suicide.

Elizabeth Bouvia, whose legal struggle to compel a psychiatric hospital to assist her in committing suicide ended with a decision that she could be force fed by the hospital, presented the psychiatric community with a host of ethical questions concerning the rights of a patient to choose death, and the obligations of the medical profession to promote life. What the courts did not decide is when a patient is incompetent to decide her own fate, and what is the duty of the hospital to intervene with a suicidal patient. The authors suggest that there is an ambiguity present whenever a patient presents herself to a hospital or therapist as suicidal, and that a time limited period, or cooling-off period, should exist that would allow an alliance to form between patient and care-giver, if possible, and then permit them to explore underlying issues of depression. The authors believe that there is a need to acknowledge the patient's ultimate right to choose death, but that autonomy should not be confused with impulsivity when anyone is faced with the irrevocability of the decision to die.

Adult↗
PubMed1986

Process analysis of judges' commitment decisions: a preliminary empirical study.

The current debate over the "police powers" versus parens patriae rationales for involuntary hospitalization of the mentally ill underscores the need for empirical study of the process of judicial decision making in civil commitment and determinations of competence. The authors report the ratings on 26 descriptive variables made by five Massachusetts district court judges for 35 patients in civil commitment hearings. Nearly all of the hearings resulted in commitments. These findings suggest that psychiatrists may be setting too high a threshold for petitioning for commitment. Experienced judges appeared to be sensitive to the kinds of clinical issues that earlier studies have shown to contribute significantly to the psychiatrist's decision to petition for commitment.

Attitude↗
PubMed1986

Clinicians' guidelines for assessing and presenting subtle forms of patient incompetence in legal settings.

Even for nonforensic clinicians, the assessment of the patient's competence has grown in importance, particularly regarding the issues of informed consent and right to treatment. However, the incompetence of patients with paranoid states, depression, mania, and anorexia nervosa may be so subtle that both assessors and the court are deceived, incompetence is not recognized, and treatment is stalemated. The authors provide guidelines designed to equip the clinician to assess--and to present in an effective manner in court--the clinical findings relevant to incompetence, to the benefit of both the patient's rights and treatment.

Adolescent↗
PubMed1985

Facilitating patient acceptance of a psychiatric referral.

There are five common ways in which a patient may object to a physician's suggestion of a psychiatric referral. The patient may reject the referral because of the social stigma of being a psychiatric patient; because the referral damages his or her self-esteem; because the patient does not understand the role of emotions in physical discomfort; because the patient feels rejected by the referring physician; or because of the effects of psychiatric illness. Following a thorough medical workup, the physician can best discharge his or her responsibility to the patient by paying attention to these possible misunderstandings. The physician can discuss the role of social stigma, offset the blows to the patient's self-esteem, educate the patient about the psychosomatic model of disease, and assure the patient of the physician's continuing interest and involvement.

Adult↗
PubMed1983

Unexpected clinical features of the Tarasoff decision: the therapeutic alliance and the "duty to warn".

The authors present a case report and discuss the clinical effects of the Tarasoff decision on the therapy of a potentially violent patient. They emphasize that the patient's ambivalence toward the intended victim can be used to foster the therapeutic alliance. The therapist's legal duty to the victim and therapeutic duty to the patient, they assert, can then be synergistically applied with an unexpected benefit: the patient's capacity to make choices is enhanced.

Adult↗
PubMed1982

The clinical utility of utility assessment.

The usefulness of utility assessment as a method for revealing individual patients' desires is limited by two methodological problems. Different utility assessment methods can yield inconsistent results, both within a single clinical context and in different contexts; and the methods may not reflect universal rules that a patient may wish to abide by. To make utility assessment useful to the clinician, future research needs to address these problems in the clinical context.

Decision Making↗