Matthé Scholten | Ruhr University, Bochum (original) (raw)
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Papers by Matthé Scholten
Medicine, Health Care and Philosophy
The ethics review of qualitative health research poses various challenges that are due to a misma... more The ethics review of qualitative health research poses various challenges that are due to a mismatch between the current practice of ethics review and the nature of qualitative methodology. The process of obtaining ethics approval for a study by a research ethics committee before the start of a research study has been described as “procedural ethics” and the identification and handling of ethical issues by researchers during the research process as “ethics in practice.” While some authors dispute and other authors defend the use of procedural ethics in relation to qualitative health research, there is general agreement that it needs to be supplemented with ethics in practice. This article aims to provide an illustration of research ethics in practice by reflecting on the ways in which we identified and addressed ethical and methodological issues that arose in the context of an interview study with mental health service users and relatives. We describe the challenges we faced and the...
Psychiatric Services, Apr 1, 2023
Ethik in Der Medizin, Apr 13, 2022
Zusammenfassung Mit der 2023 in Kraft tretenden Reform des Betreuungsrechts wird der Begriff "Woh... more Zusammenfassung Mit der 2023 in Kraft tretenden Reform des Betreuungsrechts wird der Begriff "Wohl" aus dem Gesetz gestrichen. Hierdurch soll stärker hervorgehoben werden, dass sich der Betreuer an den subjektiven Wünschen des Betreuten statt an einem objektiven Wohlverständnis orientieren soll. In diesem Beitrag wird ermittelt, welches Verständnis von Wohl das reformierte Betreuungsrecht in Abgleich zu gängigen medizinethisch-philosophischen Auffassungen des Wohls implizit enthält. Indem untersucht wird, in welchem Verhältnis das betreuungsrechtliche und das medizinethische bzw. philosophische Verständnis von Wohl zueinanderstehen, soll die interdisziplinäre Verständigung zwischen Recht und Ethik gefördert werden. In der Begründung zur Reform wird betont, dass dem Betreuungsrecht weiterhin ein subjektives Verständnis von Wohl zugrunde liege. Dieses Verständnis deckt sich jedoch nicht mit philosophischen subjektiven Theorien des Wohlergehens, nach denen nur das zum Wohl einer Person beiträgt, was diese sich wünscht. Das Betreuungsrecht nimmt hingegen an, dass die Befolgung bestimmter Wünsche zu objektiven Schädigungen der Person führen und damit ihr Wohl beeinträchtigen kann. Negative Konsequenzen für das objektive Wohl eines Betreuten sind betreuungsrechtlich insofern relevant, als dass sie eine Grenze für die Befolgung aktueller Wünsche aufzeigen, die auf einem natürlichen Willen basieren und nicht Ausdruck Dr. med. Esther Braun, M.A.
International Journal of Law and Psychiatry, Nov 1, 2020
The COVID-19 pandemic poses significant challenges in psychiatric hospitals, particularly in the ... more The COVID-19 pandemic poses significant challenges in psychiatric hospitals, particularly in the context of the treatment of people under involuntary commitment. The question arises at various points in the procedure for and process of involuntary commitment whether procedural modifications or further restrictive measures are necessary to minimise the spread of COVID-19 and protect all people involved from infection. In the light of current developments in Germany, this article examines under which conditions changes in the treatment of people under involuntary commitment are ethically justified in view of the COVID-19 pandemic. Among others, we discuss ethical arguments for and against involuntary commitments with reference to COVID-19, the use of different coercive interventions, the introduction of video hearings, an increased use of video surveillance and interventions based on the German Infection Protection Act. We argue that strict hygiene concepts, the provision of sufficient personal protective equipment and frequent testing for COVID-19 should be the central strategies to ensure the best possible protection against infection. Any further restrictions of the liberty of people under involuntary commitment require a sound ethical justification based on the criteria of suitability, necessity and proportionality. A strict compliance with these criteria and the continued oversight by external and independent control mechanisms are important to prevent ethically unjustified restrictions and discrimination against people with the diagnosis of a mental disorder during the COVID-19 pandemic.
International journal of qualitative methods, 2023
Psych. Pflege Heute, Nov 25, 2022
Menschen dürfen selbst bestimmen, welche medizinischen oder pflegerischen Maßnahmen durchgeführt ... more Menschen dürfen selbst bestimmen, welche medizinischen oder pflegerischen Maßnahmen durchgeführt oder unterlassen werden sollen. Einwilligungsfähigkeit und Freiwilligkeit sind Voraussetzungen, um dieses Recht auf Selbstbestimmung auszuüben – sie lassen sich jedoch besonders in der psychiatrischen Versorgung nicht immer einfach beurteilen. Eine Hilfestellung bietet der folgende Artikel.
American Journal of Bioethics, Jul 28, 2023
Treatment pressures are communicative strategies that mental health professionals use to influenc... more Treatment pressures are communicative strategies that mental health professionals use to influence the decision-making of mental health service users and improve their adherence to recommended treatment. Szmukler and Appelbaum describe a spectrum of treatment pressures, which encompasses persuasion, interpersonal leverage, offers and threats, arguing that only a particular type of threat amounts to informal coercion. We contend that this account of informal coercion is insufficiently sensitive to context and fails to recognize the fundamental power imbalance in mental healthcare. Based on a set of counterexamples, we argue that what makes a proposal coercive is not whether service users will actually be made worse off if they reject the proposal, but rather whether they have the justified belief that this is the case. Whether this belief is justified depends on the presence of certain contextual factors, such as strong dependency on professionals and the salient possibility of formal coercion.
Bristol University Press eBooks, May 31, 2023
Frontiers in Psychiatry, 2021
The right to make autonomous decisions is enshrined in law. However, the question how persons wit... more The right to make autonomous decisions is enshrined in law. However, the question how persons with cognitive deficits can be enabled to make autonomous decisions has not been satisfactorily addressed. In particular, the concept of supported decision-making and its implementation into practice has been poorly explored for persons with dementia (PwD).This article describes the empirical development and implementation of support tools to enhance informed consent processes (so called enhanced consent procedures/ECP) for PwD on whether to undergo lumbar puncture. In the end of the process of pilot testing and further development of the tools, the following tools were defined: (1) Standardized Interview Structure, (2) Elaborated Plain Language, (3) Ambience and Room Design, (4) Keyword Lists, (5) Priority Cards, (6) Visualization, and (7) Simplified Written Informed Consent (Patient Information), as well as the general attitude (8) Person-Centered Attitude of the facilitator. As the devel...
European Psychiatry
Background: Self-binding directives (SBDs) are psychiatric advance directives that include a clau... more Background: Self-binding directives (SBDs) are psychiatric advance directives that include a clause in which mental health service users consent in advance to involuntary hospital admission and treatment under specified conditions. Medical ethicists and legal scholars identified various potential benefits of SBDs but have also raised ethical concerns. Until recently, little was known about the views of stakeholders on the opportunities and challenges of SBDs. Aims: This article aims to foster an international exchange on SBDs by comparing recent empirical findings on stakeholders' views on the opportunities and challenges of SBDs from Germany, the Netherlands, and the United Kingdom. Method: Comparisons between the empirical findings were drawn using a structured expert consensus process. Results: Findings converged on many points. Perceived opportunities of SBDs include promotion of autonomy, avoidance of personally defined harms, early intervention, reduction of admission length, improvement of the therapeutic relationship, involvement of trusted persons, avoidance of involuntary hospital admission, addressing trauma, destigmatization of involuntary treatment, increase of professionals' confidence, and relief for proxy decisionmakers. Perceived challenges include lack of awareness and knowledge, lack of support, undue influence, inaccessibility during crisis, lack of cross-agency coordination, problems of interpretation, difficulties in capacity assessment, restricted therapeutic flexibility, scarce
BMC Medical Ethics
Background Self-binding directives (SBDs) are psychiatric advance directives that include the pos... more Background Self-binding directives (SBDs) are psychiatric advance directives that include the possibility for service users to consent in advance to compulsory care in future mental health crises. Legal provisions for SBDs exist in the Netherlands since 2008 and were updated in 2020. While ethicists and legal scholars have identified several benefits and risks of SBDs, few data on stakeholder perspectives on SBDs are available. Aims The aim of the study was to identify opportunities and challenges of SBDs perceived by stakeholders who have personal or professional experience with legally enforceable SBDs. Methods Data collection was carried out in the Netherlands from February 2020 to October 2021 by means of semi-structured interviews. Participants were selected through purposive sampling and snowball methods. Interviews were conducted with mental health service users (n = 7), professionals (n = 13), and an expert on SBD policy (n = 1), resulting in a total number of 21 interviews....
Journal of Medical Ethics, 2017
Medicine, Health Care and Philosophy
The ethics review of qualitative health research poses various challenges that are due to a misma... more The ethics review of qualitative health research poses various challenges that are due to a mismatch between the current practice of ethics review and the nature of qualitative methodology. The process of obtaining ethics approval for a study by a research ethics committee before the start of a research study has been described as “procedural ethics” and the identification and handling of ethical issues by researchers during the research process as “ethics in practice.” While some authors dispute and other authors defend the use of procedural ethics in relation to qualitative health research, there is general agreement that it needs to be supplemented with ethics in practice. This article aims to provide an illustration of research ethics in practice by reflecting on the ways in which we identified and addressed ethical and methodological issues that arose in the context of an interview study with mental health service users and relatives. We describe the challenges we faced and the...
Psychiatric Services, Apr 1, 2023
Ethik in Der Medizin, Apr 13, 2022
Zusammenfassung Mit der 2023 in Kraft tretenden Reform des Betreuungsrechts wird der Begriff "Woh... more Zusammenfassung Mit der 2023 in Kraft tretenden Reform des Betreuungsrechts wird der Begriff "Wohl" aus dem Gesetz gestrichen. Hierdurch soll stärker hervorgehoben werden, dass sich der Betreuer an den subjektiven Wünschen des Betreuten statt an einem objektiven Wohlverständnis orientieren soll. In diesem Beitrag wird ermittelt, welches Verständnis von Wohl das reformierte Betreuungsrecht in Abgleich zu gängigen medizinethisch-philosophischen Auffassungen des Wohls implizit enthält. Indem untersucht wird, in welchem Verhältnis das betreuungsrechtliche und das medizinethische bzw. philosophische Verständnis von Wohl zueinanderstehen, soll die interdisziplinäre Verständigung zwischen Recht und Ethik gefördert werden. In der Begründung zur Reform wird betont, dass dem Betreuungsrecht weiterhin ein subjektives Verständnis von Wohl zugrunde liege. Dieses Verständnis deckt sich jedoch nicht mit philosophischen subjektiven Theorien des Wohlergehens, nach denen nur das zum Wohl einer Person beiträgt, was diese sich wünscht. Das Betreuungsrecht nimmt hingegen an, dass die Befolgung bestimmter Wünsche zu objektiven Schädigungen der Person führen und damit ihr Wohl beeinträchtigen kann. Negative Konsequenzen für das objektive Wohl eines Betreuten sind betreuungsrechtlich insofern relevant, als dass sie eine Grenze für die Befolgung aktueller Wünsche aufzeigen, die auf einem natürlichen Willen basieren und nicht Ausdruck Dr. med. Esther Braun, M.A.
International Journal of Law and Psychiatry, Nov 1, 2020
The COVID-19 pandemic poses significant challenges in psychiatric hospitals, particularly in the ... more The COVID-19 pandemic poses significant challenges in psychiatric hospitals, particularly in the context of the treatment of people under involuntary commitment. The question arises at various points in the procedure for and process of involuntary commitment whether procedural modifications or further restrictive measures are necessary to minimise the spread of COVID-19 and protect all people involved from infection. In the light of current developments in Germany, this article examines under which conditions changes in the treatment of people under involuntary commitment are ethically justified in view of the COVID-19 pandemic. Among others, we discuss ethical arguments for and against involuntary commitments with reference to COVID-19, the use of different coercive interventions, the introduction of video hearings, an increased use of video surveillance and interventions based on the German Infection Protection Act. We argue that strict hygiene concepts, the provision of sufficient personal protective equipment and frequent testing for COVID-19 should be the central strategies to ensure the best possible protection against infection. Any further restrictions of the liberty of people under involuntary commitment require a sound ethical justification based on the criteria of suitability, necessity and proportionality. A strict compliance with these criteria and the continued oversight by external and independent control mechanisms are important to prevent ethically unjustified restrictions and discrimination against people with the diagnosis of a mental disorder during the COVID-19 pandemic.
International journal of qualitative methods, 2023
Psych. Pflege Heute, Nov 25, 2022
Menschen dürfen selbst bestimmen, welche medizinischen oder pflegerischen Maßnahmen durchgeführt ... more Menschen dürfen selbst bestimmen, welche medizinischen oder pflegerischen Maßnahmen durchgeführt oder unterlassen werden sollen. Einwilligungsfähigkeit und Freiwilligkeit sind Voraussetzungen, um dieses Recht auf Selbstbestimmung auszuüben – sie lassen sich jedoch besonders in der psychiatrischen Versorgung nicht immer einfach beurteilen. Eine Hilfestellung bietet der folgende Artikel.
American Journal of Bioethics, Jul 28, 2023
Treatment pressures are communicative strategies that mental health professionals use to influenc... more Treatment pressures are communicative strategies that mental health professionals use to influence the decision-making of mental health service users and improve their adherence to recommended treatment. Szmukler and Appelbaum describe a spectrum of treatment pressures, which encompasses persuasion, interpersonal leverage, offers and threats, arguing that only a particular type of threat amounts to informal coercion. We contend that this account of informal coercion is insufficiently sensitive to context and fails to recognize the fundamental power imbalance in mental healthcare. Based on a set of counterexamples, we argue that what makes a proposal coercive is not whether service users will actually be made worse off if they reject the proposal, but rather whether they have the justified belief that this is the case. Whether this belief is justified depends on the presence of certain contextual factors, such as strong dependency on professionals and the salient possibility of formal coercion.
Bristol University Press eBooks, May 31, 2023
Frontiers in Psychiatry, 2021
The right to make autonomous decisions is enshrined in law. However, the question how persons wit... more The right to make autonomous decisions is enshrined in law. However, the question how persons with cognitive deficits can be enabled to make autonomous decisions has not been satisfactorily addressed. In particular, the concept of supported decision-making and its implementation into practice has been poorly explored for persons with dementia (PwD).This article describes the empirical development and implementation of support tools to enhance informed consent processes (so called enhanced consent procedures/ECP) for PwD on whether to undergo lumbar puncture. In the end of the process of pilot testing and further development of the tools, the following tools were defined: (1) Standardized Interview Structure, (2) Elaborated Plain Language, (3) Ambience and Room Design, (4) Keyword Lists, (5) Priority Cards, (6) Visualization, and (7) Simplified Written Informed Consent (Patient Information), as well as the general attitude (8) Person-Centered Attitude of the facilitator. As the devel...
European Psychiatry
Background: Self-binding directives (SBDs) are psychiatric advance directives that include a clau... more Background: Self-binding directives (SBDs) are psychiatric advance directives that include a clause in which mental health service users consent in advance to involuntary hospital admission and treatment under specified conditions. Medical ethicists and legal scholars identified various potential benefits of SBDs but have also raised ethical concerns. Until recently, little was known about the views of stakeholders on the opportunities and challenges of SBDs. Aims: This article aims to foster an international exchange on SBDs by comparing recent empirical findings on stakeholders' views on the opportunities and challenges of SBDs from Germany, the Netherlands, and the United Kingdom. Method: Comparisons between the empirical findings were drawn using a structured expert consensus process. Results: Findings converged on many points. Perceived opportunities of SBDs include promotion of autonomy, avoidance of personally defined harms, early intervention, reduction of admission length, improvement of the therapeutic relationship, involvement of trusted persons, avoidance of involuntary hospital admission, addressing trauma, destigmatization of involuntary treatment, increase of professionals' confidence, and relief for proxy decisionmakers. Perceived challenges include lack of awareness and knowledge, lack of support, undue influence, inaccessibility during crisis, lack of cross-agency coordination, problems of interpretation, difficulties in capacity assessment, restricted therapeutic flexibility, scarce
BMC Medical Ethics
Background Self-binding directives (SBDs) are psychiatric advance directives that include the pos... more Background Self-binding directives (SBDs) are psychiatric advance directives that include the possibility for service users to consent in advance to compulsory care in future mental health crises. Legal provisions for SBDs exist in the Netherlands since 2008 and were updated in 2020. While ethicists and legal scholars have identified several benefits and risks of SBDs, few data on stakeholder perspectives on SBDs are available. Aims The aim of the study was to identify opportunities and challenges of SBDs perceived by stakeholders who have personal or professional experience with legally enforceable SBDs. Methods Data collection was carried out in the Netherlands from February 2020 to October 2021 by means of semi-structured interviews. Participants were selected through purposive sampling and snowball methods. Interviews were conducted with mental health service users (n = 7), professionals (n = 13), and an expert on SBD policy (n = 1), resulting in a total number of 21 interviews....
Journal of Medical Ethics, 2017