Ethical Significance of Lack of Insight and Informed Consent in Schizophrenia

Abstract

David (1990) identified three overlapping dimensions in clinicians' use of the term insight: a) the recognition that one has a mental illness; b) the ability to relabel unusual mental events as pathological and compliance with treatment. All these aspects can occur independently and need not follow a fixed sequence or simple hierarchy. The four criteria (objectivity, materiality, independence, and ethical significance) and their application to lack of insight in schizophrenia increase the chance that persons in like circumstances will be treated equally. Because insight equals or exceeds incompetence on each of the four criteria, intervention based upon lack of insight is more legitimate and ethically justified.