Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation by Nicholas Karasik

“…Guiding Distributive Justice: Capability Theory Capability theory is an account of justice opportunity that places a fundamental moral significance on individuals' ability to reach proper functioning and well-being.[52] Whether or not an individual can make use of a particular set of resources and convert them into a state of functioning depends on personal, sociopolitical, and environmental conditions ("conversion factors").[53] In this sense, liberty is not the absence of restraint from others or institutions but the freedom achieved through capability-enhancing relationships.[54] Within the context of bioethics, capability theory shifts focus toward creating circumstances by which individuals can direct their lives as they choose.[55] Acting in accordance with the principle of beneficence, peer-support specialists could enhance the capability of patients to be self-determined and autonomous, which would promote patient well-being and empowerment.[56] Those living with SMI, such as schizophrenia and bipolar disorder, are among the most disadvantaged in society, experiencing social and economic hardship related to their illness.[57] These individuals are often feared and rejected by others, which increases depression, lowers self-esteem, and engenders feelings of social isolation.[58] Compounding their challenges, especially for those facing structural inequalities, is insufficient access to appropriate mental health services supporting recovery.[59] Capability theory provides a sound justification for the resource distribution necessary to create and sustain a thriving network of peer-support specialists, to which those with SMI currently do not have access. …”
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Internet and telephone intervention to support patients discontinuing long-term antidepressants in primary care: the REDUCE research programme including RCT by Tony Kendrick, Beth Stuart, Hannah Bowers, Mahboobeh Haji Sadeghi, Helen Page, Christopher Dowrick, Michael Moore, Mark Gabbay, Geraldine Leydon, Guiqing Lily Yao, Shihua Zhu, Paul Little, Gareth Griffiths, Glyn Lewis, Carl May, Joanna Moncrieff, Chris F Johnson, Una Macleod, Simon Gilbody, Rachel Dewar-Haggart, Samantha Williams, Wendy O’Brien, Riya Tiwari, Catherine Woods, Tasneem Patel, Naila Khan, Emma Maund, Nadja van Ginneken, Amy Din, Claire Reidy, Rebecca Lucier, Bryan Palmer, Taeko Becque, Yumna Masood, Natalie Thompson, Ellen van Leeuwen, Marta Glowacka, Adam WA Geraghty

“…Background There is significant concern about increasing long-term antidepressant use in Western countries, much of which is not evidence-based. …”
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