Ethical Issues in Schizophrenia: Considerations for Treatment and Research

Clinicians who treat patients with schizophrenia may encounter a variety of ethical issues related to both psychiatric and medical treatment of patients. While informed consent is a crucial aspect of the care of all patients, it may present special challenges for patients with schizophrenia. Schizophrenia is a severe mental illness that is frequently accompanied by neuropsychological deficits. These impairments, as well as psychotic symptoms and lack of insight, can affect patients' abilities to make fully informed decisions about their own care. Ensuring that consent for treatment is informed, voluntary, and competent can thus become a more difficult endeavor. The ethical principles underlying treatment of these patients, however, are the same as those guiding treatment of all patients. Informed consent, as an embodiment of these ethical principles, represents the expression of individual rights in both clinical and research contexts. Attention to the process of informed consent as an ongoing dialogue strengthens the clinician-patient relationship, improves adherence, and helps the patient clarify options, values, and preferences. In the research setting, psychiatric researchers are increasingly concerned with maximizing the abilities of individuals with severe mental illnesses such as schizophrenia to provide meaningful informed consent for protocols. This review addresses decision-making abilities of people with schizophrenia in both treatment and research contexts.