Journal of Medical Ethics 45 (3):178-182 (2019)

Authors
Laura Guidry-Grimes
Georgetown University
Abstract
The question of whether a patient has insight is among the first to be considered in psychiatric contexts. There are several competing conceptions of clinical insight, which broadly refers to a patient’s awareness of their mental illness. When a patient is described as lacking insight, there are significant implications for patient care and to what extent the patient is trusted as a knower. Insight is currently viewed as a multidimensional and continuous construct, but competing conceptions of insight still lack consensus on the specifics. Studies also give contradictory evidence regarding the frequency and consequences of poor insight. A number of crucial questions remain unanswered. After outlining some of the key theoretical disagreements about what insight means, I highlight ethical issues that have not received much attention in the literature. Given the conceptual ambiguities and the absence of standardised bedside tools, there are significant ethical concerns about insight assessments. I highlight two main ethical concerns, specifically that these assessments risk: marginalising patients by setting unattainable ideals for self-knowledge and minimising the patient’s own perspective on their mental health. I close with recommendations for documenting and responding to concerns about poor insight, so patients who are vulnerable to losing epistemic trust are better supported in their therapeutic relationships.
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DOI 10.1136/medethics-2018-105109
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References found in this work BETA

Epistemic Injustice in Assessment of Delusions.Abdi Sanati & Michalis Kyratsous - 2015 - Journal of Evaluation in Clinical Practice 21 (3):479-485.
Is There a Moral Duty for Doctors to Trust Patients?W. A. Rogers - 2002 - Journal of Medical Ethics 28 (2):77-80.
Treatment Adherence in the Absence of Insight: A Puzzle and a Proposed Solution.Marga Reimer - 2010 - Philosophy, Psychiatry, and Psychology 17 (1):65-75.
Coercing Future Freedom: Consent and Capacities for Autonomous Choice.M. Carmela Epright - 2010 - Journal of Law, Medicine and Ethics 38 (4):799-806.
Coercing Future Freedom: Consent and Capacities for Autonomous Choice.M. Carmela Epright - 2010 - Journal of Law, Medicine and Ethics 38 (4):799-806.

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