Mental capacity assessment for terminally ill adults requesting physician assisted suicide : a qualitative study using a grounded theory approach

• Main Author: Price, Annabel
• Other Authors: Cribb, Alan ; Farsides, Calliope
• Published: King's College London (University of London) 2016
• Subjects: 362.17
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.695832

This thesis explores the issue of mental capacity assessment for terminally ill adults requesting physician assisted suicide. A grounded theory approach was used to explore the perspectives of senior doctors on assessment of mental capacity for this group. Twenty four doctors (nine psychiatrists, eight general practitioners, two oncologists, two palliative physicians and three surgeons) were theoretically sampled and participated in individual in depth interviews. Constant comparative analysis of the data led to the emergence of the core category of knowing the patient. Knowing and the process of getting to know were individually interpreted and depended on the doctor, the patient and their intersubjective relationship. The process of getting to know comprised three elements: temporality, dimensionality and quality leading to a sense of knowing. Contextualised knowing, the sense of knowing informed by individualised contextual factors existed on a spectrum ranging from not knowing to knowing too well. The place of the specific doctor patient relationship on this spectrum related to the way assessment might be approached based upon valued objectivity whereby an ‘objective’ assessment was valued above a ‘subjective’ judgement. To preserve valued objectivity the approach to assessment varied according to how well the patient was known. If a patient was not known or not known well, a structured/procedural approach was favoured; for patients who were known there was a tendency toward a gut feeling based approach; but when a patient was known too well there was a perceived threat to valued objectivity, then a conscious return to a procedural, structured approach was favoured in order to return the sense of objectivity to the assessment process. Comparison of these findings with those from other studies extended the model by incorporating wider contextual and temporal conditions of variation from which parallels with extant theory on the development of expert practice were drawn.