Determining medical decision-making capacity for patients with dissociative identity disorder: a patient-centered approach

Abstract

Patients with Dissociative Identity Disorder (DID) pose ethical challenges for clinicians regarding capacity for medical decisions. If such a patient possesses various personality states with potentially different values, opinions, and preferences, this can lead to conflicting choices regarding medical treatments. Yet, only one decision can be carried out, which might lead some clinicians to believe that DID patients cannot possess capacity. In this thesis, I argue against this presumption by demonstrating that there are clinical contexts and situations where, ethically, patients with DID should (and, in some cases, should not) possess capacity. To accomplish this, a patient-centered approach to determining capacity for DID patients is introduced. Such an approach is rooted in the attributes of patient-centered care and the current bioethical consensus that psychiatric patients should not be deemed to lack capacity for treatment decisions solely due to their diagnosis. It also implores clinicians to consider the degree of value-sharing and awareness among a patients' personality states, as well as the decision at hand and the level of risk associated with the decision when making determinations of capacity for DID patients.