European Psychiatry - Volume 41 - April 2017

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25th European Congress of Psychiatry / European Psychiatry 41S (2017) S521–S582 S581
EV0542
Decisional capacity in patients with
acute delirium. A Rawlsian approach
S. Hostiuc , I. Negoi , E. Drima ∗
1 Carol Davila University of Medicine and Pharmacy, Legal Medicine
and Bioethics, Bucharest, Romania
2 Carol Davila University of Medicine and Pharmacy, Surgery,
Bucharest, Romania
3 Clinical Hospital Of Psychiatry “Elisabeta Doamna”, Psychiatry,
Galati, Romania
∗ Corresponding author.
Delirium is characterized by a temporary, usually reversible, cause
of mental alteration; it can occur at any age, but affect most often
the elderly. Delirium patients may also present acute psychotic
episodes, which might make them decisionally incompetent. In
order to assess decisional capacity, Fan et al developed a two-stage
approach, which tries to analyse:
– the presence of delirium, using the Confusion Assessment
Method;
– a proper analysis of the decisional capacity.
Often, in patients with decreased decisional capacity, physicians
must assess which ethical principle should respect first – the prin-
ciple of autonomy, whose practical implementation is informed
consent, or beneficence – the good of the patient, irrespective of
the its declared wishes. In this poster, we will look at the issue of
decisional capacity in patients with acute delirium from a Rawl-
sian point of view, and will try to give an answer based on what is
just – to respect the autonomy of the patient, or the moral duty to
do good to the patient.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0543
Fitness to practice and fitness to
regulate
R. Kurz
Cubiks, IPT, Guildford, United Kingdom
Introduction In 2012, forensic psychology Professor Jane Ireland
published initial research claiming that two third of psychologi-
cal assessment reports sampled from UK family courts were ‘poor’
or ‘very poor’. ‘Fitness to practice’ concerns were raised by vested
interest and dismissed after a 1-week hearing – four years later.
Objectives The presentation outlines the nature of various UK
institutions, such as family courts, HCPC and GMC as well as their
practices which raise questions about their fitness to regulate.
Aims Delegateswill start to learn how institutions that purport to
serve public interest yet can be easily exploited by vested interests.
Methods Case studies are used to illustrate how extremely seri-
ous concerns were ignored but persecution concerns upheld.
Results In one case, four courts appointed experts ignored an
obvious child trafficking processwhere a toddlerwas raped to cover
up birth and disappearance of a newborn baby that succeeded from
incestuous rape. In spite of a clinical psychologist failing to cover the
two index incidents, the concerns did not meet the HCPC ‘Standard
of Acceptance’. A ‘revenge concern’ was raised by vested inter-
ests. In another case, the GMC refused to investigate a psychiatrist
who had lied and rather absurdly claimed that repeatedly seeking
return of her children was evidence for a mother’s personality dis-
order. In a widely publicized case Psychiatrist Dr Hibbert accused
of unnecessarily, breaking up families was investigated but cleared
of misconduct by the GMC.
Conclusions Institutions tasked with protecting public safety and
fairness appear to be unduly biased towards shielding inadequate
professionals and persecuting whistle-blowers.
Disclosure of interest The author has not supplied his/her decla-
ration of competing interest.
EV0544
On purpose of multiple cases:
Quaternary prevention on mental
health – “Primum non-nocere”
K.L. Lazo Chavez
Hospital Universitario Principe De Asturias, Psychiatric, Alcala De
Henares, Spain
Introduction Quaternary prevention, concept coined by the Bel-
gian Marc Jamoulle, are the actions taken to avoid or mitigate
the consequences of unnecessary or excessive intervention of the
health system. The concept alludes to actions to avoid the over-
diagnoses and over-treatment, trying to reduce the incidence of
iatrogeny in patients, which is a serious public health problem and
even more in mental health.
Methods Systematic review of bibliography.
Objectives Do a systematic review of bibliography and through
the results invite to the analytic and critic reflection of our profes-
sional activities and the current situation of mental health.
Results There is not enough studies about quaternary prevention
in mental health.
–Some studies found that about one-third of diseases of a hospital
are iatrogenic, most of them for pharmacological causes.
–There is iatrogeny at different levels of the attention of mental
health: primary prevention, diagnosis and treatment.
–Non-treatment indication avoids in multiple cases iatrogenesis
and contributes to the correct distribution of the economic and care
resources.
Conclusions Since one of the fundaments of medicine is “primun
non nocere” that means “first do no harm” and one of principles
of bioethics is “non-maleficence”, quaternary prevention should
prevail over any other preventive or curative option.
–We should define in a more realistic way the limits, benefits and
damages of our interventions in order to not promote a passive and
sick role.
–Must be recognized the non-treatment intervention as a ther-
apeutic and useful intervention, and one of the best tools of
quaternary prevention.
Disclosure of interest The author has not supplied his/her decla-
ration of competing interest.
EV0545
Multidisciplinary approach in old
aged dying patients
N. Ogando Portilla∗, S.M. Ba˜non González , M.G. García Jiménez
Hospital Universitario Rey Juan Carlos, psychiatry, Mostoles, Spain
∗ Corresponding author.
Introduction Over centuries, clinicians have had the responsibil-
ity to take care of dying patients. Lately, the withdrawal of life
sustaining treatments have assumed a main role in these patients
because of ethical aspects. Competent patients have the right to
refuse medical care but not always these rights are respected or
even explained to them, especially if they are old or they don’t
have any close family. A multidisciplinary team should agree on
how they think it is best to care for the patient and whether with-
drawal of medical interventions is appropriate by using patient’s
wishes.
Objectives To identify the most relevant aspects to deal with in
old aged dying patients.
Methods Systematic literature reviewinUp-to-date andPubmed.