Hanfried Helmchen’s reply to Hector Warnes’ comment
Hanfried Helmchen: My professional development in clinical psychopharmacology
Many thanks to Prof. Warnes for his complimentary review of my autobiographical sketch.
With regard to his comment that I only listed but did not elaborate the capacity to consent in psychiatry by two English publications:
1. Koch HG, Reiter-Theil S, Helmchen H (eds) (1996) Informed Consent in Psychiatry. Nomos, Baden-Baden.
2. Helmchen H (2015) Research with dementia patients? Ethics, Medicine and Public Health 1, 260—267:
The compelling demand for dementia research is supported by the large and demographically associated increase of dementia for which no causal treatment is available. However, during its progressive course, dementia destroys the capacity for self-determination of the ill person and thus an essential prerequisite for participation in research, i.e. a valid consent toward a research intervention. Accordingly, not only sufficient information about all issues that are relevant for decision but also a flawless assessment of the capacity to consent is important; however, currently this is not satisfactorily possible. This paper tries to find answers for related questions, such as ‘‘why?’’ and ‘‘how?’’, of its assessment including that of a substitution of consent of potential research participants for whom consent is no longer possible.
Key points:
1. Capacity to consent does not depend from a diagnosis but from the present psychopathological state; it is not a global function but is related here and now to a specific issue, i.e. it is a relational one, and may exist for one issue and not for another issue.
2. Capacity to consent may be graded by the combination of the three standards understanding, reasoning, appreciation that have different weights and thereby permit a graduation of the capacity to consent either as single standards or in combination. The joint consideration of all three standards is accepted as the strongest standard, the single consideration of the understanding standard as the weakest standard
3. Assessment of the capacity to consent, particularly for participation in research, is an obligation in order not to burden a patient with a responsibility that he cannot bear in case of incompetence.
Furthermore, I apologize that I would like to delete three small errors in Prof. Warnes comment:
1. “In 2003 the Department of Medicine of the Free University of Berlin and the Medical Faculty of the Alexander von Humboldt University in Berlin were merged and called Charité University medicine.”
The current official name of the University is “Humboldt Universität zu Berlin” in memory of both Humboldt brothers: Wilhelm and Alexander. Due to his famous voyages through Latin America Alexander v. Humboldt may be more known in Latin America, but Wilhelm v. Humboldt was a Prussian educational reformer: Wilhelm v. Humboldt elaborated the basic requirements of a humanistic and liberal education by a three-step educational plan and was (after Prussians’ defeat by Napoleon) the decisive man in the Prussian government for the founding of the Berlin University in 1809, named 1828-1945 Friedrich-Wilhelm-University (after the Prussian king Friedrich-Wilhelm III) and received – after founding the Free University in West-Berlin in 1948 – its present name in 1949 by the East-Berlin DDR-Government.
The official name of the Berlin medical school now is “Charité – University Medicine Berlin.”
2. “…spent some time at the Victoria Hospital in Australia”.
I never spent any time in Victoria Hospital or any other hospital in Australia.
3. “He was editor and wrote on Psychiatry of the present (Psychiatrie der Gegenwart) which is in its fourth edition and I believe that has already five volumes.”
The German edition has six volumes, the English edition of “Contemporary Psychiatry” has three volumes.
March 22, 2018