Conspiracy theories and clinical decision-making

Area of Science:

• Medical Ethics
• Philosophy of Mind
• Clinical Psychology

Background:

• Delusions are typically seen as undermining decisional capacity, invalidating patient refusal of treatment.
• The COVID-19 pandemic highlighted patients refusing interventions based on conspiracy beliefs, which share traits with delusions.
• Similarities include unrealistic posits, resistance to evidence, and paranoia, prompting questions about capacity assessment.

Purpose of the Study:

• To define conspiracy theories and differentiate them from delusions.
• To analyze the impact of conspiracy beliefs on a patient's clinical decision-making capacity.
• To explore implications for surrogate decision-making and address counterarguments.

Main Methods:

• Conceptual analysis of conspiracy theories and delusions.
• Examination of psychological features of both belief types.
• Application of standard criteria for assessing decisional capacity to conspiracy beliefs.

Main Results:

• Conspiracy beliefs share key characteristics with delusions, such as recalcitrance and paranoia.
• While distinct from delusions, conspiracy beliefs can, in some instances, undermine a patient's decision-making capacity.
• The assessment of capacity in such cases is complex and requires careful consideration.

Conclusions:

• Conspiracy beliefs present a unique challenge in assessing patient decisional capacity.
• Ethical frameworks may need adaptation to address capacity when beliefs are conspiracy-based.
• Further discussion is needed on surrogate decision-making for patients holding such beliefs.