Ethics and Autonomy in Schizophrenia Care : Reflections from a Latin American Perspective

Bioethics has undergone significant evolution in recent decades, particularly in its application to medical sciences and mental health. Its purpose has been to provide solutions to ethical conflicts that arise in healthcare. In this paper, we review the principle of autonomy in the context of people diagnosed with schizophrenia. In schizophrenia, the main difficulty people face is the ability to make decisions autonomously. This ability is affected primarily by the fluctuating nature of the symptoms and particularly their impact on cognition and judgement. This paper discusses the aspects of this condition that affect autonomy and how to address them from a healthcare perspective, with a view to avoiding depersonalization and respecting people's right to make decisions about their lives and treatment. Securing these aims proves to be highly complex when a person's consent must be obtained and health conditions prevent them from exercising this capacity. The possibility of establishing a balance between autonomy and obtaining the best possible care is an ethical dilemma that persists in mental health treatment, particularly for people diagnosed with schizophrenia. In this situation, advance directives in psychiatry are a viable mechanism to sustain the exercise of autonomy. However, they are still under-utilized, and some medical teams resist their implementation. In Latin America, their use is more restricted. With this in mind, it is necessary to discuss projections for their use, the requirements for their implementation, and to generate reflection among professionals regarding the bioethical and legal challenges raised by the prospect of incorporating advance directives in the treatment of people with schizophrenia.