Assessing Patients' Capacities to Consent to Treatment

Abstract

The right of patients to accept or refuse recommended treatment requires careful reassessment when their decision-making capacities are called into question. Patients must be informed appropriately about treatment decisions and be given an opportunity to demonstrate their highest level of mental functioning. The legal standards for competence include the four related skills of communicating a choice, understanding relevant information, appreciating the current situation and its consequences, and manipulating information rationally. Since competence is a legal concept and can be formally determined only in court, the clinical examiner's proper role is to gather relevant information and decide whether an adjudication of incompetence is required. Treatment for impairment of mental functioning can sometimes restore patients' capacities, making it unnecessary to deprive them of their decision-making powers.

Homeward bound or bound for a home? Assessing the capacity of dementia patients to make decisions about hospital discharge: Comparing practice with legal standards

“…Over the past 40 years a number of valuable empirical research studies have been conducted internationally and in the UK, which have attempted to conceptualize the notion of capacity and its assessment (Roth et al, 1977;Weisstub, 1990;Appelbaum and Grisso, 1988;Appelbaum and Grisso, 1995;Wong et al, 1999;Wong et al, 2000).…”

Influence of Psychiatric Symptoms on Decisional Capacity in Treatment Refusal

“…Competence is a legal determination of mental capacity that includes those abilities evaluated by clinicians in assessing decisional capacity. The legal standards for evaluating capacity are generally based on patients' ability to: (1) understand the relevant information about their condition and proposed treatment; (2) appreciate the nature of their situation, including their underlying values and the potential consequences of their choice; (3) reason about the potential risks and benefits of their choices; and (4) express their choice [4,5]. This assessment process is in accordance with the American Medical Association Code of Medical Ethics' "Opinions on Consent, Communication & Decision Making" [6].…”

Comunicación diagnóstica en enfermedad de Alzheimer: Reflexión y propuesta

“…De la misma manera que en principio ha de considerarse a toda persona autónoma, la capacidad debe presumirse y la falta de capacidad deberá demostrarse 21,22 .…”

“…Existen muchas propuestas para intentar protocolizar la verifi cación de la capacidad. De ellas la más utilizada en servicios clínicos en Estados Unidos de Norteamérica es la denominada "Mac Arthur Competence Assessment Tool", diseñada por Grisso y Appelbaum 22 . Se divide en cuatro criterios y diez subcriterios.…”