Capable of More: Some Underemphasized Aspects of Capacity Assessment

Kontos, Nicholas; Querques, John; Freudenreich, Oliver

doi:10.1016/j.psym.2014.11.004

Cited by 25 publications

(12 citation statements)

References 81 publications

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“…The above four-component model of capacity is not without its critics. In particular, there have been some concerns expressed that it is overly "cognitive" and does not sufficiently attend to issues such as authenticity, patient values, or the impact of affect or emotions (Karel, 2000;Karel, Gurrera, Hicken, & Moye, 2010;Kontos, Querques, & Freudenreich, 2015;Mackenzie & Rogers, 2013). However, at least at present, the above model predominates the contemporary definition of what it means to be "decisionally capable" both in terms of healthcare and in term of other civil capacities.…”

Section: Four Component Model Of Decisional Capacitymentioning

confidence: 99%

Assessment of Healthcare Decision-making Capacity

Palmer

Harmell

2016

Arch Clin Neuropsychol

113

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It is often necessary for neuropsychologists, clinical psychologists, and other healthcare professionals to assess an individual's capacity to consent to treatment related to healthcare. This task can be challenging and requires a delicate balance of both respect for individuals' autonomy, as well as the protection of individuals with diminished capacity to make an autonomous decision. The purpose of the present review is to provide an overview of the conceptual model of decisional capacity as well as a brief summary of some of the currently available instruments designed to help evaluate medical decision making. In addition, current empirical literature on the relationship between neuropsychological abilities and decision-making capacity is discussed and a brief set of recommendations is provided to further aid clinicians or consultants when they are required to complete the ethically important but difficult task of making determinations about healthcare decision-making capacity.

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Section: Four Component Model Of Decisional Capacitymentioning

confidence: 99%

Assessment of Healthcare Decision-making Capacity

Palmer

Harmell

2016

Arch Clin Neuropsychol

113

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“…When there is too much focus on the cognitive aspect of decision-making, the under-emphasized non-cognitive aspects may be neglected. It is essential to always consider the values and emotions of the patient as well during these evaluations and to ensure that mental illness is not impairing the patient's DMC, even when they do not have cognitive impairment ( 10 , 37 ). This recommendation is supported by the findings of the current study where the incapacity was judged to be due to delusional thinking, thought process disturbances, and lack of insight in cases without prominent cognitive impairments.…”

Section: Discussionmentioning

confidence: 99%

End-of-Life Decision-Making Capacity in Older People With Serious Mental Illness

2021

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Background: The study's main aim was to assess the end-of-life decision-making capacity and health-related values of older people with serious mental illness.Methods: A cross-sectional, observational study, was done at Weskoppies Psychiatric Hospital, Gauteng Province, South Africa that included 100 adults older than 60 years of age and diagnosed with serious mental illness. The Mini-Cog and a semi-structured clinical assessment of end-of-life decision-making capacity was done before a standardized interview, Assessment of Capacity to Consent to Treatment, was administered. This standardized instrument uses a hypothetical vignette to assess decision-making capacity and explores healthcare-related values.Results: The Assessment of Capacity to Consent to Treatment scores correlated (p < 0.001) with the outcomes of the semi-structured decision-making capacity evaluation. Significant correlations with impaired decision-making capacity included: lower scores on the Mini-Cog (p < 0.001); a duration of serious mental illness of 30–39 years (p = 0025); having a diagnosis of schizophrenia spectrum disorders (p = 0.0007); and being admitted involuntarily (p < 0.0001). A main finding was that 65% of participants had decision-making capacity for end-of-life decisions, were able to express their values and engage in advance care discussions.Discussion and Conclusion: Healthcare providers have a duty to initiate advance care discussions, optimize decision-making capacity, and protect autonomous decision-making. Many older patients with serious mental illness can engage in end-of-life discussions and can make autonomous decisions about preferred end-of-life care. Chronological age or diagnostic categories should never be used as reasons for discrimination, and older people with serious mental illness should receive end-of-life care in keeping with their preferences and values.

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“…Opponents of an emotion-inclusive approach to DMC further argue that emotions need to be clearly operationalized and measurable in a reliable manner before being included in DMC evaluations ( Appelbaum, 1998 ). This is indeed a challenging or even conclusive argument, as it seems more difficult as well as inappropriate to provide technical operationalizations and measurements for emotions comparable to those used in the assessment of cognitive faculties ( Kontos et al, 2015 ). Emotional processing seems not only more subjective but also to require more contextually embedded evaluation that is sensitive to the person in their entirety.…”

Section: Discussionmentioning

confidence: 99%

Emotion and Value in the Evaluation of Medical Decision-Making Capacity: A Narrative Review of Arguments

et al. 2016

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Ever since the traditional criteria for medical decision-making capacity (understanding, appreciation, reasoning, evidencing a choice) were formulated, they have been criticized for not taking sufficient account of emotions or values that seem, according to the critics and in line with clinical experiences, essential to decision-making capacity. The aim of this paper is to provide a nuanced and structured overview of the arguments provided in the literature emphasizing the importance of these factors and arguing for their inclusion in competence evaluations. Moreover, a broader reflection on the findings of the literature is provided. Specific difficulties of formulating and measuring emotional and valuational factors are discussed inviting reflection on the possibility of handling relevant factors in a more flexible, case-specific, and context-specific way rather than adhering to a rigid set of operationalized criteria.

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Capable of More: Some Underemphasized Aspects of Capacity Assessment

Cited by 25 publications

References 81 publications

Assessment of Healthcare Decision-making Capacity

Assessment of Healthcare Decision-making Capacity

End-of-Life Decision-Making Capacity in Older People With Serious Mental Illness

Emotion and Value in the Evaluation of Medical Decision-Making Capacity: A Narrative Review of Arguments

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