Informed Consent for Neuroleptics with Elderly Patients in Two Settings

Abstract

This paper presents the results of four studies that evaluated the use of neuroleptics in an aging population both in nursing homes and in a psychiatric teaching hospital. The purpose was to determine the degree to which prescribing practices were in compliance with recent court rulings respecting the right of patients to informed consent to "exceptional" medication. The results indicate that physicians in nursing homes do not inform their patients of the risks of neuroleptics, do not seek consent, and do not consider competency to be even an issue. Elderly patients in the acute academic setting were informed of risks and benefits. However, both consent to medication and the competency to give this consent were presumed until or unless the patient failed to acquiesce. The degree to which these practices might be in potential conflict with state law, ignore the benefits of a negotiated doctor/patient partnership, and demonstrate one aspect of poor quality of care are discussed, and policy recommendations are made.

Getting Meaningful Informed Consent from Older Adults: A Structured Literature Review of Empirical Research

“…In evaluating decision making capacity, investigators used as an outcome measure either an assessment of global capacity or a particular capacity criterion. The studies using global measures of capacity 28 , 33 , 37 , 45 , 69 , 77 , demonstrated a range of capacity within the study population, suggesting that certain subsets of the population do need a formal evaluation of decision‐making capacity. The particular criteria evaluated for assessing decision‐making capacity included the rationality of a choice, 31 , 59 , 60 , 79 , 80 patient's appreciation of illness, 31 , 37 , 59 understanding, 23 , 37 , 59 , 97 evidence of a choice, 59 and reasonableness of choice 59 .…”

Teen Health Care Decisions: How Maturity and Social Policy Affect Four Hard Cases

“…In practice, when adult patients disagree with medical advice, health care providers not infrequently ignore their wishes. Sometimes, health care providers frankly admit that they are ignoring what they regard as an illconsidered decision (Garrison, 2007;Grisso & Appelbaum, 1995;Gurian et al, 1990;Saks & Jeste, 2006;Vars, 2008) and sometimes they are just more willing to challenge a dissenting patient's decision-making capacity (Farnsworth, 1990;Grisso & Appelbaum, 1995).…”

Substitute consent for nursing home residents prescribed psychotropic medication

“…The identification of 'incapable' patients by clinical staff is not optimal and even when staff recognised patients' incapacity to give informed consent, proper legal procedures for appointing surrogate decision makers are not generally followed (Barton et al, 1996). In fact, the usual practice, as reported from a survey of Massachusetts nursing homes, is the presumption of capacity until a patient fails to acquiesce to treatment and only at that point is the issue of capacity fully addressed (Gurian et al, 1990). Gurian et al (1990) concluded that informed consent for neuroleptics was not considered an issue and that decision making capacity was not being tested.…”

“…In fact, the usual practice, as reported from a survey of Massachusetts nursing homes, is the presumption of capacity until a patient fails to acquiesce to treatment and only at that point is the issue of capacity fully addressed (Gurian et al, 1990). Gurian et al (1990) concluded that informed consent for neuroleptics was not considered an issue and that decision making capacity was not being tested.…”