Complexities in Decision-Making Capacity

REVIEW THESE KEY ETHICS TERMS:

READ this seminal article by Paul Applebaum on the criteria for assessing a patient’s capacity to make medical decisions: Applebaum, Paul S. (2007). “Assessment of Patients’ Competence to Consent to Treatment”, The New England Journal of Medicine, 357(18): 1834-1840.

Keep in mind Applebaum’s 4 Criteria because they are frequently used today as the standard for assessing decisional capacity and assessing for capacity to consent to treatment. :

CRITERIA FOR ASSESSING DECISION-MAKING CAPACITY
  1. Communicate a Choice
  2. Understand the Relevant Information
  3. Appreciate the Situation and its Consequences
  4. Reason About Treatment Options

REVIEW THESE TWO CASES:

CASE 1

A 64-year-old woman with MS is hospitalized. The team feels she may need to be placed on a feeding tube soon to assure adequate nourishment. They ask the patient about this in the morning and she agrees. However, in the evening (before the tube has been placed), the patient becomes disoriented and seems confused about her decision to have the feeding tube placed. She tells the team she doesn’t want it in. They revisit the question in the morning, when the patient is again lucid. Unable to recall her state of mind from the previous evening, the patient again agrees to the procedure.

Is this patient competent to decide? Which preference should be honored?

CASE 2

A 55-year-old man has a 3-month history of chest pain and fainting spells. You feel his symptoms merit cardiac catheterization. You explain the risks and potential benefits to him, and include your assessment of his likely prognosis without the intervention. He is able to demonstrate that he understands all of this, but refuses the intervention.

Can he do that, legally? Should you leave it at that?

 

**Cases taken from: http://depts.washington.edu/bioethx/topics/consent.html

 


For further investigation (not required):