scholarly journals Is this person with dementia (currently) competent to request euthanasia? A complicated and underexplored question

2020 ◽  
pp. medethics-2020-106091
Author(s):  
Scott YH Kim ◽  
Dominic Mangino ◽  
Marie Nicolini
Keyword(s):  
Assisted Suicide ◽  
Previous Analysis ◽  
Functional Model ◽  
Capacity Assessment ◽  
Decisional Capacity ◽  
Policy And Practice ◽  
Ethical Implications ◽  
Decision Making Capacity ◽  
Scant Attention ◽  
Person With Dementia

In euthanasia and/or assisted suicide (EAS) of persons with dementia, the controversy has mostly focused on decisionally incapable persons with very advanced dementia for whom the procedure must be based on a written advance euthanasia directive. This focus on advance euthanasia directive-based EAS has been accompanied by scant attention to the issue of decision-making capacity assessment of persons with dementia who are being evaluated for concurrent request EAS. We build on a previous analysis of concurrent request EAS cases from the Netherlands, which showed that many such cases involve persons with significant cognitive impairment. We use illustrative cases to describe the difficulty of determining decisional capacity in persons whose stage of dementia falls between severely impaired and mildly impaired. We show that the Dutch practice of capacity assessment in such dementia cases is difficult to reconcile with the widely accepted functional model of capacity—a model explicitly endorsed by the Dutch euthanasia review committees. We discuss why such deviations from the standard functional model might be occurring, as well as their ethical implications for dementia EAS policy and practice.

Decisional capacity to consent to treatment and anaesthesia in patients over the age of 60 undergoing major orthopaedic surgery

2019 ◽  
Vol 59 (4) ◽  
pp. 247-254 ◽  
Author(s):  
Gabriele Mandarelli ◽  
Giovanna Parmigiani ◽  
Felice Carabellese ◽  
Silvia Codella ◽  
Paolo Roma ◽  
...  
Keyword(s):  
Informed Consent ◽  
Orthopaedic Surgery ◽  
Decisional Capacity ◽  
Capacity To Consent ◽  
Capacity Evaluation ◽  
Decision Making Capacity ◽  
Consent To Treatment ◽  
Major Orthopaedic Surgery ◽  
Pain Symptoms ◽  
State Examination

Despite growing attention to the ability of patients to provide informed consent to treatment in different medical settings, few studies have dealt with the issue of informed consent to major orthopaedic surgery in those over the age of 60. This population is at risk of impaired decision-making capacity (DMC) because older age is often associated with a decline in cognitive function, and they often present with anxiety and depressive symptoms, which could also affect their capacity to consent to treatment. Consent to major orthopaedic surgery requires the patient to understand, retain and reason about complex procedures. This study was undertaken to extend the literature on decisional capacity to consent to surgery and anaesthesia of patients over the age of 60 undergoing major orthopaedic surgery. Recruited patients ( N=83) were evaluated using the Aid to Capacity Evaluation, the Beck Depression Inventory, the State–Trait Anxiety Inventory Y, the Mini-Mental State Examination and a visual analogue scale for measuring pain symptomatology. Impairment of medical DMC was common in the overall sample, with about 50% of the recruited patients showing a doubtful ability, or overt inability, to provide informed consent. Poor cognitive functioning was associated with reduced medical DMC, although no association was found between decisional capacity and depressive, anxiety and pain symptoms. These findings underline the need of an in-depth assessment of capacity in older patients undergoing major orthopaedic surgery.

The capacity to designate a surrogate is distinct from decisional capacity: normative and empirical considerations

2021 ◽  
pp. medethics-2020-107078
Author(s):  
Mark Navin ◽  
Jason Adam Wasserman ◽  
Devan Stahl ◽  
Tom Tomlinson
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Decisional Capacity ◽  
Risks And Benefits ◽  
Relative Risks ◽  
Decision Making Capacity ◽  
Cognitive Diseases ◽  
Surrogate Selection

The capacity to designate a surrogate (CDS) is not simply another kind of medical decision-making capacity (DMC). A patient with DMC can express a preference, understand information relevant to that choice, appreciate the significance of that information for their clinical condition, and reason about their choice in light of their goals and values. In contrast, a patient can possess the CDS even if they cannot appreciate their condition or reason about the relative risks and benefits of their options. Patients who lack DMC for many or most kinds of medical choices may nonetheless possess the CDS, particularly since the complex means-ends reasoning required by DMC is one of the first capacities to be lost in progressive cognitive diseases (eg, Alzheimer’s disease). That is, patients with significant cognitive decline or mental illness may still understand what a surrogate does, express a preference about a potential surrogate, and be able to provide some kind of justification for that selection. Moreover, there are many legitimate and relevant rationales for surrogate selection that are inconsistent with the reasoning criterion of DMC. Unfortunately, many patients are prevented from designating a surrogate if they are judged to lack DMC. When such patients possess the CDS, this practice is ethically wrong, legally dubious and imposes avoidable burdens on healthcare institutions.

scholarly journals 307 - Exploratory Study on Healthcare Decision-Making Capacity Assessment

2020 ◽  
Vol 32 (S1) ◽  
pp. 65-65
Author(s):  
Ana Saraiva Amaral ◽  
Rosa Marina Afonso ◽  
Mário R. Simões ◽  
Sandra Freitas
Keyword(s):  
Decision Making ◽  
Content Analysis ◽  
Focus Groups ◽  
Exploratory Study ◽  
Assessment Instrument ◽  
Funding Agency ◽  
Capacity Assessment ◽  
Healthcare Decision ◽  
Healthcare Decision Making ◽  
Decision Making Capacity

Mild cognitive impairment (MCI) and Alzheimer’s Disease (AD) prevalence is expected to continue to increase, due to the population ageing. MCI and AD may impact patients’ decision-making capacities, which should be assessed through the disease course. These medical conditions can affect the various areas of decision-making capacity in different ways. Decision-making capacity in healthcare is particularly relevant among this population. Elders often suffer from multimorbidity and are frequently asked to make healthcare decisions, which can vary from consenting a routine diagnostic procedure to decide receiving highly risk treatments.To assess this capacity in elders with MCI or AD, we developed the Healthcare Decision-Making Capacity Assessment Instrument (IACTD-CS - Instrumento de Avaliação da Capacidade de Tomada de Decisão em Cuidados de Saúde). This project is funded by Portuguese national funding agency for science, research and technology, FCT (SFRH/BD/139344/2018). IACTD-CS was developed based on Appelbaum and Grisso four abilities model, literature review and review of international assessment instruments. After IACTD-CS first version development, an exploratory study with focus groups was conducted. This study included focus groups with healthcare professionals and nursing homes’ professionals.The focus groups main goals were: 1) understand the participants perception regarding healthcare decision-making capacity, 2) distinguish relevant aspects of decision-making, 3) discuss the abilities and items included in IACTD-CS and 4) identify new aspects or items to be added to IACTD-CS. A content analysis of the focus groups results, with resource to MAXQDA, was conducted afterwards. This exploratory study allowed to identify professionals’ perceptions on healthcare decision-making and its results were a significant contribute to IACTD-CS development. The proposed communication aims to describe the methodology used and present the results of content analysis.

scholarly journals The U-ARE Protocol: A Pragmatic Approach to Decisional Capacity Assessment for Clinical Research

2020 ◽  
Vol 73 (2) ◽  
pp. 431-442
Author(s):  
Rachel K.B. Hamilton ◽  
Cynthia H. Phelan ◽  
Nathaniel A. Chin ◽  
Mary F. Wyman ◽  
Nickolas Lambrou ◽  
...  
Keyword(s):  
Clinical Research ◽  
Capacity Assessment ◽  
Decisional Capacity ◽  
Pragmatic Approach

scholarly journals WHAT DO GREEKS BELIEVE ABOUT ELDERS AND MENTAL CAPACITY?

2014 ◽  
Vol 8 (3) ◽  
pp. 1-5 ◽  
Author(s):  
Vaitsa Giannouli
Keyword(s):  
Older Persons ◽  
Mental Health Problems ◽  
Capacity Assessment ◽  
Legal Capacity ◽  
Discussion Forums ◽  
Legal Implications ◽  
Decision Making Capacity ◽  
Current Assessment ◽  
Financial Decision ◽  
Individuals With Intellectual Disabilities

Despite the plethora of studies abroad, in Greece views on individuals with intellectual disabilities and older persons with mental health problems is not a well investigated topic. The results of the present study reveal that generally acts with financial-legal implications (mainly financial decision-making capacity) are of concern to the participants, as they consider this sort of capacity the main predictor for legal (in)capacity on the whole, especially when they consider elderly patients. Participants have doubts about the appropriateness of the current assessment methods followed by forensic psychiatrists and psychologists in Greece and hope for future improvements in the field of legal capacity assessment. In addition to that participants seem to welcome any form of provided information (live lectures from conferences, videos, interviews, discussion forums and texts) from experts with an emphasis on issues for elders. No significant differences were found in the expressed views based on gender or age, but subtle differences were found according to educational level. 

scholarly journals Broad concepts and messy realities: optimising the application of mental capacity criteria

2021 ◽  
pp. medethics-2021-107571
Author(s):  
Scott Y H Kim ◽  
Nuala B Kane ◽  
Alexander Ruck Keene ◽  
Gareth S Owen
Keyword(s):  
Decision Making ◽  
Clinical Research ◽  
Functional Capacity ◽  
Functional Model ◽  
Relevant Information ◽  
Mental Capacity ◽  
Capacity Assessment ◽  
Diverse Range ◽  
England And Wales ◽  
Mental Capacity Act

Most jurisdictions require that a mental capacity assessment be conducted using a functional model whose definition includes several abilities. In England and Wales and in increasing number of countries, the law requires a person be able to understand, to retain, to use or weigh relevant information and to communicate one’s decision. But interpreting and applying broad and vague criteria, such as the ability ‘to use or weigh’ to a diverse range of presentations is challenging. By examining actual court judgements of capacity, we previously developed a descriptive typology of justifications (rationales) used in the application of the Mental Capacity Act (MCA) criteria. We here critically optimise this typology by showing how clear definitions—and thus boundaries—between the criteria can be achieved if the ‘understanding’ criterion is used narrowly and the multiple rationales that fall under the ability to ‘use or weigh’ are specifically enumerated in practice. Such a typology-aided practice, in theory, could make functional capacity assessments more transparent, accountable, reliable and valid. It may also help to create targeted supports for decision making by the vulnerable. We also discuss how the typology could evolve legally and scientifically, and how it lays the groundwork for clinical research on the abilities enumerated by the MCA.

Clinical Issues

2021 ◽  
pp. 151-175
Author(s):  
Timothy E. Quill ◽  
Judith K. Schwarz
Keyword(s):  
Decision Making ◽  
Advance Directives ◽  
Oral Intake ◽  
Decisional Capacity ◽  
Clinical Issues ◽  
Decision Making Capacity ◽  
Seriously Ill

All seriously ill persons should complete advance directives specifying indications for limiting future provision of food and fluids. AD’s for SED specify When oral intake is to be limited and What limitations are to be imposed. Two categories include: (1) withholding all assisted oral intake from a person who has lost decision-making capacity, and previously indicated her wish to not receive any assisted feeding, and (2) Comfort Feeding Only (CFO) which involves providing as much or as little food and fluid as the patient seems to desire. CFO has three subcategories: (a) “Self-feeding only”—limiting oral intake to what the patient is able to self-administer. (b) Both “self-feeding” and “caregiver assisted-feeding” in whatever amount the patient enjoys. (c) “Minimum Comfort Feeding Only” is a modification for those who had expressed a desire to SED but lost decisional capacity before implementation, but now seem to desire food or fluid.

scholarly journals Medical Decision-Making in Oncology for Patients Lacking Capacity

2020 ◽  
pp. e186-e196
Author(s):  
Jonathan M. Marron ◽  
Kaitlin Kyi ◽  
Paul S. Appelbaum ◽  
Allison Magnuson
Keyword(s):  
Decision Making ◽  
Developmentally Disabled ◽  
Medical Decision ◽  
Decisional Capacity ◽  
Medical Decisions ◽  
Diminished Capacity ◽  
Decision Making Capacity ◽  
Minor Children ◽  
Oncology Practice ◽  
Do So

Modern oncology practice is built upon the idea that a patient with cancer has the legal and ethical right to make decisions about their medical care. There are situations in which patients might no longer be fully able to make decisions on their own behalf, however, and some patients never were able to do so. In such cases, it is critical to be aware of how to determine if a patient has the ability to make medical decisions and what should be done if they do not. In this article, we examine the concept of decision-making capacity in oncology and explore situations in which patients may have altered/diminished capacity (e.g., depression, cognitive impairment, delirium, brain tumor, brain metastases, etc.) or never had decisional capacity (e.g., minor children or developmentally disabled adults). We describe fundamental principles to consider when caring for a patient with cancer who lacks decisional capacity. We then introduce strategies for capacity assessment and discuss how clinicians might navigate scenarios in which their patients could lack capacity to make decisions about their cancer care. Finally, we explore ways in which pediatric and medical oncology can learn from one another with regard to these challenging situations.

scholarly journals DECISION-MAKING CAPACITY ASSESSMENT (DMCA) TRAINING FOR PHYSICIANS

2017 ◽  
Vol 1 (suppl_1) ◽  
pp. 203-203
Author(s):  
L. Charles ◽  
J. Parmar ◽  
B.M. Dobbs ◽  
S. Brémault-Phillips ◽  
O. Babenko ◽  
...  
Keyword(s):  
Decision Making ◽  
Capacity Assessment ◽  
Decision Making Capacity

Should euthanasia and assisted suicide for psychiatric disorders be permitted? A systematic review of reasons

2020 ◽  
Vol 50 (8) ◽  
pp. 1241-1256
Author(s):  
Marie E. Nicolini ◽  
Scott Y. H. Kim ◽  
Madison E. Churchill ◽  
Chris Gastmans
Keyword(s):  
Systematic Review ◽  
Policy Making ◽  
Assisted Suicide ◽  
Qualitative Content Analysis ◽  
Self Determination ◽  
Future Research ◽  
Decisional Capacity ◽  
Goals Of Medicine ◽  
Ethical Debate ◽  
Life Sustaining Treatment

AbstractBackgroundEuthanasia and assisted suicide (EAS) based on a psychiatric disorder (psychiatric EAS) continue to pose ethical and policy challenges, even in countries where the practice has been allowed for years. We conducted a systematic review of reasons, a specific type of review for bioethical questions designed to inform rational policy-making. Our aims were twofold: (1) to systematically identify all published reasons for and against the practice (2) to identify current gaps in the debate and areas for future research.MethodsFollowing the PRISMA guidelines, we performed a search across seven electronic databases to include publications focusing on psychiatric EAS and providing ethical reasons. Reasons were grouped into domains by qualitative content analysis.ResultsWe included 42 articles, most of which were written after 2013. Articles in favor and against were evenly distributed. Articles in favor were mostly full-length pieces written by non-clinicians, with articles against mostly reactive, commentary-type pieces written by clinicians. Reasons were categorized into eight domains: (1) mental and physical illness and suffering (2) decisional capacity (3) irremediability (4) goals of medicine and psychiatry (5) consequences for mental health care (6) psychiatric EAS and suicide (7) self-determination and authenticity (8) psychiatric EAS and refusal of life-sustaining treatment. Parity- (or discrimination-) based reasons were dominant across domains, mostly argued for by non-clinicians, while policy reasons were mostly pointed to by clinicians.ConclusionsThe ethical debate about psychiatric EAS is relatively young, with prominent reasons of parity. More direct engagement is needed to address ethical and policy considerations.

Sign in / Sign up

Export Citation Format

Share Document