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Assessing Decision-Making Capacity in Patients with Communication Impairments

A Case Study

Published online by Cambridge University Press:  16 September 2016

MOLLY CAIRNCROSS ,
ANDREW PETERSON ,
ANDREA LAZOSKY ,
TENEILLE GOFTON  and
CHARLES WEIJER
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Abstract:

The ethical principle of autonomy requires physicians to respect patient autonomy when present, and to protect the patient who lacks autonomy. Fulfilling this ethical obligation when a patient has a communication impairment presents considerable challenges. Standard methods for evaluating decision-making capacity require a semistructured interview. Some patients with communication impairments are unable to engage in a semistructured interview and are at risk of the wrongful loss of autonomy. In this article, we present a general strategy for assessing decision-making capacity in patients with communication impairments. We derive this strategy by reflecting on a particular case. The strategy involves three steps: (1) determining the reliability of communication, (2) widening the bandwidth of communication, and (3) using compensatory measures of decision-making capacity. We argue that this strategy may be useful for assessing decision-making capacity and preserving autonomy in some patients with communication impairments.

Keywords

autonomyethicsbrain traumadecision-making capacitycommunication impairmentsneuropsychology
Type
Articles
Information
Cambridge Quarterly of Healthcare Ethics , Volume 25 , Special Issue 4: Clinical Neuroethics , October 2016 , pp. 691 - 699
Copyright
Copyright © Cambridge University Press 2016 

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Notes

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