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Assessing Decision-Making Capacity

Published online by Cambridge University Press:  29 April 2021

Bernard Lo
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Extract

Physicians frequently are asked to assess whether a patient has the capacity to make informed decisions about his or her medical care. Such assessments may be difficult and controversial. There are few explicit legal standards for judging competency to make medical decisions. Furthermore, clinical practices for evaluating decision-making capacity are problematic. The following case illustrates some of these problems.

Mrs. C., a 74 year old widow with congestive heart failure, angina pectoris, and mild dementia, has been admitted to the hospital for shortness of breath and chest pain. In the past three years she has suffered two heart attacks. During the past two months, her symptoms have worsened despite several medications, including maximally tolerated doses of diltiazem, furosemide and enalapril. She now develops shortness of breath and chest pain when walking one block. Because there are no other medical treatments for her condition, her physician recommends angioplasty or bypass surgery in order to ameliorate her symptoms.

Type
Article
Information
Law, Medicine and Healthcare , Volume 18 , Issue 3 , Fall 1990 , pp. 193 - 201
Copyright
Copyright © 1990 American Society of Law, Medicine & Ethics

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References

Appelbaum, P.S., Lidz, C.W., Meisel, A.. Informed Consent: Legal Theory and Clinical Practice. New York, Oxford University Press, 1987; Meisel, A., The Right to Die. New York, John Wiley & Sons, 1989; Buchanan, A.E., Brock, D.W., Deciding for Others. Cambridge, Cambridge University Press, 1989.Google Scholar
Id., Buchanan, ; President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Making Health Care Decisions. Washington, U.S. Government Printing Office, 1982; President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Deciding to Forego Life-Sustaining Treatment. Washington, U.S. Government Printing Office, 1983.Google Scholar
Id., Buchanan, ; Id., Meisel; Id., President's Commission, Making Health Care Decisions.Google Scholar
President's Commission, note 2 supra, Making Health Care Decisions, Deciding to Forego Life-Sustaining Treatment.Google Scholar
Buchanan, A., Brock, D.W., “Deciding for others”, Milbank Memorial Quarterly 1986, 64(supp 2):17–94.Google Scholar
Pelegrino, E.D. Thomasma, D.G., For the Patient's Good: The Restoration of Beneficence in Health Care. New York, Oxford University Press, 1988.Google Scholar
Appelbaum, et al., supra note 1.Google Scholar
Drane, J.F., “Competency to give an informed consent”, JAMA 1984, 252:925–927; Buchanan, , supra note 1.Google Scholar
Wolf, S.M., “Conflict between doctor and patient”, Law, Medicine & Health Care 1988, 16:197–203.Google Scholar
Appelbaum, , supra note 1; Meisel, supra note 1.Google Scholar
Meisel, , supra note 1.Google Scholar
Ibid.Google Scholar
Ibid.Google Scholar
Ibid.Google Scholar
Faden, R., Beauchamp, T., A History and Theory of Informed Consent. New York, Oxford University Press, 1988; Buchanan, , supra note 1.Google Scholar
Appelbaum, , supra note 1; Buchanan, , supra note 1.Google Scholar
Faden, supra note 15.Google Scholar
State Dep't of Human Resources v. Northern. 563 S.W.2d 197 (Tenn. Ct. App. 1978).Google Scholar
In re Brooks. 32 Ill.2d 361, 205 N.E.2d 435 (1965).Google Scholar
Buchanan, , supra note 1.Google Scholar
Lipowski, Z.J., “Delirium in the elderly patient”, N Engl J Med 1989, 320:578–582; Katzman, R., “Alzheimer's disease”, N Engl J Med 1986, 314:964–973.Google Scholar
Larson, E.B., Kukull, W.A., Buchner, D., Reifler, B.V., “Adverse drug reactions associated with global cognitive impairment in elderly persons”, Ann Intern Med 1987, 107:169–173.CrossRefGoogle Scholar
Applebaum, P.S., Grisso, T., “Assessing patients' capacities to consent to treatment”, N Engl J Med 1988, 319:1635–1638.Google Scholar
Kane, R.L., Ouslander, J.G., Ibrass, I.B., Essentials of Clinical Geriatrics (2nd ed.). New York, McGraw-Hill, 1989.Google Scholar
Ibid.Google Scholar
In re Quackenbush. 156 N.J. Super. 282, 383 A.2d 785 (1978).Google Scholar
Ibid.Google Scholar
Lane v. Candura. 6 Mass. App. 377,376 N.E.2d 1232 (1978).Google Scholar
Ibid.Google Scholar
Perl, M., Shelp, E.E., “Psychiatric consultation masking moral dilemmas in medicine”, N Engl J Med 1982, 307:618–621; Appelbaum, supra notes 1 and 23.CrossRefGoogle Scholar
Id., Perl.Google Scholar
Ibid.Google Scholar
Candura, Lane v., supra note 28.Google Scholar
Lo, B., “The Bartling case: Protecting patients from harm while respecting their wishes”, J Am Geriatr Soc 1986, 34:44–48.Google Scholar
Quill, T.E., “Partnerships in patient care: A contractual approach”, Ann Intern Med 193, 98:228–234.CrossRefGoogle Scholar
A Report by the Hastings Center, Guidelines on the termination of life-sustaining treatment in the care of the dying. Briarcliff Manor, N.Y., The Hastings Center, 1987; Wanzer, S.H., Federman, D.D., Adelstein, S.J. et al., “The physician's responsibility toward hopelessly ill patients: A second look”, N Engl J Med 1989, 320:844–849; Stein-Brook, R., Lo, B., “Artificial feedings; solid ground, not slippery slope”, N Engl J Med 1988, 318:286–290; Meisel, supra note 1; President's Commission, supra note 2.CrossRefGoogle Scholar
Cruzan vs. Harmon. 760 S.W.2d 408; In re O'Connor. 72 N.Y.2d 517, 531 N.E.2d 607,534 N.Y.S.2d 886 (1988); Lo, B., Rouse, F., Dornbrand, L., “Family decisionmaking on trial: Who decides for incompetent patients?” N Engl J Med 1990, 322:1228–1231.Google Scholar
Id., In re O'Connor.Google Scholar
Cruzan vs. Harmon, supra note 37.Google Scholar