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Decision-Making Capacity

Stanford Encyclopedia of Philosophy (2020)

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  1. By What Authority? Conflicts of Interest in Professional Ethics.Louis Charland - 2008 - Journal of Ethics in Mental Health 3 (2):1-3.
    Paradoxically, the profession whose primary mandate is to instruct and comment on matters of ethics spends inordinately little time reflecting on its own ethical practices. Consider the fact that while professional ethicists of all stripes crusade to expose and denounce conflicts of interests in all other branches of the health care system, they typically fail to pay much attention to their own potential ‘ethical’ conflicts of interest. Admittedly, there have been some efforts to address the problem. However, despite laudable intentions, (...)
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  • Deciding for Others: The Ethics of Surrogate Decision Making.Allen E. Buchanan & Dan W. Brock - 1989 - Cambridge University Press.
    This book is the most comprehensive treatment available of one of the most urgent - and yet in some respects most neglected - problems in bioethics: decision-making for incompetents. Part I develops a general theory for making treatment and care decisions for patients who are not competent to decide for themselves. It provides an in-depth analysis of competence, articulates and defends a coherent set of principles to specify suitable surrogate decisionmakers and to guide their choices, examines the value of advance (...)
     
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  • Emotion and Value in the Evaluation of Medical Decision-Making Capacity: A Narrative Review of Arguments.Helena Hermann, Manuel Trachsel, Bernice S. Elger & Nikola Biller-Andorno - 2016 - Frontiers in Psychology 7.
    ver since the traditional criteria for medical decision-making capacity (understanding, appreciation, reasoning, evidencing a choice) were formulated, they have been criticized for not taking sufficient account of emotions or values that seem, according to the critics and in line with clinical experiences, essential to decision-making capacity. The aim of this paper is to provide a nuanced and structured overview of the arguments provided in the literature emphasizing the importance of these factors and arguing for their inclusion in competence evaluations. Moreover, (...)
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  • Disability and Sunshine: Can Hedonic Predictions Be Improved by Drawing Attention to Focusing Illusions or Emotional Adaptation?Peter A. Ubel, George Loewenstein & Christopher Jepson - 2005 - Journal of Experimental Psychology: Applied 11 (2):111-123.
  • The Varieties of Compulsion in Addiction.Louis C. Charland - 2012 - American Journal of Bioethics 2 (2):50-51.
    The target of Hanna Pickard's very erudite and thought-provoking article is compulsion. She argues that “addiction is not a form of compulsion” and that “addictive desires are not irresistible” (Pickard 2012, 40). However, I fear that compulsion as she presents it is ultimately a metaphysical straw figure, trapped in a false metaphysical dichotomy. What is lacking is a proper attention to specific individual clinical cases, examined over time. At the same time, Pickard's discussion is extremely important because of the manner (...)
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  • Anorexia Nervosa as a Passion.Louis C. Charland, Tony Hope, Anne Stewart & Jacinta Tan - 2013 - Philosophy, Psychiatry, and Psychology 20 (4):353-365.
    Contemporary diagnostic criteria for anorexia nervosa explicitly refer to affective states of fear and anxiety regarding weight gain, as well as a fixed and very strong attachment to the pursuit of thinness as an overarching personal goal. Yet current treatments for that condition often have a decidedly cognitive orientation and the exact nature of the contribution of affective states and processes to anorexia nervosa remains largely uncharted theoretically. Taking our inspiration from the history of psychiatry, we argue that conceptualizing anorexia (...)
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  • Treatment-Resistant Major Depressive Disorder and Assisted Dying.Udo Schuklenk & Suzanne van de Vathorst - 2015 - Journal of Medical Ethics 41 (8):577-583.
  • Physician-Assisted Death with Limited Access to Palliative Care.Joaquín Barutta & Jochen Vollmann - 2015 - Journal of Medical Ethics 41 (8):652-654.
  • Depression and Competence to Refuse Psychiatric Treatment.A. Rudnick - 2002 - Journal of Medical Ethics 28 (3):151-155.
    Individuals with major depression may benefit from psychiatric treatment, yet they may refuse such treatment, sometimes because of their depression. Hence the question is raised whether such individuals are competent to refuse psychiatric treatment. The standard notion of competence to consent to treatment, which refers to expression of choice, understanding of medical information, appreciation of the personal relevance of this information, and logical reasoning, may be insufficient to address this question. This is so because major depression may not impair these (...)
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  • Decision-Making Capacity for Research Participation Among Addicted People: A Cross-Sectional Study.Inés Morán-Sánchez, Aurelio Luna, Maria Sánchez-Muñoz, Beatriz Aguilera-Alcaraz & Maria D. Pérez-Cárceles - 2016 - BMC Medical Ethics 17 (1):1-10.
    BackgroundInformed consent is a key element of ethical clinical research. Addicted population may be at risk for impaired consent capacity. However, very little research has focused on their comprehension of consent forms. The aim of this study is to assess the capacity of addicted individuals to provide consent to research.Methods53 subjects with DSM-5 diagnoses of a Substance Use Disorder and 50 non psychiatric comparison subjects participated in the survey from December 2014 to March 2015. This cross-sectional study was carried out (...)
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  • Decision-Making Capacity.Louis Charland - 2011 - Stanford Encyclopedia of Philosophy.
    In many Western jurisdictions, the law presumes that adult persons, and sometimes children that meet certain criteria, are capable of making their own health care decisions; for example, consenting to a particular medical treatment, or consenting to participate in a research trial. But what exactly does it mean to say that a subject has or lacks the requisite capacity to decide? This last question has to do with what is commonly called “decisional capacity,” a central concept in health care law (...)
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  • Decision-Making Capacity to Consent to Medical Assistance in Dying for Persons with Mental Disorders.Louis C. Charland, Trudo Lemmens & Kyoko Wada - 2016 - Journal of Ethics in Mental Health:1-14.
    Following a Canadian Supreme Court ruling invalidating an absolute prohibition on physician assisted dying, two reports and several commentators have recommended that the Canadian criminal law allow medical assistance in dying (MAID) for persons with a diagnosis of mental disorder. A key element in this process is that the person requesting MAID be deemed to have the ‘mental capacity’ or ‘mental competence’ to consent to that option. In this context, mental capacity and mental competence refer to ‘decision-making capacity’, which is (...)
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  • Mental Disorder and the Concept of Authenticity.Alexandre Erler & Tony Hope - 2014 - Philosophy, Psychiatry, and Psychology 21 (3):219-232.
    Authenticity has recently emerged as an important issue in discussions of mental disorder. We show, on the basis of personal accounts and empirical studies, that many people with psychological disorders are preoccupied with questions of authenticity. Most of the data considered in this paper are from studies of people with bipolar disorder and anorexia nervosa. We distinguish the various ways in which these people view the relationship between the disorder and their sense of their authentic self. We discuss the principal (...)
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  • Ethical and Conceptual Issues in Eating Disorders.Louis C. Charland - 2013 - Current Opinion in Psychiatry 26 (6):562-565.
    Purpose of review This review considers the literature on ethical and conceptual issues in eating disorders from the last 18 months. Some reference to earlier work is necessary in order to provide context for the recent findings from research that is ongoing. -/- Recent findings Empirical ethics research on anorexia nervosa includes novel ethical and conceptual findings on the role of authenticity and personal identity in individuals’ reports of their experience, as well as new evidence on the role of affective (...)
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  • Mental Competence and Value: The Problem of Normativity in the Assessment of Decision-Making Capacity.Louis C. Charland - 2004 - In Françoise Baylis, Jocelyn Downie, Barry Hoffmaster & Susan Sherwin (eds.), Health Care Ethics in Canada. Toronto, ON, Canada: pp. 267-278.
     
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  • Reinstating the Passions: Arguments From History of Psychopathology.Louis C. Charland - 2009 - In Peter Goldie (ed.), The Oxford Handbook of Philosophy of Emotion. Oxford University Press.
  • Anorexia and the MacCAT-T Test for Mental Competence: Validity, Value, and Emotion.Louis C. Charland - 2007 - Philosophy, Psychiatry, and Psychology 13 (4):283-287.
  • Passion and Decision-Making Capacity in Anorexia Nervosa.Louis C. Charland - 2015 - American Journal of Bioethics Neuroscience 6 (4):66-68.
    The question of decision-making capacity for informed consent to experimental brain surgery for severely ill anorectic patients is about as dramatic an ethical issue one can imagine. Sabine Muller and her co-authors (2015) should be commended for this extremely timely and original clinical and ethical discussion of decision-making capacity in relation to the issues raised by informed consent to such therapies. In this commentary, I elaborate on the new account of the nature of anorexia nervosa that the authors allude to (...)
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  • Mental Competence and Value: The Problem of Normativity in the Assessment of Decision-Making Capacity.Louis C. Charland - 2001 - Psychiatry, Psychology and Law 8 (2):135-145.
    Mental competence, or decision‐making capacity, is an important concept in law, psychiatry, and bioethics. A major problem faced in the development and implementation of standards for assessing mental competence is the issue of objectivity. The problem is that objective standards are hard to formulate and apply. The aim here is to review the limited philosophical literature on the place of value in competence in an attempt to introduce the issues to a wider audience. The thesis that the assessment of competence (...)
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  • Appreciation and Emotion: Theoretical Reflections on the Macarthur Treatment Competence Study.Louis C. Charland - 1998 - Kennedy Institute of Ethics Journal 8 (4):359-376.
    When emotions are mentioned in the literature on mental competence, it is generally because they are thought to influence competence negatively; that is, they are thought to impede or compromise the cognitive capacities that are taken to underlie competence. The purpose of the present discussion is to explore the possibility that emotions might play a more positive role in the determination of competence. Using the MacArthur Treatment Competence Study as an example, it is argued that appreciation, a central theoretical concept (...)
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  • As Autonomy Heads Into Harm's Way.Louis C. Charland - 2004 - Philosophy, Psychiatry, and Psychology 11 (4):361-363.
    Interdisciplinary work of the sort attempted in my paper is fraught with risks and obstacles. One especially pernicious obstacle is the short-sighted prejudice that insists we should always divide a problem into its various components, allocate different parts to their respective disciplines, publish each separately, and, above all, keep the ethics separate from the rest. Although this may sometimes constitute good tactical advice in the mature stages of inquiry on a complex topic, it begs the question in the early initial (...)
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  • Temporal Inabilities and Decision-Making Capacity in Depression.Gareth S. Owen, Fabian Freyenhagen, Matthew Hotopf & Wayne Martin - 2015 - Phenomenology and the Cognitive Sciences 14 (1):163-182.
    We report on an interview-based study of decision-making capacity in two classes of patients suffering from depression. Developing a method of second-person hermeneutic phenomenology, we articulate the distinctive combination of temporal agility and temporal inability characteristic of the experience of severely depressed patients. We argue that a cluster of decision-specific temporal abilities is a critical element of decision-making capacity, and we show that loss of these abilities is a risk factor distinguishing severely depressed patients from mildly/moderately depressed patients. We explore (...)
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  • Depression, Possibilities, and Competence: A Phenomenological Perspective. [REVIEW]Gerben Meynen - 2011 - Theoretical Medicine and Bioethics 32 (3):181-193.
    Competent decision-making is required for informed consent. In this paper, I aim, from a phenomenological perspective, to identify the specific facets of competent decision-making that may form a challenge to depressed patients. On a phenomenological account, mood and emotions are crucial to the way in which human beings encounter the world. More precisely, mood is intimately related to the options and future possibilities we perceive in the world around us. I examine how possibilities should be understood in this context, and (...)
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  • Editorial: Mental Capacity: In Search of Alternative Perspectives.Berghmans Ron, Dickenson Donna & Meulen Ruud Ter - 2004 - Health Care Analysis 12 (4):251-263.
    Editorial introduction to series of papers resulting from a European Commission Project on mental capacity.
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  • The Cognitive Based Approach of Capacity Assessment in Psychiatry: A Philosophical Critique of the MacCAT-T. [REVIEW]Torsten Marcus Breden & Jochen Vollmann - 2004 - Health Care Analysis 12 (4):273-283.
    This article gives a brief introduction to the MacArthur Competence Assessment Tool-Treatment (MacCAT-T) and critically examines its theoretical presuppositions. On the basis of empirical, methodological and ethical critique it is emphasised that the cognitive bias that underlies the MacCAT-T assessment needs to be modified. On the one hand it has to be admitted that the operationalisation of competence in terms of value-free categories, e.g. rational decision abilities, guarantees objectivity to a great extent; but on the other hand it bears severe (...)
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  • Anorexia Nervosa and the Language of Authenticity.Tony Hope, Jacinta Tan, Anne Stewart & Ray Fitzpatrick - 2011 - Hastings Center Report 41 (6):19-29.
    It feels like there’s two of you inside—like there’s another half of you, which is my anorexia, and then there’s the real K [own name], the real me, the logic part of me, and it’s a constant battle between the two. The anorexia almost does become part of you, and so in order to get it out of you I think you do have to kind of hurt you in the process. I think it’s almost inevitable. We came to the (...)
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  • Patient Capacity in Mental Health Care: Legal Overview. [REVIEW]Herman Nys, Sander Welie, Tina Garanis-Papadatos & Dimitris Ploumpidis - 2004 - Health Care Analysis 12 (4):329-337.
    The discriminatory effects of categorizing psychiatric patients into competent and incompetent, have urged lawyers, philosophers and health care professionals to seek a functional approach to capacity assessment. Dutch and English law have produced some guidelines concerning this issue. So far, most legal systems under investigation have concentrated on alternatives for informed consent by the patient in case of mental incapacity, notably substitute decision-making, intervention of a judge and advance directives. It is hard to judge the way in which the law (...)
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  • Moving Perspectives on Patient Competence: A Naturalistic Case Study in Psychiatry.A. M. Ruissen, T. A. Abma, A. J. L. M. Van Balkom, G. Meynen & G. A. M. Widdershoven - 2016 - Health Care Analysis 24 (1):71-85.
    Patient competence, defined as the ability to reason, appreciate, understand, and express a choice is rarely discussed in patients with obsessive compulsive disorder, and coercive measures are seldom used. Nevertheless, a psychiatrist of psychologist may doubt whether OCD patients who refuse treatment understand their disease and the consequences of not being treated, which could result in tension between respecting the patient’s autonomy and beneficence. The purpose of this article is to develop a notion of competence that is grounded in clinical (...)
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  • Patient Decision Making Competence: Outlines of a Conceptual Analysis. [REVIEW]Jos V. M. Welie & Sander P. K. Welie - 2001 - Medicine, Health Care and Philosophy 4 (2):127-138.
    In order to protect patients against medical paternalism, patients have been granted the right to respect of their autonomy. This right is operationalized first and foremost through the phenomenon of informed consent. If the patient withholds consent, medical treatment, including life-saving treatment, may not be provided. However, there is one proviso: The patient must be competent to realize his autonomy and reach a decision about his own care that reflects that autonomy. Since one of the most important patient rights hinges (...)
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  • Does Decision-Making Capacity Require the Absence of Pathological Values?Demian Whiting - 2009 - Philosophy, Psychiatry, and Psychology 16 (4):341-344.
    Decision-making capacity (DMC) is normally taken to include (1) understanding (and appreciation); (2) the ability to deliberate or weigh up; and (3) the ability to express a choice. In an article published recently in PPP, Jacinta Tan and her colleagues (2006) suggest that DMC requires also (4) the absence of 'pathological values' (i.e., values that arise from mental disorder). In this paper, I argue that although (1)–(3) might be necessary for DMC, (4) is not necessary (barring cases where pathological values (...)
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  • Competence to Make Treatment Decisions in Anorexia Nervosa: Thinking Processes and Values.Jacinta Tan, Anne Stewart, Ray Fitzpatrick & R. A. Hope - 2007 - Philosophy, Psychiatry, and Psychology 13 (4):267-282.
  • Studying Penguins to Understand Birds.Jacinta Tan, Anne Stewart, Ray Fitzpatrick & R. A. Hope - 2007 - Philosophy, Psychiatry, and Psychology 13 (4):299-301.
  • Evaluating Medico-Legal Decisional Competency Criteria.Demian Whiting - 2015 - Health Care Analysis 23 (2):181-196.
    In this paper I get clearer on the considerations that ought to inform the evaluation and development of medico-legal competency criteria—where this is taken to be a question regarding the abilities that ought to be needed for a patient to be found competent in medico-legal contexts. In the “Decisional Competency in Medico-Legal Contexts” section I explore how the question regarding the abilities that ought to be needed for decisional competence is to be interpreted. I begin by considering an interpretation that (...)
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  • Addiction, Autonomy, and Informed Consent: On and Off the Garden Path.Neil Levy - 2015 - Journal of Medicine and Philosophy 41 (1):56-73.
    Several ethicists have argued that research trials and treatment programs that involve the provision of drugs to addicts are prima facie unethical, because addicts can’t refuse the offer of drugs and therefore can’t give informed consent to participation. In response, several people have pointed out that addiction does not cause a compulsion to use drugs. However, since we know that addiction impairs autonomy, this response is inadequate. In this paper, I advance a stronger defense of the capacity of addicts to (...)
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  • Four Reasons Why Assisted Dying Should Not Be Offered for Depression.Thomas Blikshavn, Tonje Lossius Husum & Morten Magelssen - 2017 - Journal of Bioethical Inquiry 14 (1):151-157.
    Recently, several authors have argued that assisted dying may be ethically appropriate when requested by a person who suffers from serious depression unresponsive to treatment. We here present four arguments to the contrary. First, the arguments made by proponents of assisted dying rely on notions of “treatment-resistant depression” that are problematic. Second, an individual patient suffering from depression may not be justified in believing that chances of recovery are minimal. Third, the therapeutic significance of hope must be acknowledged; when mental (...)
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  • The Varieties of Religious Experience.William James - 1903 - Philosophical Review 12 (1):62-67.
  • Clarifying Confusions About Coercion.Jennifer Susan Hawkins & Ezekiel J. Emanuel - 2005 - Hastings Center Report 35 (5):16-19.
    Commentators often claim that medical research subjects are coerced into participating in clinical studies. In recent years, such claims have appeared especially frequently in ethical discussions of research in developing countries. Medical research ethics is more important than ever as we move into the 21st century because worldwide the pharmaceutical industry has grown so much and shows no sign of slowing its growth. This means that more people are involved in medical research today than ever before, and in the future (...)
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  • Thinking About the Good: Reconfiguring Liberal Metaphysics (or Not) for People with Cognitive Disabilities.Anita Silvers & Leslie Pickering Francis - 2009 - Metaphilosophy 40 (3-4):475-498.
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  • When Concretized Emotion-Belief Complexes Derail Decision-Making Capacity.Jodi Halpern - 2012 - Bioethics 26 (2):108-116.
    There is an important gap in philosophical, clinical and bioethical conceptions of decision-making capacity. These fields recognize that when traumatic life circumstances occur, people not only feel afraid and demoralized, but may develop catastrophic thinking and other beliefs that can lead to poor judgment. Yet there has been no articulation of the ways in which such beliefs may actually derail decision-making capacity. In particular, certain emotionally grounded beliefs are systematically unresponsive to evidence, and this can block the ability to deliberate (...)
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  • Ought We to Require Emotional Capacity as Part of Decisional Competence?Paul S. Appelbaum - 1998 - Kennedy Institute of Ethics Journal 8 (4):377-387.
  • Competency and Risk-Relativity.Tom Buller - 2001 - Bioethics 15 (2):93–109.
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  • Emotions, Autonomy, and Decision-Making Capacity.Jodi Halpern - 2011 - American Journal of Bioethics Neuroscience 2 (3):62-63.
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  • The Place of Emotions in Capacity Assessments.Ron Berghmans, Dorothee Horstkötter & Guido de Wert - 2011 - American Journal of Bioethics Neuroscience 2 (3):66-68.
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  • Including Emotionality in Tests of Competence: How Does Neurodiversity Affect Measures of Free Will and Agency in Medical Decision Making?Robin Mackenzie & John Watts - 2011 - American Journal of Bioethics Neuroscience 2 (3):27-36.
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  • Should Psychiatrists Serve as Gatekeepers for Physician‐Assisted Suicide?Mark D. Sullivan, Stuart J. Youngner & Linda Ganzini - 1998 - Hastings Center Report 28 (4):24-31.
  • Depression and Decision-Making Capacity for Treatment or Research: A Systematic Review.Thomas Hindmarch, Matthew Hotopf & Gareth S. Owen - 2013 - BMC Medical Ethics 14 (1):54.
    Psychiatric disorders can pose problems in the assessment of decision-making capacity (DMC). This is so particularly where psychopathology is seen as the extreme end of a dimension that includes normality. Depression is an example of such a psychiatric disorder. Four abilities (understanding, appreciating, reasoning and ability to express a choice) are commonly assessed when determining DMC in psychiatry and uncertainty exists about the extent to which depression impacts capacity to make treatment or research participation decisions.
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  • Appreciating Anorexia: Decisional Capacity and the Role of Values.Thomas Grisso & Paul S. Appelbaum - 2007 - Philosophy, Psychiatry, and Psychology 13 (4):293-297.
  • Competence to Consent.Becky Cox White - 1989 - Dissertation, Rice University
    Informed consent is valid only if the person giving it is competent. Although allegedly informed consents are routinely tendered, there are nonetheless serious problems with the concept of competence as it stands. First, conceptual work upon competence is incomplete: the concept is unanalyzed and no logic of competence has been identified. It is thus virtually impossible to reliably discern who is competent. ;Traditional work on competence has explicated three dichotomies from which the necessary conditions for the possibility of competence will (...)
     
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  • Decisional Capacity and Consent for Schizophrenia Research.Allison Kaup, Laura Dunn, Elyn Saks, Dilip Jeste & Barton Palmer - 2011 - IRB: Ethics & Human Research 33 (4):1-9.
    Despite substantial research on overall decision-making capacity levels in schizophrenia, the factors that cause individuals to make errors when making decisions regarding research participation or treatment are relatively unknown. We examined the responses of 84 individuals, middle-aged or older, with schizophrenia or schizoaffective disorder. We used a structured decision-making capacity measure, the MacArthur Competence Assessment Tool for Clinical Research, to determine the frequency and apparent cause of participants’ errors. We found that most errors were due to difficulty recalling the disclosed (...)
     
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  • Essai sur les Passions.Th Ribot - 1907 - Revue de Métaphysique et de Morale 15 (1):1-1.
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