Decision Capacity Assessment in Consultation-Liaison Psychiatry

Abstract

Introduction:   Decision   Capacity   Assessment is one of the functions of consultation psychiatry.  It  involves  the  ability  to  make choices autonomously and arises in a relevant way in clinical practice as a precondition to informed consent.

Aims:  The  authors  pretend  to  review  the process underlying decision capacity assessment, as well as other relevant information published in this regard.

Methods: Non systematic review of the literature, through electronic search in Medline/Pubmed.

Results: The ability to decide can only be assessed  in  relation  to  a  particular  decision,  and  its  outcome  is  not  necessarily stable  over  time.  Similarly,  there  is  no single  diagnosis  that  allows  concluding for  incapacity,  nor  dispensing  its  proper evaluation.  It  depends  on  various  factors like  the  thought  content,  thinking  process or  cognitive  functions.  It  can  also  be  influenced by the individual’s level of edu- cation, personality traits, emotional states/ coping mechanisms or circumstantial factors. Every doctor should be able to carry out this evaluation. The liaison psychiatrist should  be  involved  in  case  of  suspected mental illness that can impair the ability to  consent  or  before  the  need  to  validate an assessment already taken. Appelbaum and Grisso proposed a systematic evaluation  based  on  the  following  criteria:  a) communication  of  choice,  b)  understanding, c) appreciation and d) rational decision making. In an attempt to minimize differences between evaluators, several assessment  instruments  were  developed, among  which  the  MacArthur  Competence Assessment  Tool  assumes  a  special  focus. Mini  Mental  State  Examination  has  also been  used  in  patients  with  cognitive  impairment, emerging proposals for correlating the scores obtained with the presence of decision-making. When a patient is unable to decide, it should be respected his best interest, and seek a “replacement decision”, with respect for ethics and the law."

Conclusions: A patient who is able to deci- de must present: a) attention focused on the problem; b) ability to consider the different options proposed; c) ability to assess the risks and  benefits  and  d   ability  to  anticipate their possible results.