It's a spiral staircase, not just two steps: An iterative approach to assessing patient capacity for medical decision-making.

Autor: Tunzi M; Family Medicine Residency, Natividad Medical Center, 1441 Constitution Boulevard, Salinas, CA 93906, USA; Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA. Electronic address: tunzim@natividad.com., Day PG; Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA. Electronic address: philip.day@umassmed.edu., Satin DJ; Department of Family Medicine and Community Health, Affiliate Faculty, Center for Bioethics, University of Minnesota Medical School, Minneapolis, MN, USA. Electronic address: sati0003@umn.edu.
Jazyk: angličtina
Zdroj: Patient education and counseling [Patient Educ Couns] 2024 Oct; Vol. 127, pp. 108362. Date of Electronic Publication: 2024 Jun 25.
DOI: 10.1016/j.pec.2024.108362
Abstrakt: The assessment of medical decision-making capacity as part of the process of clinical informed consent has been considered a bioethical housekeeping matter for decades. Yet in practice, the reality bears little resemblance to what is described in the medical literature and professed in medical education. Most literature on informed consent refers to medical decision-making capacity as a precondition to the consent process. That is, a clinician must first determine if a patient has capacity, and only then may the clinician engage with the patient for the rest of informed consent. The problem with this two-step approach is that it makes no sense in actual practice. We see the assessment of medical decision-making capacity within the process of informed consent as a spiral staircase, not just two steps, requiring clinicians to keep circling up and around, making progress, until they get to where they need to be: 1. Clinicians start with a general presumption of capacity for most adults, sometimes having a provisional appraisal of capacity based on prior patient contact. 2. Then, they begin performing informed consent for the current situation and intervention options. 3. Next, they must reassess capacity during this process. 4. After that, they continue with informed consent. 5. If capacity is not yet clear, they repeat 1-4.
Competing Interests: Declaration of Competing Interest On behalf of David Satin, Philip Day and myself, I wish to declare that we have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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