Assessing Decisional Capacity for Clinical Research  or Treatment: A Review of Instruments

Dunn, Laura B.; Nowrangi, Milap A.; Palmer, Barton W.; Jeste, Dilip V.; Saks, Elyn R.

doi:10.1176/ajp.2006.163.8.1323

Cited by 326 publications

(258 citation statements)

References 85 publications

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“…La anoréctica tiene el privilegio de rechazar o rehusarse a cualquier tratamiento aunque parezca insensato, irrazonable o aun contrario a sus intereses, evaluados según criterios del clínico o su familia [16][17][18][19][20] . El consentimiento informado evalúa de manera objetiva su capacidad de autonomía radical -facultad para decidir voluntariamente sin coerción ni manipulación-para vivir de acuerdo a su concepción de existencia digna y, por ello también, como indica el tercer parámetro, para optar por la calidad de vida que le parezca más suya como persona [21][22][23] .…”

Section: Procedimientos De Decisiónunclassified

Bioética de la anorexia nerviosa ¿autonomía, beneficencia o responsabilidad?

Figueroa

2008

Rev. méd. Chile

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PROCEDIMIENTOS DE DECISIÓNLa anorexia plantea una serie de cuestionamientos morales que culminan en la inminencia de muerte (Tabla 1). Jonsen et al propusieron un procedimiento de toma de decisiones que considera cuatro dimensiones siguendo una secuencia progresiva (Tabla 2) 7 . El primer parámetro incluye a la anorexia dentro de los trastornos CEPA (crónico, eficaz tratamiento, paliativo, ambulatorio), pero el cuadro clínico se puede tornar crítico y requerir hospitalización, alimentación forzada por sonda, L a anorexia se ha constituido en una afección de crecimiento explosivo, con elevadas tasas de prevalencia en mujeres adolescentes y jóvenes, catalogándosela de catástrofe nacional antes que de enfermedad catastrófica [1][2][3][4] . Los dilemas éticos se han debatido entre respeto irrestricto a la autonomía desde que se alcanza determinada edad ("menor maduro") o aplicación de tratamientos médicos coercitivos por motivos de beneficencia para prevenir secuelas graves o aun mortales 5,6 . El presente trabajo intenta mostrar que la dicotomía entre derechos a la "libertad" o a

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Section: Procedimientos De Decisiónunclassified

Bioética de la anorexia nerviosa ¿autonomía, beneficencia o responsabilidad?

Figueroa

2008

Rev. méd. Chile

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“…A number of assessment instruments are available for assessing capacity in treatment and research settings (Dunn et al, 2006). Although useful, these are not a substitute for a clinical interview (and clinical judgement) which is necessary, not only to allow the requirements of a legal test of capacity to be met but also to test the potentially wide range of decisions necessary, provide properly tailored support and enable consideration of relevant evidence such as previous actions and observed behaviour (such as in activities of daily living).…”

Section: Make a Decision-specific Testmentioning

confidence: 99%

Assessment of mental capacity: a flow chart guide

Church¹,

Watts

2007

Psychiatr. bull.

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The Mental Capacity Act 2005 provides a new legal framework within which health and social care professionals (as well as informal carers) must act when providing care and treatment for the estimated 2 million people in England, Wales and Northern Ireland who lack the capacity to make certain decisions for themselves. Although the Mental Capacity Act 2005 Code of Practice provides comprehensive advice on good practice in assessing capacity, it does not identify a specific process to be used. Good clinical practice depends on the exercise of clinical judgement within a valid and contestable process. This article outlines a flow chart (Fig. 1) that can be used to guide the process of capacity assessments in more complex cases, in line with the Mental Capacity Act 2005 and the Code of Practice.

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“…In order to provide informed consent they need to understand the information provided, appreciate its significance to themselves, make decisions, and express a clear choice. 4 Their assessment does not occur in a vacuum, but rather in the midst of a life-threatening illness or injury and during a time when they are in the midst of multiple and competing demands. Repeated assessments, interventions, treatment decisions, and multiple diagnostic tests can consume the mental, emotional, and physical energy of patients and families and may push to the background decisions about entry into a research study.…”

Section: Challengesmentioning

confidence: 99%