Emotion and Value in the Evaluation of Medical Decision-Making Capacity: A Narrative Review of Arguments

Abstract

Ever 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, a broader reflection on the findings of the literature is provided. Specific difficulties of formulating and measuring emotional and valuational factors are discussed inviting reflection on the possibility of handling relevant factors in a more flexible, case-specific, and context-specific way rather than adhering to a rigid set of operationalized criteria.

The capacity of schizophrenia and bipolar disorder individuals to make autonomous decisions about pharmacological treatments for their illness in real life: A scoping review

“…The review also shows that, in mental health research, the capacity for decision making is usually assessed according to the four traditional criteria of understanding, appreciation, reasoning, and expressing a choice 9 and that each of these elements contributes in different ways to the person's decisional capacity. The effects of impairments in schizophrenia and bipolar disorder on patients' decision‐making and functional capacity may vary in intensity depending on the individual, the phase of the illness, the prevailing psychotic symptoms, cognitive function, the moment in time, and the type of decision to be made 55 …”

“…It is important to distinguish between the concepts of capacity and competency. Capacity describes a person's ability to a make a particular decision, whereas competency is a global assessment and a legal determination made by a judge in court 9 . In a medical context, capacity refers to the ability to use information about an illness and proposed treatment options to make a choice that is congruent with one's own values and preferences 10 ; it is the determining element that establishes the role of patient choices in medical decisions.…”

Das Lebensende in der Schweiz - Individuelle und gesellschaftliche Perspektiven

“…Für die Entscheidung, ob sie in ein Pflegeheim umziehen will oder ob nach ihrer Oberschenkelhalsfraktur eine komplexe Operation durchgeführt werden soll, ist sie aber nicht mehr urteilsfähig. Es bedarf in der Regel einer sehr guten Kommunikation und Kenntnis der Patienten, um in solchen Situationen eine zutreffende Einschätzung vornehmen zu können Hermann, Trachsel, Elger & Biller-Andorno, 2016;Hermann, Trachsel, Mitchell & Biller-Andorno, 2014;Trachsel, Hürlimann, Hermann & Biller-Andorno, 2015).…”

Involuntary psychiatric hospitalization of children and adolescents in Northern Greece: Retrospective epidemiological study and related ethical issues

“…[12][13][14] Furthermore, scholars argue that perfect understanding and appreciation of the information provided are not necessarily requirements for decision-making capacity. 15 In the present study, the data from the Child Psychiatry Department in Thessaloniki -the largest city northern Greece-were studied over a decade (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014). Quantitative and qualitative characteristics of the adolescents hospitalized in the clinic were studied and an attempt was made to identify the factors that prompted the prosecution order for the clinical assessment and admission of minors to the child psychiatry department.…”