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Assessing Decision-Making Capacity in Patients with Communication Impairments

A Case Study

Published online by Cambridge University Press:  16 September 2016

MOLLY CAIRNCROSS ,
ANDREW PETERSON ,
ANDREA LAZOSKY ,
TENEILLE GOFTON  and
CHARLES WEIJER
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Abstract:

The ethical principle of autonomy requires physicians to respect patient autonomy when present, and to protect the patient who lacks autonomy. Fulfilling this ethical obligation when a patient has a communication impairment presents considerable challenges. Standard methods for evaluating decision-making capacity require a semistructured interview. Some patients with communication impairments are unable to engage in a semistructured interview and are at risk of the wrongful loss of autonomy. In this article, we present a general strategy for assessing decision-making capacity in patients with communication impairments. We derive this strategy by reflecting on a particular case. The strategy involves three steps: (1) determining the reliability of communication, (2) widening the bandwidth of communication, and (3) using compensatory measures of decision-making capacity. We argue that this strategy may be useful for assessing decision-making capacity and preserving autonomy in some patients with communication impairments.

Keywords

autonomyethicsbrain traumadecision-making capacitycommunication impairmentsneuropsychology
Type
Articles
Information
Cambridge Quarterly of Healthcare Ethics , Volume 25 , Special Issue 4: Clinical Neuroethics , October 2016 , pp. 691 - 699
Copyright
Copyright © Cambridge University Press 2016 

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References

Notes

1. Maiser, S, Kabir, A, Sabsevitz, D, Peltier, W. Locked-in syndrome: Case report and discussion of decisional capacity. Journal of Pain and Symptom Management. 2016 Apr;51(4):789–93.CrossRefGoogle ScholarPubMed

2. Faden, RR, Beauchamp, TL, King, NM. A History and Theory of Informed Consent. New York: Oxford University Press; 1986.Google Scholar

3. Appelbaum, PS. Assessment of patients’ competence to consent to treatment. New England Journal of Medicine 2007 Nov 1;357(18):1834–40.CrossRefGoogle ScholarPubMed

4. Appelbaum, PS, Grisso, T. The MacArthur Treatment Competence Study I: Mental illness and competence to consent to treatment. Law and Human Behavior 1995 Apr;19(2):105.CrossRefGoogle ScholarPubMed

5. Americans with Disabilities Act of 1990, Pub. L. No. 101-336, 104 Stat. 328 (1990).

6. UN General Assembly. Convention on the Rights of Person with Disabilities: Resolution Adopted by the General Assembly. A/RES/61/106; 2007 Jan 24.

7. Grisso, T, Appelbaum, PS. Assessing Competence to Consent to Treatment: A Guide for Physicians and Other Health Professionals. New York: Oxford University Press; 1998.Google Scholar

8. Carling-Rowland EA. Adaptation of the capacity evaluation process to make admission decisions: Increasing access for people with aphasia and other communication barriers [dissertation]. Toronto, ON: University of Toronto; 2011.

9. See note 8, Carling-Rowland 2011.

10. Rowland, A, McDonald, L. Evaluation of social work communication skills to allow people with aphasia to be part of the decision making process in healthcare. Social Work Education 2009 Mar 1;28(2):128–44.CrossRefGoogle Scholar

11. Beauchamp, TL, Childress, JF. Principles of Biomedical Ethics. New York: Oxford University Press; 2001.Google ScholarPubMed

12. Coughlan, AK, Rix, KJ, Neumann, V. Assessing decision-making and capacity in minimally-aware patients. Medicine, Science and the Law 2005 July 1;45(3):249–55.CrossRefGoogle ScholarPubMed

13. Diener BL, Bischof-Rosario JA. Determining decision-making capacity in individuals with severe communication impairments after stroke: The role of augmentative-alternative communication (AAC). Topics in Stroke Rehabilitation 2004 Jan 1;11(1):84–8.

14. Dunn LB, Jeste DV. Enhancing informed consent for research and treatment. Neuropsychopharmacology 2001 June 1;24(6):595–607.

15. Okonkwo, OC, Griffith, HR, Belue, K, Lanza, S, Zamrini, EY, Harrell, LE, et al. Cognitive models of medical decision-making capacity in patients with mild cognitive impairment. Journal of the International Neuropsychological Society 2008 Mar 1;14(2):297–308.CrossRefGoogle ScholarPubMed

16. Dreer, LE, DeVivo, MJ, Novack, TA, Krzywanski, S, Marson, DC. Cognitive predictors of medical decision-making capacity in traumatic brain injury. Rehabilitation Psychology 2008 Nov;53(4):486.CrossRefGoogle ScholarPubMed

17. See note 16, Dreer et al. 2008.

18. Triebel KL, Novack TA, Kennedy R, Martin RC, Dreer LE, Raman R, et al. Neurocognitive models of medical decision-making capacity in traumatic brain injury across injury severity. Journal of Head Trauma Rehabilitation 2016 May–June ;31(3):E49–59.

19. Taub HA, Baker MT. The effect of repeated testing upon comprehension of informed consent materials by elderly volunteers. Experimental Aging Research 1983 Sept 1;9(3):135–8.

20. Taub HA, Kline GE, Baker MT. The elderly and informed consent: Effects of vocabulary level and corrected feedback. Experimental Aging Research 1981 June 1;7(2):137–46.

21. Gerstenecker A, Meneses K, Duff K, Fiveash JB, Marson DC, Triebel KL. Cognitive predictors of understanding treatment decisions in patients with newly diagnosed brain metastasis. Cancer 2015 June 15;121(12):2013–9.

22. Stern, RA, White, T. Neuropsychological Assessment Battery. Lutz, FL: Psychological Assessment Resources; 2003.Google Scholar

23. Dunn L, Dunn D. Peabody Picture Vocabulary Test: Examiner’s Manual. 4th ed. San Antonio, TX: Pearson Assessments; 2007.

24. Heaton RK, Chelune GJ, Talley JL, Kay GG, Curtis G. Wisconsin Card Sorting Test (WCST) Manual. Revised and expanded ed. Odessa, FL: Psychological Assessment Resources; 1993.

25. See note 22, Stern, White 2003.

26. Delis D, Kaplan E, Kramer J. Delis-Kaplan Executive Function System. The Psychological Corporation. San Antonio, TX: Harcourt Brace; 2001.

27. See note 16, Dreer et al. 2008.

28. See note 7, Grisso, Appelbaum 1998.

29. Buchanan, AE, Brock, DW. Deciding for Others: The Ethics of Surrogate Decision Making. Cambridge: Cambridge University Press; 1989.Google Scholar

30. See note 29, Buchanan, Brock 1989.

31. Silvers, A, Francis, LP. Thinking about the good: Reconfiguring liberal metaphysics (or not) for people with cognitive disabilities. Metaphilosophy 2009;40(3–4):475–98.CrossRefGoogle Scholar

32. Peterson A, Naci L, Weijer C, Cruse D, Fernández-Espejo D, Graham M, et al. Assessing decision-making capacity in the behaviorally nonresponsive patient with residual covert awareness. American Journal of Bioethics Neuroscience 2013 Oct 1;4(4):3–14.

33. Peterson, A, Naci, L, Weijer, C, Owen, AM. A principled argument, but not a practical one. American Journal of Bioethics Neuroscience 2013 Jan 1;4(1):52–3.Google Scholar