Clinical and Ethical Issues When Completing Decision-Making Capacity Evaluations with People Diagnosed with FASD

Abstract

Decisional Capacity is a complex socio-legal construct, and is commonly conceptualized as an individual’s ability to use cognitive processes to understand and identify options, to appreciate the consequences of choosing or not choosing the various options identified, and to either personally follow through with the chosen option, or to direct a surrogate to follow through with the chosen option on his or her behalf. Due to the multiple legal, ethical, medical, social, and cultural factors involved, decisional capacity issues are challenging for all affected parties. Similarly complex, Fetal Alcohol Spectrum Disorders (FASD), which involve neurodevelopmental impairment second to prenatal alcohol exposure can manifest in profound disabilities along a spectrum of disorders. Within the FASD population, in general, those afflicted tend to exhibit impairments that are likely to interfere with capable decision-making, such as impaired social and adaptive functioning and impulse control issues. As such, consideration of the interplay between decisional capacity and FASD is warranted. This chapter aims to highlight the vital tenants integral to the conscientious conceptualization of decisional capacity, to discuss decisional capacity assessment from a best-practice perspective, and finally, to provide a broader context for some of the clinical nuances within the decisional capacity evaluation process, in particular, how the practice of decisional capacity assessment looks within the context of assessing individuals who carry a FASD diagnosis.