Evaluation Of Decision-making Capacity Research Articles

Cognitive predictors of understanding treatment decisions in patients with newly diagnosed brain metastasis.

Medical decision-making capacity is a higher-order functional skill that refers to a patient's ability to make informed, sound decisions related to care and treatment. In a medical context, understanding is the most cognitively demanding consent standard and refers to a patient's ability to comprehend information to the extent that informed decisions can be made. The association between reasoning and cognition was examined using data from 41 patients with diagnosed brain metastasis. All diagnoses were made by a board-certified radiation oncologist and were verified histologically. In total, 41 demographically matched, cognitively healthy controls were also included to aid in classifying patients with brain metastasis according to reasoning status (ie, intact or impaired). Results indicate that measures of simple attention, verbal fluency, verbal memory, processing speed, and executive functioning were all associated with understanding, and that verbal memory and phonemic fluency were the primary cognitive predictors. Using these two primary predictors, equations can be constructed to predict the ability to understand treatment decisions in patients with brain metastasis. Although preliminary, these data demonstrate how cognitive measures can estimate understanding as it relates to medical decision-making capacities in these patients. Clinically, these findings suggest that poor verbal memory and expressive language function could serve as "red flags" for reduced consent capacity in this patient population, thus signaling that a more comprehensive medical decision-making capacity evaluation is warranted.

Forensic medicine evaluation of Alzheimer patients: a series from Ankara, Turkey.

Pathophysiological changes due to Alzheimer disease and increasing age might result in situations requiring forensic evaluation in the elderly. Judicial bodies might need forensic evaluation of trauma and the decision-making capacity of Alzheimer patients. This study aimed to determine the demographic and clinical characteristics of Alzheimer patients seen for forensic evaluation. Forensic records issued by the Department of Forensic Medicine of Hacettepe University in 2012 and 2013 were investigated. Patients with Alzheimer disease were included in the study and were analyzed in terms of age, sex, reason for application, comorbid medical conditions, occupation, and place and status of living. There were 30 Alzheimer patients examined in the study period. Of these, 17 (56.6%) were male and 13 (43.3%) were female. The patients' ages ranged between 51 and 90 years, and the mean age was 78.7 years. The majority of cases (25, 83.3%) were transferred for evaluation of decision-making capacity, while only 5 (17.7%) were referred to our department for forensic reporting of bodily damage. Forensic reporting of bodily damage in Alzheimer patients is similar to common injury cases. However, in conditions requiring evaluation of decision-making capacity in Alzheimer patients, all records should be carefully examined and a complete neuropsychiatric evaluation should be performed.

Key Technology of Pilot’s Cognitive Decision-making Capacity Evaluation Based on Distributed Computing

To provide effective technological means for evaluation of the pilot’s information processing capacity for combat missions, tactical capability, command capability and cognitive decision-making capacity to compensate for the deficiency in the paper and pencil test, psychological dynamoscopy and other technological means used for traditional pilot’s cognitive decision-making capacity evaluation. Based on distributed computing technology, build a topological structure of the evaluation system, design a background of typical combat mission, and simulate combat control interface and process; based on software engineering, establish records, manage and analyze the evaluation technology of process data. The result of this study is that a scientific method and objective measurement means need to be provided for “real” evaluation of the pilot’s cognitive decision-making capacity.

Who Has the Competence to Assess Capacity?

Who Has the Competence to Assess Capacity?

Resident Physician Perceptions About Assessment of Decision-Making Capacity: An Opportunity For Geriatric Psychiatrists

Methods: We reviewed inpatient admissions to an acute psychiatry inpatient unit from Jan 1, 2012 April 1, 2012 to determine if Veterans admitted to the unit, had adequate exposure to PAD, and identify any gaps in the flow of information related to Psychiatric Advance Directives. Information regarding PAD is offered to psychiatric inpatients at the time of admission and on discharge. We studied the process which was used to provide this information, and if it was done in a timely manner. Results: The age of patients ranged from 22-85 with a median age of 52. The majority were males (93%). 55.5% of those admitted were African American, 43% Caucasian and 1.5% of Arab American, Asian and Latino origin. Majority of the patients had more than one diagnosis. The most common admitting diagnoses were Substance abuse and a Mood disorder secondary to substance use (44.4%). A dementia diagnosis was recorded for only 2% of admissions during this period. None of the 196 patients admitted during this period displayed an interest in pursuing PAD. We also noted through verbal interviews with staff, that nursing staff had poor training with regards to administering the PAD. e.g. there was no mechanism to evaluate the decision-making capacity of newly admitted psychiatric inpatients and there was no process to offer information related to PAD to patients when their capacity had improved. Conclusions: Veterans admitted to an acute psychiatric inpatient unit had poor information regarding Psychiatric advance directives. There was also no mechanism in place to determine the decision-making capacity of newly admitted and presumably incapacitated patients. There were also problems in the flow of information related to PAD to psychiatric inpatients. We recommend that staff on an inpatient psychiatric unit be given appropriate training in the understanding and implementation of Psychiatric advance directives. Provisions must also be made to train staff in the evaluation of decision-making capacity of psychiatric inpatients in relation to their ability to express their preferences for psychiatric treatment in the future. We recommend that psychiatric patients admitted on acute psychiatric inpatient units be given information related to Psychiatric Advance Directives on discharge or when their mental health condition has stabilized during their admission.

Helping Residents Make ‘Good’ or ‘Bad’ Decisions

Helping Residents Make ‘Good’ or ‘Bad’ Decisions

Euthanasia: Evolving role of the psychiatrists in India

Byline: Bir. Chavan, Suravi. Patra The honorable Supreme Court of India passed a landmark judgment of legalizing passive euthanasia on 7 [sup]th March 2011. The 110-page long document which gave this verdict was delivered in response to a criminal writ petition filed on behalf of Aruna Ramchandra Shanbaug in 2009. The petitioner requested for withdrawal of feeding to bring an end to her suffering. She has been lying in a persistent vegetative state since last 36 years following attempt of sexual assault and strangulation by a ward boy when she was on duty at the K. E. M. Hospital. The staffs of the hospital have been providing her with supportive medical care since then. Justice Markandey Katju and Justice Gyan Sudha Mishra in their judgment commended the dedicated efforts of K. E. M. hospital in providing selfless continuous care to Aruna and dismissed the petition. The judgment accepted the significance of the doctrine of "parens patriae" while deciding the case where the affected person has lost the decision-making capacity. This doctrine recognizes the responsibility of the state in taking care of its citizens when they are in need of a father figure to take decision on their behalf. The bench felt that withdrawal of life-supporting measures cannot be left to the sole discretion of the treating physician, relative, care giver, or friend of a person. The judgment has laid provision for care givers of cognitively incapacitated persons to request for non-voluntary and passive euthanasia to the High Court. Till the legislation from the Parliament is in place, the judgment has cited the powers of article 226 of the constitution for such a provision. On receipt of any application for passive euthanasia, the High Court would appoint a board of doctors comprising a physician, a psychiatrist, and a neurologist to examine the patient based on which the court would take the decision about life-supporting treatment. Passive euthanasia is legalized in India in this process. [sup][1] Persistent vegetative state has resulted in Aruna being partially conscious and awake but unaware of her surroundings. Her higher mental functions as well as motor and sensory functions are compromised. The inability to experience self and the environment and the loss of capacity of voluntary control over self questions the very definition of being alive. Being alive is a continuous state of experience from the past to the future and the relationship with family, society, work, and culture rather than being a machine capable of carrying out biological functions. [sup][2] Mere presence of biological functioning cannot define life. The current clinical state of Aruna has sparked off the debate on euthanasia; is life unworthy of living worthy of ending? Is moral dimension of continuing life more important than quality of life? What would Aruna wish had she been capable of expressing her desire? Persistent vegetative state resulting from asphyxiating injury to brain has a poorer prognosis than a traumatic insult. [sup][3] With only 7% chance of improvement in the state of consciousness, the efficacy of current medical interventions remains questionable. Though these interventions can prolong life, their impact on quality of life is not encouraging. Many a times, these interventions are felt as merely prolonging the process of dying. Adding to this is the amount and extent of emotional and financial burden imposed on the care givers. Withdrawal of life-supporting treatment in such states is a difficult decision to take both by the treating physician as well as by the care givers. [sup][4] End of life decisions are complex with ethical, religious, moral, and legal implications. Autonomy and self-determinism have become the guiding principles of life. People have started talking about right to die. They have started deciding their time and mode of death. The whole idea is to have a comfortable painless death at a convenient time. …