Competency assessment in psychiatry and medicine

Current Opinion in Psychiatry

Volumn 17, Issue 6, 2004, Pages 493-496

  Kitamura, Toshinori ^a   Hiramura, Hidetoshi ^a  

^a KUMAMOTO UNIVERSITY   (Japan)

Author keywords

Assessment; Autonomy; Competency; Informed consent; Medical decision making

Indexed keywords

COGNITION; CURRICULUM; ETHICS; HUMAN; INFORMED CONSENT; LIVING DONOR; PATERNALISM; PSYCHIATRY; PSYCHOMETRY; RELIABILITY; REVIEW; SUICIDE;

EID: 8344240357     PISSN: 09517367     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001504-200411000-00012     Document Type: Review

References (22)

1. Grisso T, Appelbaum PS. Assessing competence to consent to treatment: a guide for physicians and other health professionals. New York, Oxford University Press, 1998.
2. Kovnick JA, Appelbaum PS, Hoge SK, Leadbetter RA. Competence to consent to research among long-stay inpatients with chronic schizophrenia. Psychiatr Serv 2003; 54:1247-1252. This is a timely report of competency of long-stay patients with schizophrenia because they may be more vulnerable to exploitation due to their clinical as well as social situations.
3. Palmer BW, Dunn LB, Appelbaum PS, Jeste DV. Correlates of treatment-related decision-making capacity among middle-aged and older patients with schizophrenia. Arch Gen Psychiatry 2004; 61:230-236. This was a well designed study on the applicability of the MacArthur Competence Assessment Tool treatment. Competency was proved to be correlated with cognitive function.
4. Casarett DJ, Karlawish JHT, Hirschman KB. Identifying ambulatory cancer patients at risk of impaired capacity to consent to research. J Pain Symptom Management 2002; 6:615-624. This paper has shown that patients with cancer are not less competent because of the disease.
5. Lapid MI, Rummans TA, Poole KL, et al. Decisional capacity of severely depressed patients requiring electroconvulsive therapy. J ECT 2003; 19:67-72. After education about electroconvulsive therapy (discussion and video), patients with severe depression who were undergoing this treatment showed substantial improvement in competency to give informed consent.
6. Sevick MA, McConnell T, Muender M. Conducting research related to treatment of Alzheimer's disease: ethical issues. J Gerontol Nurs 2003; 29:6-12.
7. Gans M, Gunn WB Jr. End stage anorexia: criteria for competence to refuse treatment. Int J Law Psychiatry 2003; 26:677-695.
8. Bartholomew TP, Paxton SJ. General practitioners' perspectives regarding competence and confidentiality in an adolescent with suspected anorexia nervosa: legal and ethical considerations. J Law Med 2003; 10:308-324.
9. Zamperetti N, Piccinni P, Carraro R, et al. When the ICU patient refuses vital supports. Minerva Anestesiol 2003; 69:184-189.
10. Allen RS, DeLaine SR, Chaplin WF, et al. Advance care planning in nursing homes: correlates of capacity and possession of advance directives. Gerontologist 2003; 43:309-317.
11. Farrow TL, O'Brien AJ. 'No-suicide contracts' and informed consent: an analysis of ethical issues. Nurs Ethics 2003; 10:199-207. This describes interesting qualitative research showing how incompetent patients are when entering the non-suicide contract.
12. Hagger L. Some implications of the Human Rights Act 1998 for the medical treatment of children. Med Law Int 2003; 6:25-51.
13. De Lourdes Levy M, Larcher V, Kurz R. The members of the Ethics Working Group of the CESP. Informed consent/assent in children. Statement of the Ethics Working group of the Confederation of European Specialists in Paediatrics (CESP). Eur J Pediatr 2003; 162:629-633.
14. Deatrick JA, Dickey SB, Wright R, et al. 0 Correlates of children's competence to make healthcare decisions. J Clin Ethics 2003; 14:152-163. This is one of the few empirical studies on children's competency to give informed consent.
15. Hoehner PJ. Ethical aspects of informed consent in obstetric anesthesia: new challenges and solutions. J Clin Anesth 2003; 15:587-600. This is a succinct review of ethics related to the realm of informed consent obstetric anaesthesia.
16. Rudrow DL, Brown RS Jr. Evaluation of living liver donor. Prog Transplant 2003; 13:110-116. This paper summarizes the process of the living liver transplantation with emphasis on the informed consent from the donor.
17. Colardyn F. Organizational and ethical aspects of living donor liver transplantation. Liver Transplant 2003; 9:s2-s5.
18. Chin JJ, Sahadevan S. Neurofibrillary and ethico-legal tangles: in search of surrogates for dementia patients lacking decision-making capacity and relatives. Ann Acad Med Singapore 2003; 32:756-763.
19. Edwards SJL, Kirchin S, Huxtable R. Research ethics committees and paternalism. J Med Ethics 2004; 30:88-91.
20. Olsen DP. Influence and coercion: relational and rights-based ethical approaches to forced psychiatric treatment. J Psychiat Ment Health Nurs 2003; 10:705-712. The rights-based approach to the ethics of coercion in psychiatric treatment is currently dominant. However, this approach neglects the fact that therapists' influence is deeply rooted in the therapeutic relationship. The author makes the case for the relation-based approaches and proposes some guidelines.
21. Fisher CB. Goodness-of-fit ethic for informed consent to research involving adults with mental retardation and developmental disabilities. Ment Retard Dev Disabil Res Rev 2003; 9:27-31. The author proposes shifting the emphasis of competency assessment from the patients' (participants') cognitive function to the aspects of the consent setting that may create or exacerbate consent vulnerability.
22. Diener BL, Bischof-Rosario JA. Determining-making capacity in individuals with severe communication impairments after stroke: the role of augmentative-alternative communication (AAC). Top Stroke Rehabil 2004; 11:84-88. There are patients who are basically competent but find it difficult to express their choice because of physical difficulty. This paper proposed a means of improvement.