Health professionals' views on standards for decision-making capacity regarding refusal of medical treatment in mild Alzheimer's disease.
This study was designed to determine which elements professionals consider important for evaluation of decision-making capacity. Survey with a vignette case report of an individual with mild dementia was mailed to four groups of individuals: 1. members of the Academy of Psychosomatic Medicine, 2. chairs of Veterans Affairs (VA) Ethics Advisory Committees (EACs), 3. randomly selected geriatricians who were members of the Gerontological Society of America (GSA), and 4. randomly selected psychologists who were members of the GSA. Two hundred thirty-seven psychiatrists, 95 VA EAC chairs, 103 geriatricians, and 46 psychologists responded to this survey. The majority of the respondents endorsed all five basic elements as necessary for determination of decision-making capacity in the presented vignette, but only a minority of respondents endorsed all five basic elements, and a small proportion of respondents endorsed only one or two elements. The results indicate that physicians do not use uniform standards for assessment of decision-making capacity.
Volicer
Ladislav
L
Geriatric Research, Education Clinical Center, E.N. Rogers Memorial Hospital, Bedford, Massachusetts 01730, USA. ladislav.volicer@med.va.gov
Ganzini
Linda
L
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D003625:Data Collection; D003627:Data Interpretation, Statistical; D003657:Decision Making; D028741:Ethics Committees, Clinical; D004992:Ethics, Medical; D005260:Female; D015577:Geriatric Assessment; D005853:Geriatrics; D006801:Humans; D016743:Mental Competency; D011570:Psychiatry; D011584:Psychology; D016312:Treatment Refusal