title: Assessment of the capacity to consent to treatment in patients admitted to acute medical wards.
abstract: BACKGROUND
  Assessment of capacity to consent to treatment is an important legal and ethical issue in daily medical practice. In this study we carefully evaluated the capacity to consent to treatment in patients admitted to an acute medical ward using an assessment by members of the medical team, the specific Silberfeld's score, the MMSE and an assessment by a senior psychiatrist.
  
  
  METHODS
  Over a 3 month period, 195 consecutive patients of an internal medicine ward in a university hospital were included and their capacity to consent was evaluated within 72 hours of admission.
  
  
  RESULTS
  Among the 195 patients, 38 were incapable of consenting to treatment (unconscious patients or severe cognitive impairment) and 14 were considered as incapable of consenting by the psychiatrist (prevalence of incapacity to consent of 26.7%). Agreement between the psychiatrist's evaluation and the Silberfeld questionnaire was poor (sensitivity 35.7%, specificity 91.6%). Experienced clinicians showed a higher agreement (sensitivity 57.1%, specificity 96.5%). A decision shared by residents, chief residents and nurses was the best predictor for agreement with the psychiatric assessment (sensitivity 78.6%, specificity 94.3%).
  
  
  CONCLUSIONS
  Prevalence of incapacity to consent to treatment in patients admitted to an acute internal medicine ward is high. While the standardized Silberfeld questionnaire and the MMSE are not appropriate for the evaluation of the capacity to consent in this setting, an assessment by the multidisciplinary medical team concurs with the evaluation by a senior psychiatrist.
authors.affiliation: Service of Liaison Psychiatry, CHUV-University hospital, Lausanne, Switzerland. Sylfa.Fassassi@chuv.ch
authors.forename: Sylfa
authors.initials: S
authors.lastname: Fassassi
authors.forename: Yanik
authors.initials: Y
authors.lastname: Bianchi
authors.forename: Friedrich
authors.initials: F
authors.lastname: Stiefel
authors.forename: Gérard
authors.initials: G
authors.lastname: Waeber
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D005260:Female; D006748:Hospital Departments; D006785:Hospitals, University; D006801:Humans; D007258:Informed Consent / Q000941:ethics; D033183:Interdisciplinary Communication; D007388:Internal Medicine; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D009483:Neuropsychological Tests; D011570:Psychiatry; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013557:Switzerland