title: Do Consultation Psychiatrists, Forensic Psychiatrists, Psychiatry Trainees, and Health Care Lawyers Differ in Opinion on Gray Area Decision-Making Capacity Cases? A Vignette-Based Survey.
abstract: Previous research in the area of medical decision-making capacity has demonstrated relatively poor agreement between experienced evaluators in "gray area" cases. We performed a survey to determine the level of agreement about gray area decision-making capacity case scenarios within and between individuals of different professional backgrounds.
  
  
  
  Participants received a survey consisting of 3 complicated decision-making capacity vignettes with an accompanying "yes/no" question regarding capacity and a certainty scale for each vignette. Participants were identified from mailing lists of professional organizations and local hospitals. We received responses from psychiatry trainees, consultation-liaison psychiatrists, forensic psychiatrists, and lawyers with experience in health care law. Results were analyzed using SPSS.
  
  
  
  Across the 3 vignettes, the percentage agreeing that the individual described had capacity to refuse medical treatment ranged between 35% and 40% for trainees, 33% and 67% for consult psychiatrists, 41% and 76% for forensic psychiatrists, and 40% and 83% for health care lawyers. Only question 2 reached significance between-group differences (Pearson χ(2) = 11.473, p < 0.01). Across vignettes, trainees were less likely to consider patients to have capacity for decision-making than were forensic psychiatrists and lawyers.
  
  
  
  As found in previous research, agreement among experienced evaluators appears generally low in gray area capacity cases. It is noteworthy that individuals of different professional backgrounds at times offer divergent between-group opinions on capacity.
authors.affiliation: Department of Psychiatry, Brigham and Women's Hospital, Boston, MA; Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts Mental Health Center, Boston, MA. Electronic address: jarmontr@bidmc.harvard.edu.
authors.forename: James
authors.initials: J
authors.lastname: Armontrout
authors.affiliation: Department of Psychiatry, Brigham and Women's Hospital, Boston, MA.
authors.forename: David
authors.initials: D
authors.lastname: Gitlin
authors.affiliation: Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA; Massachusetts Mental Health Center, Boston, MA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gutheil
mesh_terms: D000430:Alcohol Withdrawal Delirium / Q000523:psychology / Q000628:therapy; D001249:Asthma / Q000523:psychology / Q000628:therapy; D003253:Consultants; D003657:Decision Making; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D005555:Forensic Psychiatry; D006471:Gastrointestinal Hemorrhage / Q000523:psychology / Q000628:therapy; D019538:Health Care Surveys; D006703:Ill-Housed Persons / Q000523:psychology; D006801:Humans; D033183:Interdisciplinary Communication; D007396:Internship and Residency; D000070516:Intersectoral Collaboration; D033241:Lawyers; D016743:Mental Competency / Q000331:legislation & jurisprudence*; D010351:Patient Discharge / Q000331:legislation & jurisprudence*; D011570:Psychiatry / Q000193:education*; D012131:Respiratory Insufficiency / Q000523:psychology / Q000628:therapy; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000331:legislation & jurisprudence*
keywords: capacity determinations.; decision-making capacity; forensic psychiatrists