title: Assessing Decision-Making Capacity in Patients with Communication Impairments.
abstract: The ethical principle of autonomy requires physicians to respect patient autonomy when present, and to protect the patient who lacks autonomy. Fulfilling this ethical obligation when a patient has a communication impairment presents considerable challenges. Standard methods for evaluating decision-making capacity require a semistructured interview. Some patients with communication impairments are unable to engage in a semistructured interview and are at risk of the wrongful loss of autonomy. In this article, we present a general strategy for assessing decision-making capacity in patients with communication impairments. We derive this strategy by reflecting on a particular case. The strategy involves three steps: (1) determining the reliability of communication, (2) widening the bandwidth of communication, and (3) using compensatory measures of decision-making capacity. We argue that this strategy may be useful for assessing decision-making capacity and preserving autonomy in some patients with communication impairments.
authors.forename: Molly
authors.initials: M
authors.lastname: Cairncross
authors.forename: Andrew
authors.initials: A
authors.lastname: Peterson
authors.forename: Andrea
authors.initials: A
authors.lastname: Lazosky
authors.forename: Teneille
authors.initials: T
authors.lastname: Gofton
authors.forename: Charles
authors.initials: C
authors.lastname: Weijer
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic; D003142:Communication; D003147:Communication Disorders; D003657:Decision Making / Q000941:ethics*; D005260:Female; D006801:Humans; D010344:Patient Advocacy / Q000941:ethics*; D026684:Personal Autonomy; D013119:Spinal Cord Injuries; D013124:Spinal Injuries
keywords: autonomy; brain trauma; communication impairments; decision-making capacity; ethics; neuropsychology